Assessment of dietary, genetic and metabolic factors in South Indian adolescents with metabolic dysfunction-associated steatotic liver disease: a case-control study protocol.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of liver disease among adolescents. The objectives of this study are to investigate the associations of dietary, genetic and metabolic factors with MASLD in South Indian adolescents.

Methods and analysis: The study will employ a case-control study design. We will recruit 280 adolescents (140 cases and 140 controls) from hospital and school settings. The hospital setting will be the paediatric gastroenterology outpatient department (OPD) at the study institution and the school setting will be selected urban schools from Ernakulam, Kerala. At the hospital, cases and controls will be selected from the patients who are attending the paediatric gastroenterology OPD with complaints of generalised abdominal pain or constipation with no other significant medical complaints or use of medications. A sensitisation programme on MASLD for parents of adolescents will be conducted in schools. All consenting parents along with their adolescent wards will be invited for study participation. Cases will be defined as adolescents having evidence of hepatic steatosis in ultrasound and meeting any one of the paediatric cardiometabolic criteria for MASLD. Those who fail to satisfy this criteria will be defined as controls. All participants will undergo nutritional and physical activity assessments using validated questionnaires along with blood sampling for biochemical analysis and genetic testing. We will examine the associations between MASLD and dietary parameters using Pearson's χ² tests after stratifying dietary variables into categorical groups. Logistic regression will be used to assess the impact of dietary parameters and single-nucleotide polymorphisms (SNPs) on the risk of MASLD.

Ethics and dissemination: Ethics approval was obtained from the Ethics Committee of Amrita School of Medicine, Kochi. Informed consent will be obtained from participants and their legal guardians before enrolment. The study findings will provide valuable insights into the evolution of MASLD among adolescents in South India.