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Treatment and outcomes for pediatric patients with nonalcoholic fatty liver disease (NAFLD) may be hindered by the negative connotations associated with the disease name itself and diagnosis of exclusion. Renaming and redefining the disease state is an important step in overcoming these limitations, according to a consensus statement published in Lancet Gastroenterology Hepatology.
The use of the term NAFLD and the undertones associated with the name itself pose problems, especially for pediatric patients with this disease. Alcohol consumption is normally not an issue in this population, though the diagnosis may carry this stigma along with it. For these reasons, an international panel proposed updated criteria for disease diagnosis, along with a more age-appropriate disease name and definition.
Metabolic (dysfunction)-associated fatty liver disease (MAFLD), the proposed updated term for NAFLD, has a more positive diagnosis criteria. Similar to the proposed criteria for adults, pediatric patients presenting with steatosis in addition to excess adiposity, prediabetes or type 2 diabetes, and/or metabolic dysregulation meet the diagnostic criteria for MAFLD. Metabolic dysregulation is determined by the presence of at least 2 risks according to age and sex percentiles of waist circumference, lipid panels, hypertension, and fasting glucose.
Similar to NAFLD, treatment of MAFLD focuses on mitigating the risks for complications. Various treatments have been studied; however, there are currently no approved medications indicated for pediatric NAFLD.
While the presence of MAFLD does not preclude the presence of other liver diseases, the consensus group believes that “simplification of how a condition is diagnosed in real-world settings can inform and improve the standard of care.”
Disclosure: The authors declared affiliations with biotech, pharmaceutical, and/or device companies. Pleases see the original reference for a full list of author disclosures.
Reference
Eslam M, Alkhouri N, Vajro P, et al. Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus statement. Lancet Gastroenterol Hepatol. 2021;6(10):864-873. doi: 10.1016/S2468-1253(21)00183-7
