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Despite the rising prevalence of obesity among children and adolescents, no studies have examined risk factors or developed models to estimate MASLD burden by sex, age group, or geographic location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate and predict the distribution and shifting patterns of the burden of MASLD in children and adolescents aged 5 to 24\u00a0years, globally, regionally, and in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, EMBASE, Web of Science, Cochrane, and CNKI for studies reporting the prevalence of MASLD and its closely related diagnostic constructs, including metabolic dysfunction-associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD), in 5\u201324-year-olds, and synthesized evidence across these definitions to estimate the burden of MASLD. Random-effects meta-regression synthesized age-, sex-, and year-specific prevalence and risk factors. Additionally, using data from the Global Burden of Disease, World Population Prospects, and Chinese National Survey on Students\u2019 Constitution and Health, a risk factor-based model estimated global, regional, and provincial (China) MASLD burden. The protocol was registered in PROSPERO (CRD420251062351).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2747 records, 56 studies (54 English, 2 Chinese) were included; 37 informed prevalence and 38 informed risk factors. Our model indicated that the global MASLD prevalence among 5\u201324-year-olds was 7.0% (95% CI: 4.1, 11.7), increasing with age and year, and higher in boys. Asia had the largest number of cases in 2000 (63.8 million [51.5, 76.6]) and 2020 (160.9 million [134.5, 187.6]). Our model further indicated that Africa is projected to surpass Asia in total case numbers from 2040 onward. In China, MASLD prevalence among 6\u201318-year-olds was highest in Hebei, Shandong, and Beijing (2000) and in Tianjin, Shandong, and Heilongjiang (from 2020 onwards).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of MASLD among children and adolescents continues to rise alongside the epidemic of obesity. Model-based estimates suggest that the burden of MASLD may shift over time towards currently less developed regions of the world, such as Africa, and less well-developed regions in China. Targeted investment in obesity prevention is urgently needed, as are health services to reduce the health impacts of MASLD during and beyond childhood and adolescence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-026-04801-3","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T04:47:46Z","timestamp":1773809266000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Global and regional prevalence, burden, and risk factors for MASLD in children and adolescents aged 5 to 24\u00a0years: a systematic review, meta-analysis, and modeling study"],"prefix":"10.1186","volume":"24","author":[{"given":"Yunfei","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruolan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junkang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajia","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiheng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyue","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Sawyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"10440","key":"4801_CR1","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1016\/S0140-6736(24)00685-8","volume":"403","author":"GBD Forecasting Collaborators","year":"2024","unstructured":"GBD Forecasting Collaborators. 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