Ability of triglyceride‐glucose indices to predict metabolic dysfunction associated with steatotic liver disease in pediatric obesity

Objectives We aimed to evaluate the best cut‐off of alanine aminotransferase (ALT) to predict the metabolic dysfunction‐associated steatotic liver disease (MASLD) in youths with overweight/obesity (OW/OB) and analyze the performance of the triglyceride‐glucose index (TyG) or its association with anthropometric variables compared to ALT. Methods This multicenter, cross‐sectional study analyzed data of 2813 youths (1463 boys and 1350 girls) aged 6–17 years recruited in 10 Italian centers for the management of pediatric OB. Exclusion criteria were: body mass index (BMI) Z ‐score >5, diabetes, secondary obesity, triglycerides (TG) ≥ 400 mg/dL. MASLD was defined on the presence of hepatic steatosis at abdominal ultrasound, in combination with at least one cardiometabolic risk factor. The performance of ALT and TyG‐derived indices for MASLD diagnosis was assessed using the receiver operation curve and the area under the curve (AUC) with the 95% confidence intervals were obtained. Results MASLD was observed in 1278 youths (45.1%). The global AUC of ALT was 0.661 (0.641–0.682), p < 0.0001. Using Youden's index the best cut‐off of ALT was ≥26 IU/L in boys and ≥22 IU/L in girls. The AUCs of TyG‐BMI, TyG‐WC, and TyG‐ALT were 0.678 (0.659–0.698), 0.659 (0.639–0.679), and 0.666 (0.645–0.686), respectively. Using Delong's test none TyG‐derived index showed a better performance than ALT alone. Conclusions This study demonstrates that the values of ALT ≥ 26 IU/L in boys and ≥22 IU/L in girls can be used for the screening of MASLD in youths with OW/OB, while the combination of TyG‐derived indices is not superior to ALT alone.