ESPGHAN position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction‐associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) ≥ 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score ≥+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of ≥20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.

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Publication Details

Journal
Journal of Pediatric Gastroenterology and Nutrition
Published
2026-06-30
DOI
https://doi.org/10.1002/jpn3.70490
Primary Topic
Liver Disease Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00

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article

ESPGHAN position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction‐associated steatotic liver disease

Aglaia Zellos, Sander Lefere, Anita Vreugdenhil, Jake P. Mann et al.
Journal of Pediatric Gastroenterology and Nutrition
Liver Disease Diagnosis and Treatment
article

ESPGHAN position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction‐associated steatotic liver disease

Aglaia Zellos, Sander Lefere, Anita Vreugdenhil, Jake P. Mann, Wojciech Jańczyk, Emer Fitzpatrick, Eberhard Lurz, Giulia Fiore, P SOCHA, Hadar Moran‐Lev, Lauren Johansen, Claudia Mandato, Antonella Mosca, Anastasia Konidari, Giusy Ranucci, Anna Alisi, Penelope C. Rose, Jernej Brecelj, Pietro Vajro, Elvira Verduci, Maarten Buytaert, Maria Rogalidou, Rachel M. Brown, Maria Mercadal-Hally, S Francque, Cigdem Arikan, Christian A. Hudert, Natalia Zavhorodnia, Bart G. Koot, Ruth De Bruyne, Irene Degrassi
article en

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) ≥ 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score ≥+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of ≥20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.

Journal of Pediatric Gastroenterology and Nutrition
Hebron University (PS), Western Cape Department of Health (ZA), University of Salerno (IT), Koç University (TR), University of Antwerp (BE), University of Ljubljana (SI), Tel Aviv University (IL), University of Milan (IT), National and Kapodistrian University of Athens (GR), Stellenbosch University (ZA), Aalborg University Hospital (DK), Maastricht University Medical Centre (NL), Ghent University Hospital (BE), Ljubljana University Medical Centre (SI), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Children's Health Ireland at Crumlin (IE), LMU Klinikum (DE), Maastricht University (NL), Ospedale Maggiore (IT), Emma Kinderziekenhuis (NL), Birmingham Children's Hospital (GB), Antwerp University Hospital (BE), Children's Memorial Health Institute (PL), Bambino Gesù Children's Hospital (IT), Vall d'Hebron Hospital Universitari (ES), Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine (UA), Institute of Immunology (HR), Birmingham Women’s and Children’s NHS Foundation Trust (GB), Panagiotis & Aglaia Kyriakou Children's Hospital (GR), Iaso Children’s Hospital (GR), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), Charité - Universitätsmedizin Berlin (DE), Ludwig-Maximilians-Universität München (DE)
Royal Society, Guts UK Charity, Royal College of Physicians
Good health and well-being
Openalex Percentile: Top 8%
Liver Disease Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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