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Review

Pediatric MASLD in Severe Obesity: Current Clinical Perspectives on Diagnosis and Treatment

by
Ewa Kostrzeba
1,*,
Mirosław Bik-Multanowski
2,3,
Stephanie Brandt-Heunemann
4,5,
Ewa Małecka-Tendera
6,
Artur Mazur
7,
Michael B. Ranke
8,
Martin Wabitsch
4,5,
Małgorzata Wójcik
9,
Agnieszka Zachurzok
10 and
Elżbieta Petriczko
1
1
Department of Pediatrics, Endocrinology and Diabetology of the Development Age, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
2
Department of Medical Genetics, Jagiellonian University Medical College, 31-008 Cracow, Poland
3
University Hospital, Institute of Human Genetics, LMU, 80336 München, Germany
4
Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent, Medicine, University Medical Center Ulm, 89075 Ulm, Germany
5
German Center for Child and Adolescent Health (DZKJ), Partner Site Ulm, 89075 Ulm, Germany
6
Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, 40-752 Katowice, Poland
7
Department of Pediatrics, Pediatric Endocrinology and Diabetes, Institute of Medical Sciences, Medical College of Rzeszów University, 35-301 Rzeszów, Poland
8
Children’s Hospital in Tübingen, University of Tübingen, 72076 Tübingen, Germany
9
Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, 31-008 Cracow, Poland
10
Department of Pediatrics, Faculty of Medical Sciences, Medical University of Silesia in Zabrze, 41-800 Zabrze, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(1), 137; https://doi.org/10.3390/jcm15010137
Submission received: 28 November 2025 / Revised: 22 December 2025 / Accepted: 23 December 2025 / Published: 24 December 2025
(This article belongs to the Section Clinical Pediatrics)
Review Reports Versions Notes

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now one of the most common chronic liver diseases in children and closely parallels the rising prevalence of severe pediatric obesity. Methods: This review synthesizes current evidence (2019–2025) and landmark studies on the diagnosis and management of pediatric MASLD, integrating contemporary guidelines and future directions. Results: Based on current data, we propose practical algorithms for screening and management of pediatric MASLD. Screening with alanine aminotransferase (ALT) as the initial test should be initiated in all children aged 9–11 years with obesity, in those who are overweight with additional risk factors, and in children with severe obesity or a family history of MASLD. Non-invasive imaging techniques show important limitations in children with increased amount of subcutaneous tissue requiring cautious interpretation. Lifestyle modification remains the cornerstone of therapy, while pharmacological treatments are investigational. In adolescents with severe obesity and significant comorbidities, bariatric surgery represents an effective therapeutic option with durable metabolic effects. Conclusions: Early identification of high-risk children, especially those with severe obesity, and implementation of multidisciplinary management are essential to prevent MASLD progression. Refinement of screening strategies and development of validated non-invasive biomarkers remain key priorities for future pediatric care.
Keywords: severe obesity; MASLD; childhood obesity severe obesity; MASLD; childhood obesity

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MDPI and ACS Style

Kostrzeba, E.; Bik-Multanowski, M.; Brandt-Heunemann, S.; Małecka-Tendera, E.; Mazur, A.; Ranke, M.B.; Wabitsch, M.; Wójcik, M.; Zachurzok, A.; Petriczko, E. Pediatric MASLD in Severe Obesity: Current Clinical Perspectives on Diagnosis and Treatment. J. Clin. Med. 2026, 15, 137. https://doi.org/10.3390/jcm15010137

AMA Style

Kostrzeba E, Bik-Multanowski M, Brandt-Heunemann S, Małecka-Tendera E, Mazur A, Ranke MB, Wabitsch M, Wójcik M, Zachurzok A, Petriczko E. Pediatric MASLD in Severe Obesity: Current Clinical Perspectives on Diagnosis and Treatment. Journal of Clinical Medicine. 2026; 15(1):137. https://doi.org/10.3390/jcm15010137

Chicago/Turabian Style

Kostrzeba, Ewa, Mirosław Bik-Multanowski, Stephanie Brandt-Heunemann, Ewa Małecka-Tendera, Artur Mazur, Michael B. Ranke, Martin Wabitsch, Małgorzata Wójcik, Agnieszka Zachurzok, and Elżbieta Petriczko. 2026. "Pediatric MASLD in Severe Obesity: Current Clinical Perspectives on Diagnosis and Treatment" Journal of Clinical Medicine 15, no. 1: 137. https://doi.org/10.3390/jcm15010137

APA Style

Kostrzeba, E., Bik-Multanowski, M., Brandt-Heunemann, S., Małecka-Tendera, E., Mazur, A., Ranke, M. B., Wabitsch, M., Wójcik, M., Zachurzok, A., & Petriczko, E. (2026). Pediatric MASLD in Severe Obesity: Current Clinical Perspectives on Diagnosis and Treatment. Journal of Clinical Medicine, 15(1), 137. https://doi.org/10.3390/jcm15010137

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