Practice Recommendations for Metabolic Dysfunction–Associated Steatotic Liver Disease by the ISPGHAN

Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN) recently formulated recommendations for steatotic liver disease in children, which are as follows:

• The term Metabolic dysfunction-associated steatotic liver disease (MASLD) should be preferred over non-alcoholic fatty liver disease (NAFLD). 
• The prevalence of steatotic liver disease (SLD) is high among Indian children and adolescents, especially those who are overweight or obese. 
• This condition may be progressive in childhood and linked to increased morbidity and mortality in adulthood. 
• Various lifestyle, dietary, and genetic factors may predispose individuals to MASLD, like increased consumption of calorie-dense processed foods, sweetened sugar beverages, exaggerated screen time, increased sedentary time and scarcity of moderate to vigorous physical activity. 
• MASLD is usually asymptomatic or occurs with mild, non-specific symptoms, thus demanding a high degree of suspicion for early diagnosis. 
• MASLD is usually linked with cardiometabolic factors (hypertension, insulin resistance/ diabetes mellitus, and/or dyslipidemia), and secondary causes should be excluded in all cases, especially if red flag signs are seen. 
• All obese children (body mass index or BMI ≥ 95th percentile) and all overweight children (BMI ≥ 85th and <95thpercentile) with additional risk factors, like prediabetes/diabetes, dyslipidemia, positive family history of metabolic syndrome, obstructive sleep apnea, and hypopituitarism should be screened for MASLD. 
• Abdominal ultrasound alongwith alanine aminotransferase (ALT) levels should be used to screen MASLD in Indian children as per the proposed algorithm. 
• Diet (any hypocaloric diet) and exercise (aerobic, resistance, or a combination of both; moderate to high intensity; regular in frequency) are the cornerstones of pediatric MASLD management. 
• Pharmacotherapy and/or endoscopic/surgical techniques for obesity should be viewed as adjuncts and attempted only after a failed adequate trial of lifestyle modifications.

Sood V, Alam S, Nagral A, et al. Practice Recommendations for Metabolic Dysfunction–Associated Steatotic Liver Disease by the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN). Indian Pediatrics. 2024;61.