Reclassifying Pediatric Nafld Using the Steatotic Liver Disease Framework: A Multicenter Retrospective Study From the NASH CRN

Authors

• Tin Bo Nicholas Lam
• Katherine P Yates
• Sheila L Noon
• Kimberly P Newton
• Mark H Fishbein
• Jean P Molleston
• Stavra A Xanthakos
• Ajay K Jain
• Miriam B Vos
• Niviann M Blondet
• Krupa R Mysore
• Cynthia A Behling
• Laura A Wilson
• Jeffrey B Schwimmer

Language

English

Publication Date

7-1-2026

Journal

Hepatology

DOI

10.1097/HEP.0000000000001577

PMID

41104541

PMCID

PMC13070534

PubMedCentral® Posted Date

10-17-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background and aims: The terminology for hepatic steatosis and NAFLD was revised under the umbrella of steatotic liver disease, with metabolic dysfunction-associated steatotic liver disease (MASLD) as the primary subtype. MASLD is defined by hepatic steatosis plus at least 1 cardiometabolic risk factor. A new category, Met-ALD, describes MASLD with alcohol consumption below the defined thresholds for alcohol-associated liver disease (ALD). While adult studies have demonstrated strong concordance between NAFLD and MASLD, the applicability of this framework in children remains unclear.

Approach and results: We assessed children clinically diagnosed with NAFLD and enrolled in the NASH CRN who had available liver histology. Clinical and demographic data, including body mass index, hepatotoxic medication use, and alcohol intake, were analyzed. Liver biopsies were centrally reviewed to confirm hepatic steatosis and evaluate for alternative etiologies. Participants were reclassified using the steatotic liver disease framework. Among 1019 children diagnosed with NAFLD, 858 (84%) met MASLD criteria. The average number of cardiometabolic risk factors per participant was 2.7±1.1; 41 (4.7%) met all five. Thirty-three participants (3.2%) were reclassified as Met-ALD, a prevalence that rose to 5.4% among adolescents. Sixty-six children (6.5%) were reclassified as drug-induced steatotic liver disease.

Conclusions: Most children with NAFLD met MASLD criteria, but nearly 1 in 6 were reclassified based on alcohol use or medication exposure. These findings highlight the need for a systematic diagnostic approach accounting for metabolic risk factors, alcohol use, and medication-related liver injury.

Keywords

Humans, Non-alcoholic Fatty Liver Disease, Female, Child, Male, Adolescent, Retrospective Studies, Risk Factors, Liver, Biopsy, Fatty Liver, Alcohol Drinking, adolescent health, alcohol consumption, cardiometabolic risk, DILI, metabolic dysfunction–associated steatotic liver disease

Published Open-Access

yes

Recommended Citation

Lam, Tin Bo Nicholas; Yates, Katherine P; Noon, Sheila L; et al., "Reclassifying Pediatric Nafld Using the Steatotic Liver Disease Framework: A Multicenter Retrospective Study From the NASH CRN" (2026). Faculty, Staff and Students Publications. 7570.
https://digitalcommons.library.tmc.edu/baylor_docs/7570