{
  "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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Immunology & Immunotherapy, School of Infection, Inflammation and Immunology, College of Medicine and Health University of Birmingham Birmingham UK",
    "Liver Unit (Including Small Bowel Transplantation) Birmingham Women′s and Children′s NHS Foundation Trust Birmingham UK",
    "Hepatology Research Unit, Department of Internal Medicine and Pediatrics Ghent University Ghent Belgium",
    "Genetic of Complex Phenotype Research Unit Bambino Gesù Children′s Hospital, IRCCS Rome Italy",
    "Department of Pediatric Gastroenterology and Organ Transplant Koç University School of Medicine Istanbul Turkey",
    "Department of Gastroenterology, Hepatology and Nutrition, University Children′s Hospital Ljubljana, and Department of Pediatrics, Faculty of Medicine University of Ljubljana Ljubljana Slovenia",
    "Department of Histopathology Birmingham Children′s Hospital Birmingham UK",
    "Department of Health Sciences University of Milan Milan Italy",
    "Pediatric Unit Foundation IRCCS Ca′ Granda Ospedale Maggiore Policlinico Milan Italy",
    "Department of Paediatric Gastroenterology and Hepatology Children′s Health Ireland Dublin Ireland",
    "Department of Gastroenterology and Hepatology Antwerp University Hospital Edegem Belgium",
    "InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences University of Antwerp Wilrijk Belgium",
    "Department of Paediatric Gastroenterology, Nephrology and Metabolic Diseases Charité – Universitätsmedizin Berlin Berlin Germany",
    "Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics Children′s Memorial Health Institute Warsaw Poland",
    "Department of Pediatric Gastroenterology, Emma Children′s Hospital, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands",
    "Department of Paediatrics Paidon P&A Kyriakou Children′s Hospital Athens Greece",
    "Department of Pediatrics, Dr. von Hauner Children′s Hospital KUM University Hospital LMU Munich Munich Germany",
    "Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Italy",
    "Pediatric Hepatology and Liver Transplant Unit, Department of Pediatrics Vall d′Hebron Hospital Campus, ERN Rare Liver, ERN TransplantChild Barcelona Spain",
    "Department of Pediatric Gastroenterology, Dana‐Dwek Children′s Hospital, Faculty of Medicine Tel Aviv University Tel Aviv Israel",
    "Pediatric Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT) Palermo Italy",
    "Division of Gastroenterology & Hepatology, 1st Pediatrics Department, National and Kapodistrian University of Athens “Agia Sofia” Children′s Hospital Athens Greece",
    "Department of Paediatrics Aalborg University Hospital Aalborg Denmark",
    "Department of Paediatrics and Child Health Stellenbosch University Cape Town South Africa",
    "Centre for Overweight Adolescent and Children′s Healthcare (COACH), Department of Pediatrics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+ MosaKids Children′s Hospital Maastricht The Netherlands",
    "Department of Pediatric Gastroenterology SI “Institute of Gastroenterology of the National Academy of Medical Sciences” Dnipro Ukraine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 31,
  "authors": [
    {
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        1
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      "name": "Jake Peter Mann",
      "orcid": "0000-0002-4711-9215"
    },
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        2
      ],
      "name": "Sander Lefere",
      "orcid": "0000-0001-5734-3467"
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      ],
      "name": "Maarten Buytaert",
      "orcid": "0000-0002-4165-5009"
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        3
      ],
      "name": "Anna Alisi",
      "orcid": "0000-0001-7241-6329"
    },
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      "affs": [
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      ],
      "name": "Cigdem Arikan"
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      "name": "Jernej Brecelj",
      "orcid": "0000-0002-7871-8325"
    },
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      "affs": [
        6
      ],
      "name": "Rachel M. Brown"
    },
    {
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        7
      ],
      "name": "Irene Degrassi",
      "orcid": "0000-0002-8123-7522"
    },
    {
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        7,
        8
      ],
      "name": "Giulia Fiore",
      "orcid": "0000-0002-6100-5687"
