Hepatic Steatosis and Cardiovascular Risk in Obesity: A 10‐Year Follow‐Up Study From Childhood Into Young Adulthood

Background The early vascular impact of metabolic dysfunction‐associated steatotic liver disease (MASLD) remains unclear. This study examined associations of steatosis in childhood and young adulthood with cardiovascular risk in adulthood. Methods Children with severe obesity were investigated for MASLD and cardiovascular risk, with 10‐year follow‐up. Hepatic steatosis was measured using proton magnetic resonance spectroscopy and cardiovascular risk by ultrasound carotid intima‐media thickness (cIMT). Participants were categorised into four trajectory groups based on presence of steatosis in childhood and/or adulthood: ‘absent’, ‘diminishing’, ‘adult‐onset’ and ‘persistent’. Associations between steatosis (presence and change over time) and cIMT, and between childhood metabolic factors and cIMT progression, were evaluated. Results Of 52 participants, 46% had steatosis in childhood (‘diminishing’ or ‘persistent’), and 46% in adulthood (‘adult‐onset’ or ‘persistent’). Childhood steatosis was not associated with cIMT in adulthood, whereas adulthood steatosis was independently associated with increased cIMT (mean difference 0.035 mm, 95% CI: 0.010–0.060 mm; p ‐adjusted = 0.008). Mean cIMT at follow‐up increased progressively across steatosis trajectory groups; (adjusted p ‐for‐trend = 0.003). Childhood steatosis was the only metabolic factor associated with cIMT progression ( β = 0.006, p = 0.030). Conclusions Hepatic steatosis in young adulthood is independently associated with increased cardiovascular risk, and childhood steatosis relates to cIMT progression, supporting early MASLD detection and prevention.