Special groups

1Children and adolescents (AASLD 2025)

• Screen from age 10 in children with obesity, or with overweight plus cardiometabolic risk factors or a family history. Some guidelines screen younger children with risk factors.
• Use ALT, not ultrasound, to screen. Abnormal: above 22 U/L in girls and 26 U/L in boys.
• A single high ALT in a well child: repeat within 3 months. Persistently high: evaluate or refer. Do not wait for ALT to reach twice normal.
• Diagnosis needs steatosis on imaging or biopsy plus a cardiometabolic risk factor. ALT alone is not enough.
• Look harder for other causes (Wilson disease, autoimmune hepatitis, genetic disorders).
• Family-based lifestyle change is the main treatment. No drug is approved for MASH in children.

2Lean MASLD

Check waist size, diet, activity and genetics (e.g. PNPLA3). Rule out other causes carefully. A 3–5% weight loss can help.

3Under 35 and over 65

Blood scores perform poorly under 35; use elastography if concerned. At 65 or over, use the age-adjusted cut-offs to avoid over-referral.

4MetALD

Ask about alcohol in grams per week. Use a validated tool (AUDIT-C) and offer support for alcohol use. Fibrosis progresses faster when both causes are present.

Related topics

• Definitions and diagnosis of MASLD
• The two-step fibrosis pathway
• Lifestyle treatment: the targets

References

1. Xanthakos SA, et al. AASLD Practice Statement on the evaluation and management of MASLD in children. Hepatology 2025;82(5):1352–94. doi:10.1097/HEP.0000000000001368
2. Vos MB, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of NAFLD in children. J Pediatr Gastroenterol Nutr 2017;64:319–34. doi:10.1097/MPG.0000000000001482
3. EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD. J Hepatol 2024;81:492–542. doi:10.1016/j.jhep.2024.04.031
4. Rinella ME, et al. AASLD Practice Guidance on the clinical assessment and management of NAFLD. Hepatology 2023;77:1797–835. doi:10.1097/HEP.0000000000000323
5. McPherson S, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol 2017;112:740–51. doi:10.1038/ajg.2016.453
6. Rinella ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023;79:1542–56. doi:10.1016/j.jhep.2023.06.003

A summary of published guidelines for healthcare professionals. It does not replace clinical judgement, the full guidelines or local drug labels. Disclaimer.