Doença Hepática Esteatótica Associada à Disfunção Metabólica (MASLD) e obesidade em pediatria

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease (NAFLD), has emerged as one of the leading causes of chronic liver disease in the pediatric population, associated with the rising prevalence of childhood obesity and early metabolic alterations. This literature review aimed to analyze the therapeutic strategies currently available for the management of MASLD in children and adolescents. To this end, a literature search was conducted in the PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases, considering studies published between 2013 and 2025, including clinical guidelines, consensus statements, systematic reviews, meta-analyses, and original studies. The findings indicate that preventive strategies like lifestyle interventions - focused on weight loss, balanced diet, and regular physical activity - remains the first-line therapy, promoting improvement in the cardiometabolic profile and reduction of hepatic fat. Despite ongoing investigation of pharmacological treatments, such as metformin and GLP-1 receptor agonists, there are still no medications specifically approved for pediatric MASLD, and their use is restricted to individualized contexts. Among supplements, vitamin E shows evidence of histological benefit in selected cases with confirmed steatohepatitis, whereas vitamin D and modulation of the gut microbiota demonstrate promising results, although still insufficient to support routine recommendations Further clinical research is necessary to support specific guidelines for this population.