Early-Life Nutritional Determinants of Pediatric MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder in both children and adults. Pediatric MASLD, however, is not simply an early form of adult disease, as it exhibits distinct developmental, histological, and metabolic features. These characteristics reflect the complex, multi-hit, developmental continuum that begins in utero. Maternal obesity, gestational diabetes, and poor diet quality during pregnancy are linked to hepatic steatosis in offspring, implicating intra-uterine exposure to dyslipidemia, hyperglycemia, and excess free fatty acid flux as ini-tiators of fetal hepatic lipid deposition. After birth, feeding behaviors such as a prolonged duration of breastfeeding appears protective, while formula feeding, especially high added-sugar formulations, may accelerate rapid weight gain and predispose to later steatosis. Early childhood diets high in added sugars, saturated fats, and ultra-processed foods may further promote hepatic lipogenesis and inflammation and reveal underlying genetic susceptibility to metabolic dysfunction. This narrative review summarizes recent human and translational studies examining the relationship between prenatal, postnatal, and early childhood nutrition and offspring hepatic lipid accumulation, emphasizing early-life windows for intervention to reduce the burden of pediatric MASLD.