Non-Invasive Assessment of Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents with Severe Obesity; Patient Characteristics and Association with Leptin-A Cross-Sectional Overview of Baseline Data from a RCT

doi:10.3390/children11080965

. 2024 Aug 11;11(8):965.

doi: 10.3390/children11080965.

Non-Invasive Assessment of Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents with Severe Obesity; Patient Characteristics and Association with Leptin-A Cross-Sectional Overview of Baseline Data from a RCT

Fien de Boom^{1

2}, Ali Talib^{1

2}, Yvonne G M Roebroek^{1

2}, Givan F Paulus^{1

2}, Ger H Koek³, Simon G F Robben⁴, Bjorn Winkens⁵, Nicole D Bouvy^{1

2}, L W Ernest van Heurn⁶

Affiliations

¹ Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
² NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, 6211 LK Maastricht, The Netherlands.
³ Department of Gastroenterology and Hepatology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
⁴ Department of Radiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
⁵ Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands.
⁶ Department of Pediatric Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands.

PMID: 39201901
PMCID: PMC11352657
DOI: 10.3390/children11080965

Non-Invasive Assessment of Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents with Severe Obesity; Patient Characteristics and Association with Leptin-A Cross-Sectional Overview of Baseline Data from a RCT

Fien de Boom et al. Children (Basel). 2024.

. 2024 Aug 11;11(8):965.

doi: 10.3390/children11080965.

Authors

Fien de Boom^{1

2}, Ali Talib^{1

2}, Yvonne G M Roebroek^{1

2}, Givan F Paulus^{1

2}, Ger H Koek³, Simon G F Robben⁴, Bjorn Winkens⁵, Nicole D Bouvy^{1

2}, L W Ernest van Heurn⁶

Affiliations

¹ Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
² NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, 6211 LK Maastricht, The Netherlands.
³ Department of Gastroenterology and Hepatology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
⁴ Department of Radiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
⁵ Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands.
⁶ Department of Pediatric Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands.

PMID: 39201901
PMCID: PMC11352657
DOI: 10.3390/children11080965

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease in adolescents with obesity. Nonetheless, the guidelines for screening and managing this disease are contradictory. The purpose of this study is to non-invasively assess the prevalence, patient characteristics, and potential associated factors of MASLD in this demographic. Methods: This study used baseline data from an RCT in adolescents eligible for bariatric surgery. MASLD was determined by measuring the hepatorenal index (HRI) with ultrasonography, blood liver tests, and the fatty liver index (FLI). Results: A total of 56 adolescents enrolled in the analyses; the majority were female n = 44 (79%); the mean age was 15.75 (±1.01) years; the average body mass index (BMI) was 44.08 (±5.16) kg/m². In 35 (62.5%) of the patients, the HRI was abnormal. This group had a higher waist/hip ratio, elevated liver biochemistry, and significantly lower leptin levels (mean difference = -46.35, 95% CI -76.72, -15.99) compared to the group with a normal HRI. In 32 (55.2%) of the patients, ALT levels were elevated and the FLI was abnormal in all (100%) participants. Linear regression analysis indicated associations between the HRI and typical anthropometric and metabolic measurements; and an inverse association between HRI and leptin B = -0.003 (95% CI -0.005, -0.00), independently of sex- and age-adjusted BMI. Conclusions: MASLD is highly prevalent in adolescents with severe obesity. However, the prevalence strongly depends on which tool is used, namely the HRI (62.5%), alanine transaminase levels (55.2%), and FLI (100%). Our findings suggest that leptin may be a valuable biomarker in supporting the diagnosis of MASLD.

Keywords: MASLD; adolescents; associated factors; leptin; obesity; prevalence; severely obese.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 1**
Estimated prevalence of MASLD in this study population, measured through HRI, ALT levels, and FLI. HRI—hepatorenal index; ALT—alanine transaminase; FLI—fatty liver index. Cut-off values for HRI were ≥ 1.28; cut-off values for ALT levels were 25 U/L for boys and 22 U/L for girls; cut-off values for FLI were ≥ 60.

