Clinical manifestations, and oxidative stress imbalance in children with obesity and MASLD

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is often considered a multifactorial disease that has shown high incidence in recent years in both children and adults. To date, management criteria, diagnosis, and clinical characteristics are not fully defined in childhood.

Objective

Evaluate anthropometric characteristics, biochemical data, clinical manifestations, and Redox balance status in pediatric patients with obesity.

Materials and Patients

A cross-sectional study that included 300 pediatric patients (aged 8 to 17 years) from the obesity clinic of Iztapalapa Pediatric Hospital. Subjects were classified as with MASLD or without MASLD using hepatic ultrasonography. A thorough evaluation of anthropometric characteristics, clinical features, and blood levels of reduced glutathione (GSH) and oxidized glutathione (GSSG) was conducted. Data were reported as absolute and relative frequencies (%), while continuous variables were determined as mean ± SD and analyzed using Student's t-test and Mann-Whitney U test via SPSS V.22 software.

Results

A total of 95 patients met the inclusion criteria, with 78 cases having MASLD and 17 without MASLD: 27% were aged 8-9 years and 73% were adolescents (10-17 years). Being children receiving care for obesity, anthropometric data (weight, BMI (WHO, CDC), waist/height ratio, waist/hip ratio, and % body fat) showed no significant differences between groups. Greater respiratory difficulty (p=0.037) and polyuria (p=0.047) were observed in patients with MASLD vs. those without MASLD. Additionally, AST, urea, and creatinine levels were elevated in MASLD (p<0.05). Finally, GSH was reduced in MASLD vs. non-MASLD (p=0.001), thus altering the GSH/GSSG ratio.

Conclusions

Reduced glutathione indicates increased oxidation in children with MASLD, showing a clear association with liver damage even in the early stages of the disease. The incorporation of new tools in the diagnosis and management of obese children is a primary need to reduce the high prevalence and thus improve quality of life and life expectancy.