Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is prevalent amongst children and adolescents. Despite higher incidence, effective treatment options for this population are controversial. This Meta-analysis aims to evaluate the effects of all non-invasive treatment modalities available for MASLD.

This study includes PubMed, Cochrane Library, and Embase searches (January 2010 to July 2025) for Randomised Controlled Trials (RCTs), evaluating different treatment modalities of MASLD in pediatrics and adolescent population. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Primary outcomes were Aspartate Aminotransferase (AST), Triglycerides (TGs) and Low-Density Lipoproteins (LDL). Secondary outcomes were Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), High-Density Lipoprotein (HDL) and adverse effects. Data were analyzed using Revman 5.3. Continuous values were pooled using the standard mean difference (SMD). Sensitivity analysis was performed to reduce heterogeneity. This study was registered with PROSPERO, CRD42024596682.

We included 31 RCTs, having 1722 participants. Multiple treatment modalities were identified and categorized into dietary intervention, supplementation, drug intervention and exercise. We further categorized dietary intervention into low-sugar diet, low-fat diet and mediterranean diet and compared against different controls. The low-sugar diet showed significant improvement in TG levels against placebo/usual diet [-2.44,95 %CI:3.61,-1.27] and in AST levels against low-fat diet [-1.02, 95 %CI –1.88, -0.16]. LDL levels showed significant change when probiotics were administered against placebo [-0.33, 95 % CI:0.65,0.00].

Supplements and Dietary intervention have shown improvement in liver enzymes and lipid profile. However, more research is required to evaluate the dosage and adverse effects associated with these interventions.