Liver Disease Common in Kids and Teens With Severe Obesity

Medscape

a day ago

Metabolic-associated fatty liver disease (MAFLD) was more prevalent in children and adolescents with severe obesity, with these patients showing more pronounced insulin resistance and a higher number of metabolic syndrome (MetS) components.
METHODOLOGY:
Researchers evaluated the prevalence of MAFLD in 212 children and adolescents with severe obesity (mean age, 13.2 years; 53.8% girls) recruited from four medical centres in Poland from May 2022 to September 2023.
Severe obesity was defined as having a body mass index (BMI) > 30 for individuals aged 3-6 years, > 35 for individuals aged 6-14 years, and > 40 for individuals older than 14 years.
All patients underwent abdominal ultrasonography, physical examination, body composition analysis, and biochemical assessment.
MAFLD was diagnosed on the basis of liver steatosis detected by ultrasonography and/or persistently elevated alanine aminotransferase concentrations (> 52 U/L for boys and > 44 U/L for girls). MetS was confirmed using the International Diabetes Federation (IDF) criteria for children aged 10 years or older and modified IDF criteria for those younger than 10 years.
The association of hepatosteatosis with anthropometric profiles and metabolic risk factors was also assessed.
TAKEAWAY:
MAFLD was present in 59.0% of patients, with sonographic assessment of hepatosteatosis in 55.4% of patients and elevated alanine aminotransferase concentrations without liver steatosis in 3.3% of patients.
MetS was diagnosed in 66.5% of patients with MAFLD vs 57.5% of patients without MAFLD, with a significantly higher proportion of patients with MAFLD having four or more MetS components (33.6% vs 12.6%; P = .0004).
= .0004). Patients with MAFLD had higher glucose and insulin levels both at fasting and 120 minutes during the oral glucose tolerance test. Increased insulin resistance was noted more frequently in patients with MAFLD than in those without MAFLD (16.5% vs 6.5%; P = .04).
= .04). A ratio of alanine aminotransferase to aspartate aminotransferase > 1.5 (adjusted odds ratio [aOR], 19.79; P = .018) and a fasting glucose level > 100 mg/dL (aOR, 44.53; P = .009) were independently associated with MAFLD.
IN PRACTICE:
"MAFLD is a predictor of developing MetS and an increased risk of its components, especially glucose metabolism disorders. Therefore, patients diagnosed with MAFLD should be under special medical supervision for the detection and prevention of metabolic complications," the authors wrote.
SOURCE:
This study was led by Magdalena Mierzwa, Medical University of Silesia, Zabrze, Poland. It was published online on May 20, 2025, in the Journal of Clinical Medicine .
LIMITATIONS:
Ultrasound-based steatosis assessments varied by centre, potentially leading to discrepancies due to subjective assessment. This cross-sectional study involved only children and adolescents with severe obesity, thereby limiting generalizability.
DISCLOSURES:
This study was supported by the National Science Center, Poland. One author reported being employed by Mediagnost GmbH.