JPGN Journal Club September 2026 Paediatric: MASLD, Liver Fibrosis and Risk of Type 2 Diabetes
Jake has chosen for today’s session two studies in metabolic dysfunction-associated steatotic liver disease – for convenience, henceforward “MASLD”. I’ve added three.
Jake’s choices . . . Well. One addresses the question: Can MASLD scoring identify children at high risk of developing Type II diabetes?
(Spoiler alert: Yes. Kinda sorta.)
The other presents the ESPGHAN consensus on MASLD: What, who, when, where, and why. (Authorial alert: Jake’s implicated as, Lord preserve us, senior author, although all co-authors are eminently respectable.)
And my additions? The MASLD-scoring article depends heavily on a system presented to the world only last year. To understand that system may be important if one is to understand the conclusions drawn from its use. I’d like, with listeners, to ask Jake to take apart the article introducing the system.
I’d also like, with listeners, to review an earlier article that reported a correlation between fibrosis in steatohepatitis and susceptibility to the development of Type II diabetes. What does Jake say: Has the use of MASLD scoring, as set out in Jake’s choice, brought matters beyond where they stood at publication of that earlier article?
Finally, yet a third scoring system for paediatric MASLD has been developed. Jake, are there reasons to preferentially use any of the three?
But let’s dive in. Jake, your consensus statement doesn’t draw substantially on that scoring system, which just last autumn pulled into the ESPGHAN station. Leaving that aside, then, what do you and ESPGHAN have to share with us? We’ll take on the scoring system later, with how to use it and how it’s been used, if you don’t take up all the time.
And listeners: Fasten your seat belts. This may be a bumpy flight.
LiteratureLefere S et al. Development and validation of pFIB scores for exclusion of significant liver fibrosis in pediatric MASLD. Hepatology 2025 Apr 1;81(4):1276-1287. Doi: 10.1097/HEP.0000000000001016. Epub 2024 Jul 19. PMID: 39028885
Lefere S et al. pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity. Diabetologia 2026 Jul 22. Doi: 10.1007/s00125-026-06804-4. PMID: 42486926
Mann JP et al. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction-associated steatotic liver disease. J Pediatr Gastroenterol Nutr 2026 Jun 30. Doi: 10.1002/jpn3.70490. Online ahead of print. PMID: 42374900
Newton KP et al. Incidence of type 2 diabetes in children with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2023 May;21(5):1261-1270. Doi: 10.1016/j.cgh.2022.05.028. Epub 2022 Jun 13. PMID: 35709934. PMCID: PMC19151072
Wang A et al. Development of Fibro-PeN, a clinical prediction model for moderate-to-severe fibrosis in children with nonalcoholic fatty liver disease. Hepatology 2024 Jun 1;79(6):1381-1392. Doi: 10.1097/HEP.0000000000000644. Epub 2023 Oct 23. PMID: 37870272. PMCID: PMC11035485