An international multicenter study of MASLD prevalence among children and adolescents assessed by VCTE

The worldwide prevalence of pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) remains uncertain. Using vibration-controlled transient elastography (VCTE), we estimate the prevalence of MASLD among children and adolescents in community and hospital populations and conduct additional analyses of hepatic steatosis and fibrosis severity grades. In this international multicenter study, we include 9352 children and adolescents aged 6–18 years from 38 centers across 17 countries on five continents. In the overall population, the median age is 12.0 years (IQR: 8.5–15.1), and 5471 (58.5%) are male. The prevalence of MASLD is 17.60% (95% CI: 16.63–18.61) in the community population and 58.03% (95% CI: 56.34–59.70) in the hospital population, with corresponding age-standardized prevalences of 20.97% and 52.34%, respectively. The prevalence of MASLD in the community population is highest in South America (47.92%), followed by North America (25.05%) and Asia (13.96%). MASLD prevalence among adolescents is significantly higher in 2021–2024 compared to 2017–2020, except among those with normal weight or below. Older age, obesity, and elevated serum aminotransferase levels are independently associated with hepatic steatosis and fibrosis, whereas steatosis (grades S2 and S3) is independently associated with greater hepatic fibrosis. Our findings provide useful contemporary data for estimating the epidemiology of pediatric MASLD across diverse populations. A multicenter study in 17 countries on pediatric MASLD, a liver disorder, finds a prevalence of 18% in community populations and 58% in hospital populations, differences between regions, associations with obesity and elevated liver enzyme levels.