Starting Age for Screening Metabolic Dysfunction-Associated Steatotic Liver Disease in Children Using Controlled Attenuation Parameter on Transient Elastography

Abstract

Background: Rising sedentary behaviour and consumption of sugar-sweetened beverages and ultra-processed foods have increased the risk and earlier onset of obesity in children.

Objectives: To define controlled attenuation parameter (CAP) cut-off values in healthy children, assess the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in children with overweight and obesity, and establish an appropriate starting age for MASLD screening in our population.

Methods: Healthy primary school children were recruited. Hepatic steatosis was assessed using CAP, and body composition data were collected during two periods: August 2020-March 2021 and February 2023-May 2024.

Results: Of 1653 participants (mean age 9.5 ± 1.7 years), 976 children with normal weight were used to establish reference intervals. Hepatic steatosis was defined as a CAP above 247 dB/m (97.5th percentile). The prevalences of MASLD in children with overweight and obesity were 0% and 16%, respectively, in school grade 1, which increased to 19% and 75% in school grade 6 (p < 0.001).

Conclusions: Screening for hepatic steatosis associated with obesity should begin as early as school grade 1, while screening for children with overweight may be more appropriate by school grade 6. These findings emphasise the need for age- and weight-specific screening strategies for children with overweight and obesity.

Keywords: fatty liver disease; paediatric obesity; vibration controlled transient elastography.