Stefani Tica, MD, MPH, is an assistant professor of pediatrics in the Division of Gastroenterology, Hepatology, and Nutrition at Washington University School of Medicine in St Louis.

When Does MASLD Risk Begin? New Research on Early-Life Factors

As rates of metabolic dysfunction-associated steatotic liver disease (MASLD) continue to rise, experts are increasingly examining how risk for metabolic disease may develop earlier in life than previously recognized, with emerging evidence suggesting that factors shaping MASLD risk may extend beyond an individual’s current metabolic health to include early-life exposures and parental health.

A new analysis of data from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) offers additional insight into how risk for MASLD may begin far earlier in life than previously recognized, potentially even before a child is born. In an interview discussing the study, study author Stefani Tica, MD, MPH, an assistant professor of pediatrics in the Division of Gastroenterology, Hepatology, and Nutrition at Washington University School of Medicine in St Louis, explained that the work was motivated by the complex and multifactorial nature of metabolic disease.

“One of the things that I always counsel my MASLD patients about is that usually problems with our metabolism are really complex, and there's no one single thing that has gone awry,” Tica said. “One of the inspirations for this project was really kind of leaning into these complex interactions with not only what we're eating or how we're using these energy stores, but also our genetics, our environment, stress, kind of the realities of our life.”

The study approached MASLD through a population health lens, aiming to better understand how early-life and family-level factors might shape long-term risk. Rising MASLD incidence across both pediatric and adult populations prompted the team to look beyond individual health markers at the time of diagnosis and instead consider a broader life-course perspective.

In pediatric populations, recent research examining National Health and Nutrition Examination Survey (NHANES) 2011-2020 data estimated the overall prevalence of suspected MASLD in the adolescent population was 11.3%.

In the present study, investigators included 1933 offspring from the ALSPAC to assess the associations between parental pre-pregnancy BMI and odds of offspring MASLD at age 24 years, with MASLD defined as hepatic steatosis on transient elastography and ≥1 cardiometabolic risk factors.

Results showed that at age 24 years, 10.4% of offspring had MASLD. Pre-pregnancy maternal and paternal obesity were independently associated with an increased odds of offspring MASLD, with each 1 kg/m2 increase in maternal BMI increasing the odds of MASLD by 10% (odds ratio [OR], 1.10; 95% CI, 1.06 to 1.14), while each 1 kg/m2 increase in paternal BMI raised the odds by 9% (OR, 1.09; 95% CI, 1.04 to 1.13).

Further analysis revealed biparental overweight or obesity was associated with 3.73 times the odds of offspring MASLD (OR, 3.73; 95% CI, 2.43 to 5.73) compared with parents with a normal BMI, with 67% of this association mediated by cumulative excess childhood BMI.

For clinicians, particularly pediatric hepatologists and pediatric providers, these findings underscore the importance of earlier conversations about metabolic risk. Tica noted that framing these discussions around family health and long-term outcomes may help engage both children and parents in preventive efforts.

“I think this is quite interesting in the sense that it's not necessarily the person who we're seeing right then and there and what their BMI is and what their other metabolic health markers are looking like, but that sort of risk for disease might develop much earlier on,” Tica explained. “I think having this more longitudinal life course perspective on it reinvigorates efforts from a public health standpoint to intervene earlier on in life and potentially have a much bigger impact if you can successfully do that.”

She also noted that the research raises several important unanswered questions. As an observational study, it cannot establish the biological mechanisms underlying these associations. However, emerging preclinical evidence suggests potential roles for epigenetic changes and alterations in the gut microbiome, particularly in infants exposed to maternal obesity or dietary differences during early development.

According to Tica, further mechanistic research will be essential to determine whether interventions, such as parental weight loss or metabolic improvements, can meaningfully alter MASLD risk in future generations.

Editor’s note: Tica reports no relevant disclosures.

Tica S, Luo C, Ren D, et al. Parental obesity and risk of metabolic dysfunction associated steatotic liver disease in adult offspring: UK birth cohort study. 

. Published online February 24, 2026. doi:10.1136/gutjnl-2025-336165

Brooks A. Up to 11% of US Adolescents Have Suspected MASLD, Study Finds. HCPLive. February 17, 2025. Accessed March 5, 2026. 

https://www.hcplive.com/view/an-estimated-11-us-adolescents-have-suspected-masld-study-finds

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New research suggests MASLD risk may develop early in life, highlighting the impact of parental factors and cumulative childhood adiposity.

