Screening and diagnosis of metabolic dysfunction-associated steatotic liver disease in children within public healthcare.

backgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) has increased rapidly. NASPGHAN recommends screening children at risk for MASLD, but its implementation remains unclear. We explored the implementation of screening in healthcare.

methodsData were collected from 908 children (median 11.4 years, 42.7% girls) investigated for overweight/obesity. Emphasis was placed on screening methods, diagnosis and potential secular changes. The diagnosis was confirmed retrospectively using novel criteria.

resultsInvestigations included measuring alanine aminotransferase (ALT) in 83.1%, ultrasonography in 9.1%, and no screening in 16.5%. Screening was conducted in 86.2% of children meeting the recommendations, but 69.3% of those not eligible, mostly due to young age, were also screened. Screening was more frequent in tertiary care. Overall, 87.9% were tested for metabolic comorbidities and 80.9% underwent differential diagnostics, with 5.7% having other liver-affecting diseases/medications. ALT testing increased in tertiary care from 81.9% in 2002-2011 to 91.4% in 2012-2020 (p < 0.001), and exclusion of liver-affecting conditions improved in both tertiary (79.6% vs. 87.4%, p = 0.017) and primary care (61.5% vs. 84.6%, p < 0.001). MASLD was diagnosed clinically in 7.4%, while 14.5% met the criteria retrospectively.

conclusionsMASLD screening practices are mostly aligned with the recommendations. However, many patients remain unrecognized, underscoring the need for better guidelines. IMPACT: In a large cohort of 3-17-year-old children investigated in healthcare due to obesity, implementation of MASLD screening largely aligned with current recommendations supporting general acceptance of screening. Screening was conducted in 86.2% of children meeting the NASPGHAN screening recommendations, while 87.9% were also tested for metabolic comorbidities, and 80.9% underwent differential diagnostics. MASLD was diagnosed clinically in 7.4%, while 14.5% met the criteria retrospectively, suggesting possible underdiagnosis. Compared to NASPGHAN guidelines, screening appeared excessive among younger children. Nevertheless, MASLD was also prevalent in this age group, indicating a need for further research to determine optimal age thresholds.