What's New in Pediatric Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease in children, with rising prevalence and substantial systemic consequences. This review synthesizes recent advances in pediatric MASLD and its severe form, metabolic dysfunction-associated steatohepatitis (MASH), with emphasis on new insights in epidemiology, pathogenesis, and disease burden. Diagnostic evaluation in children remains particularly challenging, requiring integration of clinical, laboratory, imaging, and histologic data, while balancing accuracy, feasibility, and risk. Progress will depend on the development of pediatric-specific tools, equitable access to care, and rigorously designed clinical trials to guide future management.