Evaluation for Fatty Liver Infiltration Should Become Standard in Pediatric Cholecystectomy Patients.

Introduction Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly becoming a health crisis. Despite clear benefits of recognition and treatment, optimal methods of detection have not been established. Children with known cholelithiasis may be at increased risk for fatty infiltration of their liver, presenting an opportunity for screening using ultrasound.  Methods A retrospective chart review was conducted on children undergoing cholecystectomy at an institution in rural Appalachia over three years. A pediatric radiologist re-evaluated ultrasounds for fatty liver infiltration. Data were analyzed with respect to BMI. Clinical indicators associated with MASLD on the presence of fatty liver infiltration.  Results Sixty-two patients met inclusion criteria; 10 had ultrasound evidence of fatty liver infiltration (16%) and they were more likely to have a higher median weight percentage (98.7 vs. 94.5, p=0.0080). Individuals who were obese or severely obese had a significantly higher blood alanine aminotransferase (ALT) than those who were not obese (43 vs 16, p=0.0432).  Conclusion Our study provides evidence that children with obesity are at greater risk for developing fatty infiltration of the liver and potentially MASLD. Evaluating a patient's ultrasound for liver pathology at the time of gallbladder evaluation is a simple intervention that should become standard.