See this image and copyright information in PMC

References

1. Aekplakorn W. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–2642. - PMC - PubMed
1. Lister N.B., Baur L.A., Felix J.F., Hill A.J., Marcus C., Reinehr T., Summerbell C., Wabitsch M. Child and adolescent obesity. Nat. Rev. Dis. Primers. 2023;9:24. doi: 10.1038/s41572-023-00435-4. - DOI - PubMed
1. Rinella M.E., Lazarus J.V., Ratziu V., Francque S.M., Sanyal A.J., Kanwal F., Romero D., Abdelmalek M.F., Anstee Q.M., Arab J.P., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J. Hepatol. 2023;79:1542–1556. doi: 10.1016/j.jhep.2023.06.003. - DOI - PubMed
1. Chan W.K., Chuah K.H., Rajaram R.B., Lim L.L., Ratnasingam J., Vethakkan S.R. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. J. Obes. Metab. Syndr. 2023;32:197–213. doi: 10.7570/jomes23052. - DOI - PMC - PubMed
1. Holterman A.X., Guzman G., Fantuzzi G., Wang H., Aigner K., Browne A., Holterman M. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity. 2013;21:591–597. doi: 10.1002/oby.20174. - DOI - PubMed

Grants and funding

This research received no external funding.

LinkOut - more resources

Full Text Sources
- MDPI
- PubMed Central

[1] Aekplakorn W. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–2642. - PMC - PubMed

[2] Aekplakorn W. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–2642. - PMC - PubMed

[3] Lister N.B., Baur L.A., Felix J.F., Hill A.J., Marcus C., Reinehr T., Summerbell C., Wabitsch M. Child and adolescent obesity. Nat. Rev. Dis. Primers. 2023;9:24. doi: 10.1038/s41572-023-00435-4. - DOI - PubMed

[4] Lister N.B., Baur L.A., Felix J.F., Hill A.J., Marcus C., Reinehr T., Summerbell C., Wabitsch M. Child and adolescent obesity. Nat. Rev. Dis. Primers. 2023;9:24. doi: 10.1038/s41572-023-00435-4. - DOI - PubMed

[5] Rinella M.E., Lazarus J.V., Ratziu V., Francque S.M., Sanyal A.J., Kanwal F., Romero D., Abdelmalek M.F., Anstee Q.M., Arab J.P., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J. Hepatol. 2023;79:1542–1556. doi: 10.1016/j.jhep.2023.06.003. - DOI - PubMed

[6] Rinella M.E., Lazarus J.V., Ratziu V., Francque S.M., Sanyal A.J., Kanwal F., Romero D., Abdelmalek M.F., Anstee Q.M., Arab J.P., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J. Hepatol. 2023;79:1542–1556. doi: 10.1016/j.jhep.2023.06.003. - DOI - PubMed

[7] Chan W.K., Chuah K.H., Rajaram R.B., Lim L.L., Ratnasingam J., Vethakkan S.R. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. J. Obes. Metab. Syndr. 2023;32:197–213. doi: 10.7570/jomes23052. - DOI - PMC - PubMed

[8] Chan W.K., Chuah K.H., Rajaram R.B., Lim L.L., Ratnasingam J., Vethakkan S.R. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. J. Obes. Metab. Syndr. 2023;32:197–213. doi: 10.7570/jomes23052. - DOI - PMC - PubMed

[9] Holterman A.X., Guzman G., Fantuzzi G., Wang H., Aigner K., Browne A., Holterman M. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity. 2013;21:591–597. doi: 10.1002/oby.20174. - DOI - PubMed

[10] Holterman A.X., Guzman G., Fantuzzi G., Wang H., Aigner K., Browne A., Holterman M. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity. 2013;21:591–597. doi: 10.1002/oby.20174. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Non-Invasive Assessment of Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents with Severe Obesity; Patient Characteristics and Association with Leptin-A Cross-Sectional Overview of Baseline Data from a RCT

Affiliations

Non-Invasive Assessment of Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents with Severe Obesity; Patient Characteristics and Association with Leptin-A Cross-Sectional Overview of Baseline Data from a RCT

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

References

Grants and funding

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Figures

Similar articles

References

Related information

Grants and funding

LinkOut - more resources

Full Text Sources