Comparison of Body Mass Index and Fat Indices in Predicting the Severity of Nonalcoholic Fatty Liver Disease Among Children Who Are Overweight and Obese

Consensus Statement on Metabolic Dysfunction-Associated Steatotic Liver Disease in Children and Adolescents From the Joint TASL-TSPGHAN Expert Committee

Background and Objective

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver condition in children and adolescents, driven by the global rise in pediatric obesity. In this consensus statement by the Taiwan Association for the Study of the Liver (TASL) and the Taiwan Society of Pediatric Gastroenterology, Hepatology, and Nutrition (TSPGHAN), we highlight the unique clinical challenges in diagnosing and managing this condition in Asian children.

Methods

This consensus was developed by expert members of TASL and TSPGHAN through a comprehensive review of current literature and clinical practice. Key topics included prevalence, screening policies, diagnostic criteria, disease characteristics, and management strategies relevant to pediatric MASLD.

Results

We emphasize the rising prevalence of pediatric MASLD, which correlates strongly with obesity but often remains underdiagnosed due to the lack of screening policy for at-risk individuals and variations in diagnostic criteria. This review also discusses the distinct natural history and histopathological features of pediatric MASLD, underscoring the critical need for a greater understanding of its long-term outcomes. Currently, liver enzymes and ultrasonography are commonly used for screening and diagnosis, though these methods have limitations. The diagnostic imaging and novel non-invasive biomarkers specifically tailored for pediatric MASLD are in urgent need. Clinical management continues to rely on lifestyle interventions, with no pharmacological treatments currently approved for pediatric MASLD.

Conclusion

Effective management of pediatric MASLD requires a comprehensive approach to risk assessment, early detection, and intervention, tailored to the disease's unique pathophysiology in children.

Longitudinal Links between Changes in Body Composition and Liver Disease Severity in Children and Adolescents with Metabolic Dysfunction-Associated Steatotic Liver Disease

OBJECTIVE

To investigate the relationship between longitudinal changes in body composition and liver disease severity in children with metabolic dysfunction-associated steatotic liver disease (MASLD).

STUDY DESIGN

This longitudinal, single-center, retrospective analysis included patients aged <20 years followed for MASLD who had had ≥2 bioelectrical impedance analyses (BIAs) performed. MASLD regression was defined as alanine aminotransferase (ALT) normalization or a decrease of >50% from baseline. Fat and skeletal muscle mass were adjusted for size by calculating respective indices (dividing by height2). Logistic and linear regressions were used to determine the independent relationship between changes in body composition over time and serological markers of liver disease severity.

RESULTS

We included 258 patients (75% male, 50% Hispanic) with a median age of 14 years (IQR, 11-16 years) at the time of first BIA. Median body mass index (BMI) z-score at baseline was 2.33 (IQR, 2.04-2.62). Median time from first to last BIA was 12 months (IQR, 6-24 months). A decrease in fat mass index was independently associated with reductions in ALT and gamma glutamyl transferase and increased odds of MASLD regression (OR; 0.55; P < .001). Fat mass index reduction was superior to BMI z-score in predicting MASLD regression. Change in skeletal muscle mass index was not associated with change in ALT or gamma glutamyl transferase.

CONCLUSIONS

Changes in fat mass, not skeletal muscle mass, are associated with serological markers of liver injury in youth with MASLD. Fat mass changes outperform BMI z-score changes in predicting MASLD regression. BIA can serve as an adjunct biomarker of liver disease progression.

The value of combining the simple anthropometric obesity parameters, Body Mass Index (BMI) and a Body Shape Index (ABSI), to assess the risk of non-alcoholic fatty liver disease

Background

Body mass index (BMI) and A Body Shape Index (ABSI) are current independent risk factors for non-alcoholic fatty liver disease (NAFLD). The aim of this study was to explore the value of combining these two most common obesity indexes in identifying NAFLD.

Methods

The subjects in this study were 14,251 individuals from the NAfld in the Gifu Area, Longitudinal Analysis (NAGALA) cohort who underwent routine health examination. We integrated BMI with WC and with ABSI to construct 6 combined obesity indicators—obesity phenotypes, the combined anthropometric risk index (ARI) for BMI and ABSI, optimal proportional combination O_BMI+WC and O_BMI+ABSI, and multiplicative combination BMI*WC and BMI*ABSI. Several multivariable logistic regression models were established to evaluate the relationship between BMI, WC, ABSI, and the above six combined indicators and NAFLD; receiver operating characteristic (ROC) curves were drawn to compare the ability of each obesity indicator to identify NAFLD.

Results

A total of 2,507 (17.59%) subjects were diagnosed with NAFLD. BMI, WC, ABSI, and all other combined obesity indicators were significantly and positively associated with NAFLD in the current study, with BMI*WC having the strongest correlation with NAFLD in female subjects (OR per SD increase: 3.13) and BMI*ABSI having the strongest correlation in male subjects (OR per SD increase: 2.97). ROC analysis showed that ARI and O_BMI+ABSI had the best diagnostic performance in both sexes, followed by BMI*WC (area under the curve: female 0.8912; male 0.8270). After further age stratification, it was found that ARI and multiplicative indicators (BMI*WC, BMI*ABSI) and optimal proportional combination indicators (O_BMI+WC, O_BMI+ABSI) significantly improved the NAFLD risk identification ability of the basic anthropometric parameters in middle-aged females and young and middle-aged males.

Conclusion

In the general population, BMI combined with ABSI best identified obesity-related NAFLD risk and was significantly better than BMI or WC, or ABSI. We find that ARI and the multiplicative combined indicators BMI*WC and BMI*ABSI further improved risk prediction and may be proposed for possible use in clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-022-01717-8.