Digital twins in pediatric metabolic dysfunction-associated steatotic liver disease: Developmentally referenced multimodal risk stratification

Table 1 Traditional pediatric metabolic dysfunction-associated steatotic liver disease monitoring compared with an author-proposed investigational digital-twin approach

Dimension	Traditional monitoring	Author-proposed investigational digital-twin approach
Data domains	Periodic anthropometrics, liver tests, and selected imaging	Minimum viable core of time-stamped developmental, clinical, biochemical, treatment, and clinically obtained imaging data; optional advanced imaging, body composition, genetics/omics, microbiome, and digital context modules
Developmental reference	Age or sex considered at individual visits	Age-, sex-, growth-, and puberty-referenced trajectories when appropriate
Update frequency	Clinic visits at fixed intervals; tests repeated when indicated	Prospective synchronization when validated new data arrive; cadence depends on data type and intended use
Primary output	Thresholds, population risk groups, and clinician synthesis	Candidate association-based trajectory or calibrated risk range with uncertainty and main drivers; not for care until prospectively validated
Therapeutic use	Retrospective assessment of response	Hypothesis-generating scenario comparison only; no individualized treatment-effect claim without a separately validated causal model
Requirements and risks	Established workflows but fragmented longitudinal context	Interoperable records, label-quality controls, explicit missing-not-at-random handling, external validation, explainability, governance, equity monitoring, and safeguards against false alerts, false reassurance, and alert fatigue

The digital-twin column describes an author-proposed research framework, not validated clinical guidance.