Endotoxin Markers Are Elevated in Adolescents With Obesity With and Without Metabolic Dysfunction-Associated Steatotic Liver Disease.

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in paediatric patients. Adult and murine studies have suggested a role for endotoxin from gram-negative bacteria in the development of MASLD, but there is incomplete and conflicting evidence for its role in adolescents.

PURPOSE: To determine if adolescents with biopsy-proven MASLD have elevated endotoxin activity and whether endotoxin markers are associated with liver histological features.

METHODS

Serum endotoxin core antibodies (EndoCab IgG), lipopolysaccharide binding protein (LBP), soluble CD14 (sCD14) and C-reactive protein (CRP) were measured in adolescents with obesity and MASLD (n = 46), and control groups without MASLD with obesity (Ob, n = 28) or normal weight (NW, n = 34).

RESULTS

Compared to the NW group, both the MASLD and Ob groups had higher EndoCab IgG (56%), LBP (33%) and CRP (11-fold), while sCD14 did not differ. LBP and CRP were positively correlated to trunk and total body fat (r = 0.45 and 0.64, respectively), and to one another (r = 0.42), all p < 0.001. None of the endotoxin markers varied between boys and girls, or with liver steatosis grade or fibrosis stage within the MASLD group.

CONCLUSION

Serum markers of endotoxin activity and inflammation are increased in adolescents with obesity but are not further increased in patients with mild to moderate MASLD.