Gut microbiota and pediatric metabolic dysfunction-associated steatotic liver disease: clinical evidence and therapeutic implications.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as Non-alcoholic fatty liver disease (NAFLD), is among the most common chronic liver conditions globally. The incidence of MASLD has been rising, primarily due to lifestyle changes, excessive calorie intake, and other metabolic conditions like obesity and Type 2 diabetes mellitus in both adults and children. An inclusive understanding of risk factors of childhood MASLD is still unknown. Based on the limited case studies published, familial clustering is prominent in MASLD suggesting role of genetic factors. Moreover, children with MASLD are at higher risk of obesity, diabetes and hypertension. Studies associating the colonic microbiome with MASLD have been limited and complicated by inconsistencies in study design and approach but mostly indicate a role in the pediatric population. The present review provides a comprehensive understanding of the most recent clinical studies (2013-2026) on the role of gut microbiome in the development of pediatric MASLD.