Long-term mortality and extrahepatic outcomes in 1096 children with MASLD: A retrospective cohort study
Jeffrey B. Schwimmer, Nhat Quang N. Thai, Sheila L. Noon, Patricia Ugalde‐Nicalo, Sabina R. Anderson, Lauren F. Chun, Rhys S. David, Nidhi P. Goyal, Kimberly P. Newton, Eleanor G. Hansen, Bonnie Lin, Warren L. Shapiro, Andrew Wang, Elizabeth L. Yu, Cynthia A. Behling
Abstract
BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children, but its long-term outcomes are poorly understood. This study aimed to quantify mortality rates, identify causes of death, and evaluate the incidence of cirrhosis and extrahepatic outcomes in children with pediatric-onset MASLD. APPROACH AND RESULTS: The Longitudinal InVestigation Evaluating Results of Steatosis (LIVERS) study is a single-center, retrospective cohort study conducted at Rady Children's Hospital San Diego. We included 1096 children aged 2-18 years who were diagnosed with MASLD between 2000 and 2017 and followed for a mean of 8.5 years. Mortality was ascertained through the National Death Index, and comorbidities were assessed through follow-up research visits and medical records. Overall, 3.4% of children died, yielding a mortality rate of 398 per 100,000 person-years; nearly half of these deaths were liver-related. Male sex and lower HDL levels independently predicted increased mortality risk. The cumulative incidence of cirrhosis was 4.7%. High incidence rates of extrahepatic comorbidities were observed, including dyslipidemia (3664 per 100,000 person-years), hypertension (1901), obstructive sleep apnea (1185), and type 2 diabetes (911). CONCLUSIONS: Pediatric MASLD is associated with significant premature mortality and a substantial burden of hepatic and extrahepatic comorbidities. These findings highlight the need for timely screening, early intervention, and long-term management strategies to improve outcomes for children with MASLD.