Assessment of hepatic steatosis in children with metabolic dysfunction-associated steatotic liver disease using ultrasound derived fat fraction: first large-scale clinical evaluation.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health concern among children and adolescents. This study aims to evaluate the diagnostic value of ultrasound derived fat fraction (uDFF) in quantifying liver fat in children with MASLD and to explore the correlation between uDFF values and various anthropometric and biochemical parameters. Methods: This cross-sectional study included 230 children diagnosed with steatotic liver via ultrasound and 38 healthy controls. Physical examinations, laboratory tests, and abdominal ultrasound examination were conducted. Results: The study included 168 boys and 62 girls in MASLD group, with an average age of 9.8 years. Significant differences were observed in waist circumference, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels between boys and girls. Among the 230 children with MASLD, 191 in the Grade 1 MASLD group came with a mean uDFF value of 11.52% and 39 in the Grade 2 MASLD group came with a mean uDFF value of 19.10%, and there was a significant difference in the uDFF values when comparing between the two groups (P<0.001). As the severity of steatotic liver increased, measurements of ultrasound-guided attenuation parameter (UGAP) and uDFF also rose. Lipid parameters and liver enzymes were significant associated with UGAP and uDFF in boys, but not in girls. The uDFF values of the children with MASLD were positively correlated with weight (P<0.001), waist (P<0.001), body mass index (BMI) (P=0.001), fasting blood glucose (P=0.008), ALT (P<0.001) and AST (P<0.001). Conclusions: Ultrasound-derived fat fraction technique has high diagnostic value in noninvasive quantitative assessment of hepatic steatosis in children with MASLD and reflects fat metabolism to some extent.