331 - Prevalence of MASLD among children and adolescents assessed by vibration-controlled transient elastography: Findings from two cross-national population-based studies

Publication Number: 331.6426

Le Zhang, Wuxi Children's Hospital, WUXI, Jiangsu, China (People's Republic); Xiaodie Yao, Institution, Wuxi, Jiangsu, China (People's Republic); Ming-Hua zheng, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (People's Republic)

Background: As childhood obesity continues to rise globally, the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among children and adolescents is also increasing. While the estimated global prevalence of MASLD in adults is 38%, its prevalence among children and adolescents remains unknown.

Objective: This study aimed to estimate the prevalence of MASLD among children and adolescents in both Chinese and US populations, using vibration-controlled transient elastography (VCTE) scores.

Design/Methods: In this cross-national study, 5,057 participants were recruited from Wuxi, China (2023-2024), and the NHANES (2017-2020). After excluding 315 participants due to inappropriate age and unreliable examinations, 4,742 children and adolescents aged 6–18 years were included in the final analysis. Steatosis was assessed using the median controlled attenuation parameter (CAP), while fibrosis was measured by median liver stiffness. MASLD was defined as liver steatosis (CAP ≥ 248 dB/m) combined with the presence of cardiometabolic risk factors. Overall and subgroup prevalence was calculated for the two cohorts. A logistic regression model was employed to evaluate the impact of exposures of interest on MASLD risk.

Results: Among the 4,742 children and adolescents, the mean age was 11.49 ± 3.29 years, and 2,612 (55.1%) were male. The prevalence of MASLD was 6.76% (5.91–7.69) in the Chinese population and 23.39% (21.32–25.57) in the US population. Notably, the prevalence of MASLD among adolescents aged 12–18 years [(11.25% (8.92–13.93)) was significantly higher than that observed in children aged 6–11 years [5.60% (4.73–6.57)] in Chinese population (P < 0.05). Moreover, compared to participants with normal weight, those who were obese had a significantly higher risk of MASLD in both the Chinese (34.77% vs. 0.75%) and US populations (66.19% vs. 1.68%). Participants who were male, Hispanic, older, overweight or obese, and had elevated glucose, ALT, and AST levels also had a significantly higher prevalence of MASLD. Multivariate logistic analysis demonstrated that older age, overweight or obesity, elevated glucose, and elevated ALT levels were all positively associated with MASLD risk.

Conclusion(s): The study indicates that the childhood obesity epidemic appears to increase the risk of MASLD, particularly in adolescents aged 12–18 years. Our findings are important to improve understanding of the prevalence of MAFLD in children and adolescents and to support disease management in high-risk subpopulations.