Clinical utility of a novel index for predicting metabolic dysfunction-associated steatotic liver disease risk in children.

UNLABELLED: Visceral adiposity is a key driver of metabolic dysfunction. Although indices such as the Visceral Adiposity Index (VAI) are widely used in adults, no standardized, practical tool exists for assessing visceral fat accumulation in children and adolescents. We aimed to develop a simple, clinically applicable model for the early identification of metabolic dysfunction-associated steatotic liver disease (MASLD) in pediatric obesity. We retrospectively analyzed 219 children and adolescents with obesity. Clinical, anthropometric, laboratory, and imaging data were collected. Hepatosteatosis and its severity were assessed by ultrasonography. Multivariable logistic regression models were constructed to identify independent predictors and to develop a parsimonious prediction model. The mean age was 13.34 ± 3.17 years, and 63% were female. Anthropometric measures (body weight, BMI, waist circumference, and waist-to-height ratio) increased across steatosis grades. Metabolic markers, including insulin, AST, ALT, and HOMA-IR, showed a progressive increase with disease severity. A parsimonious model (Model 1), incorporating only age, sex, BMI SDS, and waist circumference SDS, demonstrated robust discriminative performance and outperformed HOMA-IR and adult-derived indices (VAI and TyG), which showed limited predictive utility in this population.

CONCLUSION

We present a novel, anthropometry-based model that accurately identifies MASLD in children with obesity using readily available clinical parameters. This pragmatic approach enables early risk stratification and may facilitate implementation in routine pediatric practice.

WHAT IS KNOWN: • Visceral adiposity is closely associated with metabolic dysfunction and increased cardiometabolic risk in children with obesity. • Anthropometric and biochemical markers have been proposed as noninvasive tools for predicting metabolic associated steatotic liver disease (MASLD) in pediatric populations.

WHAT IS NEW: • Visceral adiposity-related indices were significantly associated with the presence and severity of MASLD in children and adolescents with obesity. • The study highlights the potential utility of simple anthropometric and metabolic markers in the early identification of pediatric patients at higher risk for MASLD.