European journal of pediatrics · 2026
Hepatic steatosis in pediatric obesity: association with cardiometabolic profile and considerations regarding alanine aminotransferase screening.
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Recio Linares Aranzazu, Botija Gonzalo, Bezanilla López Carolina, Barasoain Millán Alberto, Del Olmo Segura Patricia, Férreo Santos Paula, Cano Dorao Fidel Cano, Gonzalez-Hoyuela Maritza, Carrero Álvaro Juan Carrero, Garcia Hernando Thais, Pérez Fernández Elia Pérez
Аннотация
PURPOSE: Hepatic steatosis is the most common chronic liver disease in children with obesity and is associated with an adverse cardiometabolic profile. This study aimed to estimate the prevalence of cardiometabolic risk factors and ultrasound-guided attenuation parameter (UGAP)-diagnosed hepatic steatosis in children with obesity, evaluate variables associated with steatosis, and explore the diagnostic performance of alanine aminotransferase (ALT).
METHODS: This single-center, cross-sectional study included 91 children aged ≥ 9 years with obesity recruited from pediatric endocrinology and gastroenterology outpatient clinics between July 2023 and July 2025. Anthropometric, blood pressure, biochemical, and UGAP measurements were collected. Hepatic steatosis was defined as UGAP ≥ 0.680 dB/cm/MHz. Elevated ALT was defined as ≥ 44 U/L in females and ≥ 52 U/L in males. Associations with hepatic steatosis were assessed using Poisson regression.
RESULTS: The prevalence of UGAP-diagnosed hepatic steatosis was 28.6%. Higher BMI z-score, larger waist circumference, elevated ALT, arterial hypertension, dyslipidemia, insulin resistance, and metabolic syndrome were significantly associated with hepatic steatosis. Elevated ALT showed low sensitivity (19.2%) and high specificity (93.8%) for detecting hepatic steatosis. ALT discriminatory performance differed by sex, with an AUC of 0.816 in females and 0.582 in males. Exploratory ALT cutoffs showed limited clinical applicability, particularly in males because of very low specificity.
CONCLUSION: Children with obesity and UGAP-diagnosed hepatic steatosis showed a more unfavorable cardiometabolic profile. ALT alone may miss a substantial proportion of children with hepatic steatosis, supporting the need for improved screening strategies.
WHAT IS KNOWN: • Pediatric hepatic steatosis is associated with an adverse cardiometabolic profile in children with obesity. • Screening strategies based on ALT and imaging techniques show variable diagnostic performance in pediatric populations.
WHAT IS NEW: • UGAP-diagnosed hepatic steatosis in children with obesity was associated with an unfavorable cardiometabolic profile in a Spanish secondary-care cohort. • ALT showed sex-specific differences and limited usefulness as a standalone screening tool for hepatic steatosis, particularly in males, when UGAP was used as the reference method.
METHODS: This single-center, cross-sectional study included 91 children aged ≥ 9 years with obesity recruited from pediatric endocrinology and gastroenterology outpatient clinics between July 2023 and July 2025. Anthropometric, blood pressure, biochemical, and UGAP measurements were collected. Hepatic steatosis was defined as UGAP ≥ 0.680 dB/cm/MHz. Elevated ALT was defined as ≥ 44 U/L in females and ≥ 52 U/L in males. Associations with hepatic steatosis were assessed using Poisson regression.
RESULTS: The prevalence of UGAP-diagnosed hepatic steatosis was 28.6%. Higher BMI z-score, larger waist circumference, elevated ALT, arterial hypertension, dyslipidemia, insulin resistance, and metabolic syndrome were significantly associated with hepatic steatosis. Elevated ALT showed low sensitivity (19.2%) and high specificity (93.8%) for detecting hepatic steatosis. ALT discriminatory performance differed by sex, with an AUC of 0.816 in females and 0.582 in males. Exploratory ALT cutoffs showed limited clinical applicability, particularly in males because of very low specificity.
CONCLUSION: Children with obesity and UGAP-diagnosed hepatic steatosis showed a more unfavorable cardiometabolic profile. ALT alone may miss a substantial proportion of children with hepatic steatosis, supporting the need for improved screening strategies.
WHAT IS KNOWN: • Pediatric hepatic steatosis is associated with an adverse cardiometabolic profile in children with obesity. • Screening strategies based on ALT and imaging techniques show variable diagnostic performance in pediatric populations.
WHAT IS NEW: • UGAP-diagnosed hepatic steatosis in children with obesity was associated with an unfavorable cardiometabolic profile in a Spanish secondary-care cohort. • ALT showed sex-specific differences and limited usefulness as a standalone screening tool for hepatic steatosis, particularly in males, when UGAP was used as the reference method.