Clinical spectrum of paediatric MASLD: fibrosis burden, steatosis severity and extrahepatic comorbidities in a UK cohort
Jessica A Eldredge, Caitlin Murphy, Giuliana Alcivar, Valeria Gulli, Nafisha Sultanamili, Zuzanna Dulnikiewicz, Emer Fitzpatrick, Sanjay Bansal, Eirini KyranaObjective
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised in children, yet predictors of fibrosis severity and extrahepatic disease burden remain poorly characterised. We aimed to describe elastography findings and associated comorbidities in a tertiary paediatric MASLD cohort.
Methods
We retrospectively reviewed children with imaging-confirmed MASLD assessed at a tertiary paediatric hepatology centre in the UK between January 2024 and August 2025. Demographic, anthropometric, biochemical and vibration-controlled transient elastography (VCTE) data were collected. Associations were assessed using the Kruskal-Wallis test, Mann-Whitney U test and Spearman’s correlation analysis.
Results
A total of 288 children were included (71.2% male), with median age 14 years and median body mass index (BMI) z-score 2.73. Increased steatosis risk (controlled attenuation parameter (CAP) ≥280 dB/m) was present in 63.7% while 78.3% met thresholds for significant fibrosis risk (liver stiffness measurement (LSM) ≥5.5 kPa) including 16.3% with LSM ≥10 kPa. LSM correlated with BMI z-score, CAP, alanine aminotransferase (ALT) and splenic stiffness measurement. ALT, aspartate aminotransferase and gamma-glutamyl transferase were significantly higher in children with LSM ≥5.5 kPa, but statistically plateaued thereafter and did not independently predict LSM on multivariable analysis. Extrahepatic comorbidities were frequent, including menstrual irregularities in 60% of adolescent girls.
Conclusion
Children with MASLD referred to tertiary care demonstrate a high burden of severe steatosis, fibrosis risk and extrahepatic comorbidities. Routine biochemical markers may inadequately discriminate fibrosis risk estimated by LSM. Further studies are required to validate VCTE thresholds to improve paediatric MASLD risk stratification and augment real-world longitudinal care.