Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus statement

Eslam M 1 , Alkhouri N 2 , Vajro P 3 , Baumann U 4 , Weiss R 5 , Socha P 6 Show all authors , Marcus C 7 , Lee WS 8 , Kelly D 9 , Porta G 10 , El-Guindi MA 11 , Alisi A 12 , Mann JP 13 , Mouane N 14 , Baur LA 15 , Dhawan A 16 , George J 17

Affiliations 

  • 1 Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia. Electronic address: mohammed.eslam@sydney.edu.au
  • 2 Department of Hepatology, Arizona Liver Health, Chandler, AZ, USA
  • 3 Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
  • 4 Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
  • 5 Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Technion School of Medicine, Haifa, Israel
  • 6 Department of Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, Children's Memorial Health Institute, Warsaw, Poland
  • 7 Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
  • 8 Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 9 The Liver Unit, Birmingham Women's & Children's Hospital, University of Birmingham, Birmingham, UK
  • 10 Pediatric Hepatology, Transplant Unit, Hospital Sírio-Libanês, Hospital Municipal Infantil Menino Jesus, San Paulo, Brazil
  • 11 Department of Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University, Menoufia, Egypt
  • 12 Research Unit of Molecular Genetics and Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
  • 13 Metabolic Research Laboratories, Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, UK
  • 14 Department of Pediatric Hepatology, Gastroenterology and Nutrition, Academic Children's Hospital, Mohammed V University, Rabat, Morocco; Department of Pediatric Hepatology, Gastroenterology and Nutrition, Children's Hospital of Rabat, Rabat, Morocco
  • 15 Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
  • 16 Paediatric Liver, GI and Nutrition Centre, and MowatLabs, King's College Hospital, London, UK
  • 17 Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
Lancet Gastroenterol Hepatol, 2021 Oct;6(10):864-873.
PMID: 34364544 DOI: 10.1016/S2468-1253(21)00183-7

Abstract

The term non-alcoholic fatty liver disease (NAFLD), and its definition, have limitations for both adults and children. The definition is most problematic for children, for whom alcohol consumption is usually not a concern. This problematic definition has prompted a consensus to rename and redefine adult NAFLD associated with metabolic dysregulation to metabolic (dysfunction)-associated fatty liver disease (MAFLD). Similarities, distinctions, and differences exist in the causes, natural history, and prognosis of fatty liver diseases in children compared with adults. In this Viewpoint we, an international panel, propose an overarching framework for paediatric fatty liver diseases and an age-appropriate MAFLD definition based on sex and age percentiles. The framework recognises the possibility of other coexisting systemic fatty liver diseases in children. The new MAFLD diagnostic criteria provide paediatricians with a conceptual scaffold for disease diagnosis, risk stratification, and improved clinical and multidisciplinary care, and they align with a definition that is valid across the lifespan.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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