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Understanding Intergenerational Risk Factors for MASLD, With Stefani Tica, MD, MPH

Adam DeVore, MD, MHS, is an associate professor of medicine in the division of cardiology at the Duke University School of Medicine and medical director of the Duke Heart Transplant program.

Laura Peters, DNP, is an assistant professor of medicine in the Advanced Heart Failure and Cardiac Transplant at the University of Colorado, as well as director of the Children’s Hospital Colorado and UCHealth Heart Transplant Transition Program.

HFSA/AAHFN Tech in Heart Failure: How AI Can Help Heart Failure Care

A joint statement by the Heart Failure Society of America (HFSA) and the American Association of Heart Failure Nurses (AAHFN), published on January 27, 2026, emphasizes the value of integrating technology into all facets of 

 care. The statement aims to provide clinicians with suggestions for a more team-based, forward-thinking, and actionable system of care.

Integrated health technologies (IHTs) have become extremely prominent in heart failure care of late, allowing for timely clinical intervention and facilitating care coordination between disciplines. However, widespread challenges, including suboptimal engagement from patients, digital literacy and access disparities, and poor interoperability, have stymied the uptake process. This document guides clinicians in overcoming these challenges to optimize care.

, Adam DeVore, MD, MHS, and Laura Peters, DNP, come together to discuss the intrinsic value of including recent technological advancements in standard clinical care.

During the discussion, panelists highlighted the growing role artificial intelligence (AI) may play in helping clinicians manage this influx of information. Rather than requiring providers to manually interpret dozens—or even hundreds—of incoming data points, AI-driven platforms may soon be capable of filtering and prioritizing signals that warrant clinical attention. By identifying patterns or thresholds that indicate potential decompensation, these tools could present clinicians with concise, actionable insights rather than raw data streams, helping transform information overload into targeted clinical decision support.

Beyond supporting clinicians, AI may also serve as a bridge between patients and care teams. The panelists discussed the possibility of integrating institutional treatment protocols—such as guideline-directed medical therapy (GDMT) titration frameworks—into AI-supported systems that incorporate patient-specific metrics in real time. For example, individualized thresholds based on a patient’s weight trends, hemodynamic measurements, or other physiologic markers could trigger automated guidance. If a patient’s daily weight exceeds a personalized threshold, the system could prompt predefined actions, such as medication adjustments or clinician notification, ensuring earlier intervention while empowering patients to participate more actively in their own care.

The conversation also emphasized the expanding role of emerging technologies for patients with advanced heart failure who are not yet candidates for heart transplantation or left ventricular assist device (LVAD) therapy. For individuals in this transitional stage—where disease progression is evident but not yet severe enough for advanced mechanical support—technology-driven monitoring and intervention strategies may offer an opportunity to slow disease progression. By identifying subtle physiologic changes earlier and enabling proactive care adjustments, digital tools may help clinicians delay the need for advanced interventions, potentially improving both longevity and quality of life.

As the discussion concluded, the panelists reflected on the collaborative effort behind the statement and the importance of ongoing dialogue about how technology can be implemented thoughtfully in heart failure care. They expressed hope that the insights shared would encourage clinicians and healthcare leaders to consider how emerging tools—from AI-assisted analytics to remote monitoring platforms—might be integrated into their own institutions.

Ultimately, as heart failure care continues to evolve, thoughtful implementation of technology may help clinicians better manage complex data streams, deliver more personalized treatment, and support patients across the full continuum of disease—particularly those navigating the challenging transition toward advanced heart failure.

is an associate professor of medicine in the division of cardiology at Duke University School of Medicine, as well as the medical director of the Duke Heart Transplant program.

 is an assistant professor of medicine in the advanced heart failure and cardiac transplant section within the division of cardiology at the University of Colorado, as well as a senior clinical instructor in the University of Colorado College of Nursing and the director of the Children’s Hospital Colorado and UCHealth Heart Transplant Transition Program.

Editors’ Note: Peters and DeVore report no relevant disclosures.

Cajita M, Peters L, Rao VN, et al. Integrated Health Technologies in heart failure: A scientific statement from the Heart Failure Society of America and the American Association of Heart Failure Nurses. Journal of Cardiac Failure. Published online January 27, 2026. 

