Pediatricians' practices and knowledge of metabolic dysfunction-associated steatotic liver disease: An international survey.

OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in children. It is associated with significant intra- and extrahepatic comorbidity. Current guidelines lack consensus, potentially resulting in variation in screening, diagnosis and treatment practices, which may lead to underdiagnosing and/or insufficient treatment. The increasing prevalence of MASLD and associated long-term health risks demand adequate clinical management and consensus in guidelines. This study aims to evaluate the daily practices of pediatricians in screening, diagnosis and treatment of MASLD in children. METHODS: An online survey with 41 questions (single/multiple response options) was sent to pediatricians (with/without subspecialty) in Europe and Israel, via members of the ESPGHAN Fatty Liver Special Interest Group, between June and November 2022. The 454 pediatricians were included in this study. RESULTS: 51% of pediatricians indicated using any guideline for diagnosis and treatment of MASLD, with 68% reporting to follow recommendations only partially. 63% is of the opinion that guidelines need revision. The majority of pediatricians screen for MASLD with liver function tests and/or abdominal ultrasound. A large variety of treatment options is utilized, including lifestyle management, supplements and probiotics, with a notable 34% of pediatricians prescribing pharmacotherapy. When asked how often pediatricians request a liver biopsy in children with MASLD, 17% indicates they request a liver biopsy in more than 10% of cases. CONCLUSIONS: There is limited awareness and considerable variation in screening, diagnosis and treatment practices among European pediatricians, and a clear demand for new, uniform guidelines for MASLD in children.

The Role of FXR-Signaling Variability in the Development and Course of Non-Alcoholic Fatty Liver Disease in Children.

INTRODUCTION: Genetic mechanisms among many other factors play a crucial role in the development and progression of nonalcoholic fatty liver disease (NAFLD). The farnesoid X-receptor (FXR) regulates the expression of target genes involved in metabolic and energy homeostasis, so it can be assumed that genetic variations within the NR1H4 gene, encoding FXR, can affect the development or progression of associated diseases, including NAFLD. THE AIM: To study the association of SNP rs11110390 NR1H4 gene with the probability of development and course of NAFLD in children. MATERIALS AND METHODS: 76 children aged 9-17 years and overweight were examined. According to controlled attenuated parameter (CAP) measurement (Fibroscan®502touch) children were divided into 2 groups: group 1 consisted of 40 patients with NAFLD, group 2 was composed by 36 patients without hepatic steatosis. According to genetic testing children were divided into 3 subgroups - children with CC-, CT-, TT-genotype SNP rs11110390 NR1H4 gene. RESULTS: The frequency of TT-genotype SNP rs11110390 NR1H4 gene detection in children with NAFLD was 17.5% versus 2.8% in the control group (p NR1H4 gene the liver stiffness (p NR1H4 (p NR1H4 is associated with an increased probability of NAFLD development in children. An increase in the steatosis degree and liver stiffness in combination with increased taurine-conjugated bile acids fractions in the hepatic and gallbladder's bile, shift in cytokine balance due to a decrease in IL-10 level in children with TT-genotype SNP rs11110390 NR1H4 were observed.

Association of nonalcoholic fatty liver disease with small intestine bacterial overgrowth in obese children.

OBJECTIVE: Introduction: In recent years, NAFLD is considered as the key of the so-called metabolic inflammation, in which the intestinal microbiota plays an important role. The aim: To determine the effect of small intestine bacterial overgrowth on the liver structural and functional parameters in children with obesity and overweight. PATIENTS AND METHODS: Materials and methods: The object of the study was 89 children with obesity/overweight. Depending on the presence of SIBO based on the results of the hydrogen breath test with glucose, the patients were divided into 2 groups: first (I) consisted of 31 children with SIBO, the second (II) included 58 children without SIBO. All the patients under study performed a general blood analysis and a biochemical blood test, immuno-enzyme test method with insulin level determination HOMA index calculation. For diagnostics of the liver steatosis, transient elastography with the CAP (controlled attenuation parameter) function was carried out using FibroScan® 502 touch (Echosens, Paris, France). RESULTS: Results: According to fibroscan data, the presence of SIBO in obese children can lead to raise of CAP level; liver steatosis was diagnosed in 22 patients (70.9%) of the 1st group and 24 patients (41.4%) of the 2 group (p<0,05). We found significant differences in the the ratio of neutrophils and lymphocytes (NLR) (p <0.05). The average glucose level and HOMA index were significantly higher in SIBO group (p<0,05). The analysis of risk factors of SIBO showed that metabolic syndrome and NAFLD as the risk factors for SIBO development (p<0,05). CONCLUSION: Conclusions: SIBO has an effect on the structural and functional characteristics of the liver resulting in higher insulin and glucose level, higher NLR level and greater prevalence of NAFLD.