Pediatricians' practices and knowledge of metabolic dysfunction-associated steatotic liver disease: An international survey

ObjectiveMetabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in children. It is associated with significant intra- and extrahepatic comorbidity. Current guidelines lack consensus, potentially resulting in variation in screening, diagnosis and treatment practices, which may lead to underdiagnosing and/or insufficient treatment. The increasing prevalence of MASLD and associated long-term health risks demand adequate clinical management and consensus in guidelines. This study aims to evaluate the daily practices of pediatricians in screening, diagnosis and treatment of MASLD in children.MethodsAn online survey with 41 questions (single/multiple response options) was sent to pediatricians (with/without subspecialty) in Europe and Israel, via members of the ESPGHAN Fatty Liver Special Interest Group, between June and November 2022. The 454 pediatricians were included in this study.Results51% of pediatricians indicated using any guideline for diagnosis and treatment of MASLD, with 68% reporting to follow recommendations only partially. 63% is of the opinion that guidelines need revision. The majority of pediatricians screen for MASLD with liver function tests and/or abdominal ultrasound. A large variety of treatment options is utilized, including lifestyle management, supplements and probiotics, with a notable 34% of pediatricians prescribing pharmacotherapy. When asked how often pediatricians request a liver biopsy in children with MASLD, 17% indicates they request a liver biopsy in more than 10% of cases.ConclusionsThere is limited awareness and considerable variation in screening, diagnosis and treatment practices among European pediatricians, and a clear demand for new, uniform guidelines for MASLD in children.What is KnownGuidelines for screening, diagnosis and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) in children lack consensus.This lack of consensus may create practice variation among pediatricians and risks underdiagnosis and/or insufficient treatment of MASLD.What is NewThis international survey is the first to evaluate the daily practices of European and Israeli pediatricians regarding MASLD.Limited awareness and considerable variation in screening, diagnosis and treatment practices for MASLD was observed among pediatricians.There is a clear demand from pediatricians for new, uniform guidelines for MASLD in children.