Heart Failure Society of America. Integrated Health Technologies in Heart Failure: A Scientific Statement from the Heart Failure Society of America and American Association of Heart Failure Nurses. January 27, 2026. Accessed March 5, 2026. 

https://hfsa.org/integrated-health-technologies-heart-failure-scientific-statement-heart-failure-society-america-and

In the final part of this 6-part HCPLive Special Report, experts discuss the recently released HFSA/AAHFN joint statement on tech integration in heart failure care.

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How AI Can Help Heart Failure Care

HFSA/AAHFN Tech in Heart Failure: What Needs to Change in the Face of New Tech

As heart failure management evolves, many clinicians are questioning whether traditional care models—anchored by fixed follow-up intervals and episodic clinic visits—are sufficient for the complexity of modern treatment strategies. In a recent panel discussion on the implementation of technology in heart failure care, experts explored how digital tools and emerging technologies may help health systems address the practical challenges of delivering guideline-directed medical therapy (GDMT) in a timely and patient-centered way.

One of the key themes raised by the panel was the limitation of conventional care schedules. Historically, patients with heart failure have often been managed through structured follow-up intervals—return visits every several weeks or months. However, as panelists noted, this model may not align with the realities of optimizing therapy in today’s guideline-driven landscape. Achieving target doses of GDMT frequently requires rapid titration and close monitoring, which can be difficult to accomplish within traditional clinic workflows.

The challenge becomes even more apparent during the vulnerable post-discharge period. Current recommendations often call for follow-up within a week after hospitalization for heart failure, yet evidence consistently shows that initiating and optimizing GDMT within the first 1–2 months can significantly reduce rehospitalizations and mortality. Translating these recommendations into practice can be logistically demanding for health systems, clinicians, and patients alike.

Technology may offer a pathway to bridge this gap. Remote monitoring platforms, digital communication tools, and virtual care models can allow clinicians to assess patient status and adjust therapies without requiring frequent in-person visits. By extending care beyond the walls of the clinic, these solutions may help preserve valuable appointment slots for new patients or those with complex needs who require direct evaluation.

Looking ahead, panelists emphasized that the next frontier in heart failure technology may involve the integration of artificial intelligence (AI). Although AI applications remain relatively limited in many health systems today, experts agree that adoption is accelerating. In the context of heart failure care, AI has the potential to assist clinicians in identifying early warning signals, predicting decompensation, and supporting medication titration strategies based on real-time patient data.

In part 5 of this 6-part HCPLive Special Report, experts discuss the recently released HFSA/AAHFN joint statement on tech integration in heart failure care.

What Needs to Change in the Face of New Tech in Heart Failure

HFSA/AAHFN Tech in Heart Failure: Interdisciplinary Integration in Heart Failure

During the discussion, panelists emphasized that while technology can extend care beyond the clinic, barriers such as limited broadband access and low digital health literacy remain important concerns. Addressing these challenges begins early in the development and adoption process—identifying the clinical problem a technology is meant to solve and ensuring the tool is designed with the needs of the target patient population in mind. For example, digital interventions can often be adapted to function with lower bandwidth requirements, allowing more patients to benefit from remote care strategies.

The conversation also highlighted the importance of integrating these technologies into a multidisciplinary model of heart failure care. Successful implementation goes far beyond simply embedding a tool within the electronic health record. Instead, it requires coordinated workflows involving nurses, pharmacists, social workers, and other members of the care team. Social workers, for instance, may help identify social determinants of health that limit a patient’s ability to engage with digital tools, while nurses can provide hands-on education to ensure patients feel comfortable using applications that track daily weights or blood pressure readings.

Panelists noted that heart failure care has long relied on structured care plans—such as sliding-scale diuretic strategies—to empower patients and reduce unnecessary clinical burden. Digital platforms may extend this concept further by enabling protocolized care pathways based on real-time patient data. With appropriate guidance, patients can take a more active role in managing their condition, while clinicians maintain oversight through scheduled follow-ups or pharmacist-led check-ins.

Ultimately, the panel agreed that leveraging technology in heart failure care will require creativity, collaboration, and a willingness to rethink traditional care delivery models. By engaging the full multidisciplinary team and designing tools that account for real-world barriers, clinicians may be able to deliver faster, more personalized care while ensuring that innovations remain accessible to the diverse populations they serve.

