Metabolic dysfunction–associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), has emerged as the most common chronic liver disease affecting children and adolescents worldwide. The rising prevalence of childhood obesity, sedentary lifestyles, and poor dietary habits has contributed significantly to the growing burden of this disease. MASLD represents a spectrum of liver pathology ranging from simple hepatic steatosis to metabolic dysfunction–associated steatohepatitis (MASH), fibrosis, cirrhosis, and, in rare cases, hepatocellular carcinoma [1-4].

Because many children remain asymptomatic during early stages, the disease often goes undetected until advanced liver damage develops. Therefore, early recognition and intervention are essential to prevent long-term complications. Histologic diagnosis of MASLD typically requires at least 5% macrovesicular steatosis with lobular inflammation and hepatocyte injury characterized by ballooning degeneration [1,5].