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In TC, there is a universal PKM2 upregulation [68], involving circNRIP1 activated by alkB homolog 5 (ALKBH5) decrease [69], AMP-activated protein kinase (AMPK) [70], downregulated micro RNAs (miRNAs) such as miR-148a and miR-326 [71], BRAF mutation [72], as well as overexpression of phosphoribosyl pyrophosphate amidotransferase (PPAT) [73] and SIRT6 [48]

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In conclusion, GLP-1RA is a promising candidate drug therapy for pediatric MASLD, and patients may benefit from metabolic improvement even if the liver disease ameliorating effects are not yet clear