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      ],
      "name": "Emer Fitzpatrick",
      "orcid": "0000-0002-1364-5305"
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        10,
        11
      ],
      "name": "Sven Francque",
      "orcid": "0000-0002-7527-4714"
    },
    {
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        12
      ],
      "name": "Christian A. Hudert",
      "orcid": "0000-0002-3642-0838"
    },
    {
      "affs": [
        13
      ],
      "name": "Wojciech Jańczyk",
      "orcid": "0000-0002-6430-0788"
    },
    {
      "affs": [
        1
      ],
      "name": "Lauren Johansen",
      "orcid": "0000-0003-1180-0428"
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    {
      "affs": [
        14
      ],
      "name": "Bart G.P. Koot",
      "orcid": "0000-0002-4350-3084"
    },
    {
      "affs": [
        15
      ],
      "name": "Anastasia Konidari",
      "orcid": "0000-0001-8946-1353"
    },
    {
      "affs": [
        16
      ],
      "name": "Eberhard Lurz",
      "orcid": "0000-0002-7479-7388"
    },
    {
      "affs": [
        17
      ],
      "name": "Claudia Mandato",
      "orcid": "0000-0003-2425-5449"
    },
    {
      "affs": [
        18
      ],
      "name": "María Mercadal‐Hally",
      "orcid": "0000-0003-1687-6448"
    },
    {
      "affs": [
        19
      ],
      "name": "Hadar Moran‐Lev",
      "orcid": "0000-0002-5177-9478"
    },
    {
      "affs": [
        3
      ],
      "name": "Antonella Mosca",
      "orcid": "0000-0001-9646-7462"
    },
    {
      "affs": [
        20
      ],
      "name": "Giusy Ranucci",
      "orcid": "0000-0002-5895-7257"
    },
    {
      "affs": [
        21
      ],
      "name": "Maria E. Rogalidou",
      "orcid": "0000-0001-5617-2432"
    },
    {
      "affs": [
        22,
        23
      ],
      "name": "Penelope C. Rose",
      "orcid": "0000-0002-4620-9227"
    },
    {
      "affs": [
        13
      ],
      "name": "Piotr Socha",
      "orcid": "0000-0002-1621-464X"
    },
    {
      "affs": [
        17
      ],
      "name": "Pietro Vajro",
      "orcid": "0000-0002-9418-5880"
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    {
      "affs": [
        7,
        8
      ],
      "name": "Elvira Verduci",
      "orcid": "0000-0003-2111-3111"
    },
    {
      "affs": [
        24
      ],
      "name": "Anita C. E. Vreugdenhil",
      "orcid": "0000-0003-1499-5937"
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    {
      "affs": [
        25
      ],
      "name": "N.Yu. Zavhorodnia",
      "orcid": "0000-0001-5821-1351"
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    {
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        21
      ],
      "name": "Aglaia Zellos",
      "orcid": "0009-0000-2730-9639"
    },
    {
      "affs": [
        2
      ],
      "name": "Ruth De Bruyne",
      "orcid": "0000-0002-5623-3300"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6gwtmvsymbpsz.bib",
  "cited_by": 8,
  "doi": "10.1002/jpn3.70490",
  "fulltext_url": null,
  "id": "6gwtmvsymbpsz",
  "issns": [
    "0277-2116",
    "1536-4801"
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  "landing_url": "https://doi.org/10.1002/jpn3.70490",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "2713|Liver Disease Diagnosis and Treatment"
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  "openalex": "W7166692886",
  "pdf_url": null,
  "pmcid": "PMC13539658",
  "pmid": "42374900",
  "published": "2026-06-30",
  "publisher": "Lippincott Williams & Wilkins",
  "ris": "https://research.draconitic.com/paper/6gwtmvsymbpsz.ris",
  "sources": [
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      "first_seen": "2026-11-01T13:20:20Z",
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      "url": "https://doi.org/10.1002/jpn3.70490"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Liver Disease Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) steatotic liver disease special interest group position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction‐associated steatotic liver disease",
  "title_text": "European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) steatotic liver disease special interest group position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction‐associated steatotic liver disease",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T13:20:37Z",
  "url": "https://research.draconitic.com/paper/6gwtmvsymbpsz",
  "venue": "Journal of Pediatric Gastroenterology and Nutrition",
  "versions": []
}