Glucagon‐like peptide‐1 receptor agonists in pediatric metabolic dysfunction‐associated steatotic liver disease

Oct 27, 2025Journal of pediatric gastroenterology and nutrition

Glucagon-like peptide-1 drugs for fatty liver disease linked to metabolism problems in children

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Abstract

ALT improved by a mean of 56 U/L at 6 months in pediatric patients with metabolic dysfunction-associated steatotic liver disease (MASLD) treated with glucagon-like-peptide-1 receptor agonists (GLP-1RAs).

Forty-two patients aged ≤18 years with MASLD were evaluated for treatment effects of GLP-1RAs.
A statistically significant reduction in ALT was observed at both 6 months (p = 0.04) and end-of-treatment (EOT) (p = 0.004).
Patients with type 2 diabetes mellitus experienced greater ALT reductions compared to those treated for obesity.
Improvements in liver enzymes such as aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) were noted.
Glycated hemoglobin (HbA1C) and triglyceride levels also showed improvement, while body mass index (BMI) remained stable.

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OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading chronic liver disease in children. Treatment with glucagon-like-peptide-1 receptor agonists (GLP-1RAs) have shown resolution of steatohepatitis with improvement in fibrosis in adults, yet pediatric studies are extremely limited. This study evaluates the impact of GLP-1RAs on pediatric MASLD, using alanine aminotransferase (ALT) reduction as a marker of improved disease activity.

METHODS: We conducted a single-center retrospective study in patients ≤18 years old with a diagnosis of MASLD, who were prescribed a GLP-1RA from January 2, 2018 and January 10, 2024 at the Children's Hospital of Philadelphia. Data were collected at baseline, 6 months, and at end-of-treatment (EOT). Inclusion required MASLD diagnosis per new criteria, elevated baseline ALT, and paired ALT values at baseline and EOT.

RESULTS: Forty-two patients met inclusion criteria (mean age 15 years, 64% male, 55% White). ALT improved by a mean of 56 U/L at 6 months (p = 0.04), and by 37 U/L at EOT (p = 0.004). Patients prescribed a GLP-1RA for type 2 diabetes mellitus (T2DM) had greater reductions in ALT compared to those treated for obesity. Improvements were also observed in aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), glycated hemoglobin (HbA1C), and triglycerides. Body mass index (BMI) percentile and z-score showed no significant changes, but BMI stabilization was observed.

CONCLUSION: This is the largest pediatric study on GLP-1RAs in MASLD to date. On a GLP-1RA, ALT significantly improved at 6 months and EOT, suggesting their role in improving disease activity. This should thus be considered as an adjunct to lifestyle modification in treating pediatric MASLD.

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Glucagon‐like peptide‐1 receptor agonists in pediatric metabolic dysfunction‐associated steatotic liver disease

Abstract

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