https://pubmed.ncbi.nlm.nih.gov/40262118/ MASLD

Hepatology. 2025 Apr 22.
doi: 10.1097/HEP.0000000000001357. Online ahead of print.

Long-term mortality and extrahepatic outcomes in 1,096 children with MASLD: A retrospective cohort study

Jeffrey B Schwimmer 1 2, Nhat Quang N Thai 3 4, Sheila L Noon 1 5, Patricia Ugalde-Nicalo 1, Sabina R Anderson 1 6 7, Lauren F Chun 1 8, Rhys S David 2, Nidhi P Goyal 1 2, Kimberly P Newton 1 2, Eleanor G Hansen 1 9, Bonnie Lin 1, Warren L Shapiro 1 2 10, Andrew Wang 1 11, Elizabeth L Yu 1 2, Cynthia A Behling 1

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PMID: 40262118

DOI: 10.1097/HEP.0000000000001357
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Abstract

Background aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children, but its long-term outcomes are poorly understood. This study aimed to quantify mortality rates, identify causes of death, and evaluate the incidence of cirrhosis and extrahepatic outcomes in children with pediatric-onset MASLD.

Approach results: The Longitudinal InVestigation Evaluating Results of Steatosis (LIVERS) study is a single-center, retrospective cohort study conducted at Rady Children's Hospital San Diego. We included 1,096 children aged 2-18 years who were diagnosed with MASLD between 2000 and 2017 and followed for a mean of 8.5 years. Mortality was ascertained via the National Death Index, and comorbidities were assessed through follow-up research visits and medical records. Overall, 3.4% of children died, yielding a mortality rate of 398 per 100,000 person-years; nearly half of these deaths were liver-related. Male sex and lower high-density lipoprotein levels independently predicted increased mortality risk. The cumulative incidence of cirrhosis was 4.7%. High incidence rates of extrahepatic comorbidities were observed, including dyslipidemia (3,664 per 100,000 person-years), hypertension (1,901), obstructive sleep apnea (1,185), and type 2 diabetes (911).

Conclusions: Pediatric MASLD is associated with significant premature mortality and a substantial burden of hepatic and extrahepatic comorbidities. These findings highlight the need for timely screening, early intervention, and long-term management strategies to improve outcomes for children with MASLD.