In part 4 of this 6-part HCPLive Special Report, experts discuss the recently released HFSA/AAHFN joint statement on tech integration in heart failure care.

Interdisciplinary Integration in Heart Failure

HFSA/AAHFN Tech in Heart Failure: Bridging Trials and Clinical Practice

In discussing the implementation of digital tools in heart failure care, panelists reflected on the pace at which technology evolves—and the challenges that rapid innovation creates for clinical research and implementation. While new monitoring tools, digital platforms, and remote care strategies continue to emerge, the traditional timelines of clinical trials often struggle to keep up. By the time a study is completed and published, the technology it evaluated may already be outdated or replaced by a newer iteration. This reality highlights the growing need for research frameworks that can evaluate digital health innovations in real time while maintaining scientific rigor.

Another key consideration raised during the discussion was the representativeness of clinical trial populations. Historically, many studies evaluating digital health tools have been conducted in relatively idealized healthcare environments, often involving patients who have strong access to specialty care and the resources needed to participate in research. However, clinicians frequently care for patients whose circumstances differ substantially from those trial populations. As digital monitoring and remote care platforms become more widely adopted in heart failure management, ensuring that study participants reflect the diversity of real-world patients—including those with varying socioeconomic backgrounds, digital literacy levels, and access to care—will be critical.

This issue is particularly important when considering geographic disparities in cardiovascular care. In many rural regions of the United States, access to cardiology specialists remains limited, with some estimates suggesting that a substantial proportion of counties lack a practicing cardiologist. In these settings, digital monitoring technologies and remote care models could offer meaningful opportunities to extend specialty expertise to patients who might otherwise face significant barriers to care. Yet these same communities are often underrepresented in clinical trials due to logistical challenges associated with study recruitment and follow-up.

The panel also noted that patient adherence remains a significant determinant of whether digital monitoring technologies ultimately deliver meaningful clinical benefits. Even the most sophisticated remote monitoring platforms rely on patients engaging consistently with devices, reporting symptoms, or transmitting data. As a result, identifying which patients are most likely to benefit from these technologies—and understanding the barriers that may limit their use—represents an important area of ongoing research.

Ultimately, the discussion underscored that digital health technologies should be viewed as an expanding component of the heart failure care toolkit rather than a solution suited only for a narrow subset of patients. Not every patient will choose to use these tools, and not every individual will experience measurable benefit. However, as clinicians become more comfortable integrating digital platforms into routine practice, offering these options may help broaden access, enhance flexibility in care delivery, and better align heart failure management with the realities of patients’ lives.

In part 3 of this 6-part HCPLive Special Report, experts discuss the recently released HFSA/AAHFN joint statement on tech integration in heart failure care.

Bridging Trials and Clinical Practice in Heart Failure

In part 2 of this 6-part HCPLive Special Report, experts discuss the recently released HFSA/AAHFN joint statement on tech integration in heart failure care.

Adapting to the Pace of Tech Implementation in Heart Failure

In part 1 of this 6-part HCPLive Special Report, experts discuss the recently released HFSA/AAHFN joint statement on tech integration in heart failure care.

Why Tech Integration Matters in Heart Failure

Sayantani Sindher, MD, is a clinical associate professor at the Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine.

COMBINE trial data show dupilumab added to omalizumab-assisted OIT improved desensitization and reduced GI symptoms, despite no sustained response benefit.


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Sayna Norouzi, MD, is an assistant professor of medicine and clinical nephrologist at Loma Linda University Medical Center

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This segment of the latest episode of The Medical Sisterhood podcast highlights the value of a supportive partner among those who are physician parents.

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Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

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Alex Hillenbrand is an assistant editor for 

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The nephrology field continued to see advances in February 2026, with 5 headlines clincians may have missed.

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Hyundam (Dami) Gu, MD, MPH, is a postdoctoral research fellow at the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University School of Medicine.

Gu explains how addiction drives GI and liver disease and why integrated care is key to improving outcomes and survival.

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Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Barzolvolimab therapy resulted in significant improvement of cold urticaria (ColdU) following 20 weeks of treatment.

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Understanding Intergenerational Risk Factors for MASLD, With Stefani Tica, MD, MPH

How AI Can Help Heart Failure Care

What Needs to Change in the Face of New Tech in Heart Failure

Interdisciplinary Integration in Heart Failure

Bridging Trials and Clinical Practice in Heart Failure