ESPGHAN Podcast

Jake has chosen for today’s session two studies in metabolic dysfunction-associated steatotic liver disease – for convenience, henceforward “MASLD”. I’ve added three.
Jake’s choices . . . Well. One addresses the question: Can MASLD scoring identify children at high risk of developing Type II diabetes?
(Spoiler alert: Yes. Kinda sorta.)
The other presents the ESPGHAN consensus on MASLD: What, who, when, where, and why. (Authorial alert: Jake’s implicated as, Lord preserve us, senior author, although all co-authors are eminently respectable.)
And my additions? The MASLD-scoring article depends heavily on a system presented to the world only last year. To understand that system may be important if one is to understand the conclusions drawn from its use. I’d like, with listeners, to ask Jake to take apart the article introducing the system.
I’d also like, with listeners, to review an earlier article that reported a correlation between fibrosis in steatohepatitis and susceptibility to the development of Type II diabetes. What does Jake say: Has the use of MASLD scoring, as set out in Jake’s choice, brought matters beyond where they stood at publication of that earlier article?
Finally, yet a third scoring system for paediatric MASLD has been developed. Jake, are there reasons to preferentially use any of the three?
But let’s dive in. Jake, your consensus statement doesn’t draw substantially on that scoring system, which just last autumn pulled into the ESPGHAN station. Leaving that aside, then, what do you and ESPGHAN have to share with us? We’ll take on the scoring system later, with how to use it and how it’s been used, if you don’t take up all the time.
And listeners: Fasten your seat belts. This may be a bumpy flight.
LiteratureLefere S et al. Development and validation of pFIB scores for exclusion of significant liver fibrosis in pediatric MASLD. Hepatology 2025 Apr 1;81(4):1276-1287. Doi: 10.1097/HEP.0000000000001016. Epub 2024 Jul 19. PMID: 39028885
Lefere S et al. pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity. Diabetologia 2026 Jul 22. Doi: 10.1007/s00125-026-06804-4. PMID: 42486926
Mann JP et al. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction-associated steatotic liver disease. J Pediatr Gastroenterol Nutr 2026 Jun 30. Doi: 10.1002/jpn3.70490. Online ahead of print. PMID: 42374900
Newton KP et al. Incidence of type 2 diabetes in children with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2023 May;21(5):1261-1270. Doi: 10.1016/j.cgh.2022.05.028. Epub 2022 Jun 13. PMID: 35709934. PMCID: PMC19151072
Wang A et al. Development of Fibro-PeN, a clinical prediction model for moderate-to-severe fibrosis in children with nonalcoholic fatty liver disease. Hepatology 2024 Jun 1;79(6):1381-1392. Doi: 10.1097/HEP.0000000000000644. Epub 2023 Oct 23. PMID: 37870272. PMCID: PMC11035485

Hello, and welcome to another ESPGHAN podcast!
Let’s start by asking if you know a particular German idiom: What does "Leben wie Gott in Frankreich" mean? Literally, "to live like God in France"—but the French themselves describe those deliciously well set up as comme un coq en pâte, a rooster in dough... go figure.
Living like God in France, as anyone knows who has eaten at a French table, can be improved, however, with one substitution: Leben wie Gott in Lyon.
Yes, Lyon. This city, once named Lugdunum, was the capital of omnia Gallia (all three parts!). She has happily ceded that rôle to Paris. Instead, she enjoys the status of the capital of French cooking, and thus of gastronomy worldwide. Our guest today can vouch for the truth of this, as he lives in Lyon, where he is, very appropriately, a professor of both paediatrics and nutrition: Dr Noël Peretti.
Prof Peretti clinically addresses many aspects of paediatric nutrition and malnutrition, but his research concentrates on lipids and their handling—only natural in Lyon. In Lyon, where, as in Hungary, many recipes begin, "Take something that used to be a pig," in Lyon, home of the celebration of the lardon that is the salade Lyonnaise... But revenons à nos moutons, or rather à nos porcs.
Lipids, and their handling, and its disorders: Prof Peretti has chosen for discussion an article by Wiegman et al., from the European Heart Journal—"Familial Hypercholesterolaemia in Children and Adolescents: A European Atherosclerosis Society Consensus Statement." Let’s begin by defining the problem.
One in 300 of us has familial hypercholesterolaemia (FH)—yes, that many, counting heterozygotes; biallelic FH affects perhaps one in 300,000. Overall, perhaps 500,000 children in Europe have FH. Biallelic FH can manifest with fatal atherosclerosis in adolescence or childhood. Heterozygous FH speeds the progression of atherosclerosis somewhat, but less severely. The challenge for public health is to achieve diagnosis of FH, with intervention, in childhood; of those 500,000 European children, fewer than 50,000 (10%) are identified.
