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

@article{mann2026european,
  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}},
  author = {Jake Peter Mann and Sander Lefere and Maarten Buytaert and Anna Alisi and Cigdem Arikan and Jernej Brecelj and Rachel M. Brown and Irene Degrassi and Giulia Fiore and Emer Fitzpatrick and Sven Francque and Christian A. Hudert and Wojciech Jańczyk and Lauren Johansen and Bart G.P. Koot and Anastasia Konidari and Eberhard Lurz and Claudia Mandato and María Mercadal‐Hally and Hadar Moran‐Lev and Antonella Mosca and Giusy Ranucci and Maria E. Rogalidou and Penelope C. Rose and Piotr Socha and Pietro Vajro and Elvira Verduci and Anita C. E. Vreugdenhil and N.Yu. Zavhorodnia and Aglaia Zellos and Ruth De Bruyne},
  journal = {Journal of Pediatric Gastroenterology and Nutrition},
  year = {2026},
  month = jun,
  doi = {10.1002/jpn3.70490},
  url = {https://doi.org/10.1002/jpn3.70490},
  note = {CC BY},
}

TY  - JOUR
TI  - 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
AU  - Jake Peter Mann
AU  - Sander Lefere
AU  - Maarten Buytaert
AU  - Anna Alisi
AU  - Cigdem Arikan
AU  - Jernej Brecelj
AU  - Rachel M. Brown
AU  - Irene Degrassi
AU  - Giulia Fiore
AU  - Emer Fitzpatrick
AU  - Sven Francque
AU  - Christian A. Hudert
AU  - Wojciech Jańczyk
AU  - Lauren Johansen
AU  - Bart G.P. Koot
AU  - Anastasia Konidari
AU  - Eberhard Lurz
AU  - Claudia Mandato
AU  - María Mercadal‐Hally
AU  - Hadar Moran‐Lev
AU  - Antonella Mosca
AU  - Giusy Ranucci
AU  - Maria E. Rogalidou
AU  - Penelope C. Rose
AU  - Piotr Socha
AU  - Pietro Vajro
AU  - Elvira Verduci
AU  - Anita C. E. Vreugdenhil
AU  - N.Yu. Zavhorodnia
AU  - Aglaia Zellos
AU  - Ruth De Bruyne
PY  - 2026
DA  - 2026/06/30
JO  - Journal of Pediatric Gastroenterology and Nutrition
DO  - 10.1002/jpn3.70490
UR  - https://doi.org/10.1002/jpn3.70490
AB  - 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.
SN  - 0277-2116
SN  - 1536-4801
ER  -