Clinical Course and Predictors of Metabolic Dysfunction Associated Steatotic Liver Disease in Obese Children and Adolescents

OBJECTIVES: To evaluate the course and predictors of outcome of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: Records of 100 obese children with MASLD were reviewed for change in body mass index (BMI) and alanine aminotransferase (ALT) levels. RESULTS: A total of 100 (73 boys) children with mean (SD) age 12.1 (2.8) years followed for 2.0 (1.6) years were included. Normalization in ALT levels occurred in 72 (72%) at 1.1 (0.8) years of follow-up; 17 (23.6%) relapsed after 1.6 (1.3) years. Sustained remission (n = 55; 55%) was associated with greater BMI Z-score reduction (%) [median (q1, q3) 15.3 (5.1, 25.5) vs. 3.4 (- 4.3, 11.1); P < 0.001]. Multivariate regression identified BMI Z-score reduction as the only predictor of remission (OR 6.67, 95%CI 1.54-33.3; P = 0.007). ROC analysis showed BMI Z-score reduction of 13.8% predicted remission with an area under curve of 0.72 (95%CI: 0.62, 0.82; P < 0.001). CONCLUSION: Pediatric MASLD has a variable course, with remission dependent on the reduction in BMI Z-score.