Journal article
Treatment response in pediatric metabolic dysfunction-associated steatotic liver disease: Noninvasive endpoints and body composition
World journal of hepatology
09/18/2026
DOI: 10.4254/wjh.125487
Abstract
Metabolic dysfunction-associated steatotic liver disease is the most common chronic liver disease in youth, yet treatment response remains difficult to define as lifestyle therapy, anti-obesity pharmacotherapy, and metabolic and bariatric surgery produce changes across different biological domains. This narrative review examines histology, alanine aminotransferase, magnetic resonance imaging proton density fat fraction, elastography, serum biomarkers, body composition, cardiometabolic health, and patient-centered outcomes as candidate response endpoints. Diagnostic accuracy, cross-sectional severity, prognostic validity, longitudinal responsiveness, association with histological response, and validated thresholds for meaningful change are considered separately. Pediatric evidence remains strongest for repeated aminotransferases, growth-adjusted adiposity measures, and selected imaging approaches, but no single test defines response and normal aminotransferases do not exclude persistent steatohepatitis or fibrosis. Adult magnetic resonance imaging and drug-trial thresholds are informative but cannot be adopted uncritically in children. Loss of lean mass should also not be equated with sarcopenia without evidence of low muscle quantity and impaired strength or function. A practical three-tier framework is proposed: Minimum clinical assessment, specialist- center assessment, and research endpoints. The proposed tiers and reassessment intervals are pragmatic author guidance, not validated pediatric standards, and require prospective validation. Until pediatric longitudinal thresholds are validated, response assessment should be multidimensional, treatment-specific, growth-aware, patient- centered, and adapted to feasibility and equity.
Details
- Title: Subtitle
- Treatment response in pediatric metabolic dysfunction-associated steatotic liver disease: Noninvasive endpoints and body composition
- Creators
- Toshifumi Yodoshi - University of Iowa
- Resource Type
- Journal article
- Publication Details
- World journal of hepatology
- DOI
- 10.4254/wjh.125487
- ISSN
- 1948-5182
- eISSN
- 1948-5182
- Language
- English
- Electronic publication date
- 09/18/2026
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9985238182602771
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