Guidelines for diagnosis and for intervention were published in 2015. Those diagnostic criteria accurately identified FH—but in too few children. In the years since those guidelines appeared, understanding of FH and choices among therapies have increased, as has the weight given to chronic hyperlipidaemia. Algorithms for diagnosis and for treatment thus have been revisited. The work by Wiegman et al. presents state-of-the-art recommendations for FH, which Prof Peretti helped to formulate and which he sets out now for ESPGHAN listeners.
Literature
Wiegman A et al. Familial Hypercholesterolaemia in Children and Adolescents: A European Atherosclerosis Society Consensus Statement. Eur Heart J. 2026 May 25:ehag382. doi: 10.1093/eurheartj/ehag382. Online ahead of print. PMID: 42179051.
Prof. Peretti´s favourite song: Le Poinçonneur des Lilas – Serge Gainsbourg
ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Today on the ESPGHAN podcast—hello, listeners! Y’all right?—we’ll address, with the help of Dr Jutta Koeglmeier, of London’s Great Ormond Street Hospital for Sick Children, what some persons might call a first-world problem.
For millennia the principal issue with nutrition was: Will there be enough? In wealthy nations, at least, during the last century, there certainly was enough nutrition; the issues shifted in two directions, one being: Will it reach those who need it? and the other: Will some people overfeed themselves? Now a third issue is cropping up in those wealthy nations: Will some people adopt diets that slide into underfeeding?
One such diet is that imposed by veganism, which abjures (along with quite a bit else) the ingestion of food or drink not derived directly from vegetable sources. Might adherence to strict veganism lead to deficiencies in macronutrients or micronutrients? Clearly, yes. Beyond supplementation, since veganism and scepticism toward pills and Big Pharma often are parabiosed, how can such outcomes be avoided?
Dr Koeglmeier proposes three contributions in guiding today’s chat. These are "Developing a Food Exchange System for Meal Planning in Vegan Children and Adolescents", by Menal-Puey et al.; "Does the Healthy Plate Model Workshop Improve Nutrition Knowledge, Behaviors, and Habits in School-Age Children? The Impact of Workshop on Dietary Habits: Original Article", by Şahin and Özkaya; and "Vegan Diet and Nutritional Status in Infants, Children and Adolescents: A Position Paper Based on a Systematic Search by the ESPGHAN Nutrition Committee", by Verduci et al. (Complete PubMed details can be found in the podcast précis on the ESPGHAN website.)
Starting with the ESPGHAN stance toward veganism—summed up as "perhaps all very well for some, but keep an eye on how things are going for children on a vegan diet!"—what can professional nutrition counselling offer?
As always here, listen and find out...
Literature
Menal-Puey S et al. Developing a Food Exchange System for Meal Planning in Vegan Children and Adolescents.Nutrients. 2018 Dec 25;11(1):43. doi: 10.3390/nu11010043. PMID: 30585248. PMCID: PMC6356333.
Şahin HS, Özkaya V. Does the Healthy Plate Model Workshop Improve Nutrition Knowledge, Behaviors, and Habits in School-Age Children? The Impact of Workshop on Dietary Habits: Original Article. BMC Public Health. 2025 Jan 13;25(1):136. doi: 10.1186/s12889-025-21375-6. PMID: 39806359. PMCID: PMC11727504.
Verduci E et al. Vegan Diet and Nutritional Status in Infants, Children and Adolescents: A Position Paper Based on a Systematic Search by the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr. 2025 Nov;81(5):1318–1345. doi: 10.1002/jpn3.70182. Epub 2025 Aug 17. PMID: 40819279. PMCID: PMC12580465.
Dr. Koeglmeier´s favourite song: Here Comes the Sun – The Beatles
ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Hello, listeners!
Today’s guest on the ESPGHAN podcast is Prof Dr Mike Thomson, who needs no introduction as an expert in paediatric therapeutic endoscopy—whoops! Well, that’s him introduced, then.
Prof Thomson trained in Aberdeen, and after ten years knocking about various junior posts in the United Kingdom (with a jolly in Brisbane, lucky man!), he was lured into the lair of the southern beast, that is to say, London. There, at the Royal Free Hospital, he stayed for ten more years, leaving to take up his present position in Sheffield.
He offers for discussion two articles and an essay on interventional endoscopy and paediatric gastrointestinal haemorrhage, titled: "Acute Upper Gastrointestinal Bleeding in Childhood: Development of the Sheffield Scoring System to Predict Need for Endoscopic Therapy"; "There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018"; and "A Management Strategy for Nonvariceal Gastrointestinal Bleeding in Children: An ESPGHAN Position Paper."
