The triadic relationship between obesity, obstructive sleep apnea and metabolic dysfunction-associated steatotic liver disease in children: a scoping review.

PURPOSE: The aim of this scoping review is to provide a comprehensive overview of existing research exploring the potentially triadic relation between obesity, OSA, and MASLD in children.

METHODS

A systematic literature search of PubMed and Web of Science was conducted in accordance with the PRISMA Extension for Scoping Review (PRISMA-ScR) guidelines. Following title and abstract screening, eligible studies were subjected to full-text assessment, resulting in the inclusion of 15 studies in the final review.

RESULTS

The initial search identified 263 studies, of which 15 met the inclusion criteria following title and abstract screening and full-text review. Data extraction enabled a comprehensive synthesis of current evidence on the pairwise associations and the potential triadic relationship between obesity, OSA, and MASLD in children. The findings suggest that oxidative stress and inflammation are key underlying mechanisms contributing to this triadic interplay.

CONCLUSION

Key causative factors identified for the triad between pediatric obesity, OSA, and MASLD encompass adipocyte dysfunction, hypoxia-induced IR, and inflammation. However, certain ambiguities remain. Future research should clarify the underlying mechanisms, including fat distribution and the gut-liver axis, and investigate the impact of intermittent hypoxia on adipose tissue to inform treatment strategies targeting all components of the triad.