Adolescents with Childhood MASLD Show Greater Cardiovascular Structure: A Cohort Study

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been linked to an elevated risk of cardiovascular diseases and mortality in adults. The impact of MASLD on pediatric cardiovascular development remains insufficiently characterized. Methods: This prospective pediatric cohort study enrolled 1,914 primary school children from Beijing, China, with a 4.5-year follow-up beginning in October 2018. Baseline MASLD was assessed via ultrasonic screening followed by anthropometric measurement and blood assays. Carotid intima-media thickness (cIMT) was measured by vascular ultrasonography, and left ventricular mass (LVM) and LVM index (LVMI) were determined by echocardiography at baseline and follow-up. We identified differences in cIMT, LVM and LVMI between adolescents with or without baseline MASLD. Results: Among 1,356 adolescents included in the analysis, we identified 94 with MASLD at baseline. Over a follow-up period of 4.5 years, adolescents with baseline MASLD (BW-MASLD) presented with significantly higher cardiometabolic indicators and alanine transaminase levels at both baseline and follow-up. At follow-up, the BW-MASLD group presented significantly greater cIMT, LVM, and LVMI (0.55 mm, 85.4 g, and 24.8 g/m 2.7 , respectively) relative to adolescents without baseline MASLD (0.51 mm, 66.4 g, and 21.6 g/m 2.7 , respectively; BN-MASLD). Consistent findings were observed in the stratified analysis by sex and overweight status. Conclusion: Adolescents with childhood MASLD show greater cardiovascular structure, with consistently elevated cardiometabolic disorders. This underscores the crucial importance of managing MASLD early on to mitigate the risks of cardiovascular structural remodeling.