Whilst full bibliographic details are available in a précis on the ESPGHAN website, there can be no harm in noting here that the first author of each is a certain Thomson M.
Endoscopy in practice is, of course, practical: one learns how to do it by doing it. Yet the lessons that practising endoscopy teaches can be gathered, studied, and passed along to those less experienced at the trade, in hopes of minimising individual re-invention of the bicycle.
When the day comes that listeners must, on their own, glove up for an endoscopy in a child with haematemesis, then to have paid attention to this podcast, to have become familiar with Prof Thomson’s writings, may prove useful indeed. Stepping onto the pedals, one can be more confident that the bicycle beneath one is sturdily built and that the ride ahead will not be disastrously wobbly.
Literature
Thomson MA et al. Acute Upper Gastrointestinal Bleeding in Childhood: Development of the Sheffield Scoring System to Predict Need for Endoscopic Therapy. J Pediatr Gastroenterol Nutr. 2015 May;60(5):632–636. doi: 10.1097/MPG.0000000000000680. PMID: 25539193.
Thomson M. There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018. J Pediatr Gastroenterol Nutr. 2018 Dec;67(6):684–688. doi: 10.1097/MPG.0000000000002148. PMID: 30211844.
Thomson M et al. A Management Strategy for Nonvariceal Gastrointestinal Bleeding in Children: An ESPGHAN Position Paper. J Pediatr Gastroenterol Nutr. 2026 Mar;82(3):895–915. doi: 10.1002/jpn3.70278. Epub 2026 Jan 1. PMID: 41479032.
Prof. Thompson´s favourite song: Three Little Birds - Bob Marley

ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Welcome back to ESPGHAN Journal Club! We have another Manager’s Special at the ESPGHAN podcast supermarket – Aisle 2, listeners! Two at once, tag-team interviewing: Prof Dr Carolin Schneider of the Rheinisch-Westfälische Technische Hochschule Aachen, in Aachen (soon to take up a professorship in Dresden), and Dr Jake Mann of Birmingham.
Dr Mann is… well, he’s the bloke that you all know – or so let’s hope! – from faithful attendance at ESPGHAN Journal Club. No need to rabbit on about him. Prof Schneider is a new rocket, or rather perhaps someone riding a new rocket. She comes from Neuss, the garden spot of the Ruhrpott, across the River Rhine from Düsseldorf – and she stayed close to home for her medical training: Lured irresistibly by Printen, a regional type of gingerbread and the emblem of the city of Aachen – Charlemagne’s capital – she headed a few kilometres to the southwest, matriculated at RWTH Aachen University, and took all the prizes. She now heads a laboratory at her alma mater, administratively within the department of gastroenterology. Her Printen-fuelled career-rocket is powered by artificial intelligence (AI), that is to say, by the use of AI to mine large data sets for features that may be of value in population screening.
She and Jake have recommended two articles for listener attention: “Learning the natural history of human disease with generative transformers” and “Machine learning predicts hepatocellular carcinoma risk from routine clinical data: A large population-based multicentric study”, the latter from her team. The former describes use of GPTs – generative pre-trained transformers; a form of AI – to model health trajectories for populations and to identify biomarker combinations of predictive value for morbidity of multiple aetiologies. The latter uses AI as well, again seeking biomarker combinations, but those associated predictively with a particular single disorder – hepatocellular carcinoma.
Now, a recommendation: Seek out these publications (elsewhere on the ESPGHAN website is a précis of this podcast, with bibliographic data). Pore over them. Then come back to the podcast and listen again. Why? To cite Mark Twain: “The statements are interesting, but tough.” They are written in Epidemiology and in Statistics, neither of which is a language that many of us speak. And to plough through these articles and to emerge at the other end feeling that one has understood them… is tough.
Prof Schneider and Jake in the following discussion are excellent guides on a listener’s pilgrimage to the Celestial City of comprehension – yes, the metaphor is from John Bunyan, as were the statements on which Twain commented. But only to a certain extent can their unaided efforts make the crooked straight and the rough places plain. So aid them – read, ponder, and make time to listen to this podcast more than once.
Literature
Clusmann J et al. Machine learning predicts hepatocellular carcinoma risk from routine clinical data: A large population-based multicentric study. Cancer Discov 2026 Mar 26. DOI: 10.1158/2159-8290.CD-25-1323. Online ahead of print. PMID: 41881847
Shmatko A et al. Learning the natural history of human disease with generative transformers. Nature 2025 Nov;647(8088):248–256. DOI: 10.1038/s41586-025-09529-3. Epub 2025 Sep 17. PMID: 40963019. PMCID: 12589094. Erratum: Nature 2025 Nov;647(8091):E8. DOI: 10.1038/s41586-025-09879-y. PMID: 42225015