Metabolic Dysfunction-Associated Steatotic Liver Disease in an Urban Paediatric Cohort With High Socioeconomic Deprivation.

Background: Whether higher socioeconomic deprivation indices are associated with more severe paediatric metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease (NAFLD), remains unknown.

Objective: We aimed to evaluate differences in MASLD characteristics and social deprivation in a cohort of urban children.

Methods: Retrospective study of 277 paediatric patients ≤ 18 years old evaluated between January 2009 and December 2019 with a suspected diagnosis of MASLD who underwent liver biopsy. Patients were classified as having metabolic dysfunction-associated steatohepatitis (MASH) based on their NAFLD Activity Score (NAS). Fibrosis was determined based on biopsy presence. Social deprivation index (SDI) scores were calculated using patient address.

Results: Patients were predominantly Hispanic males with obesity and a median age of 12 years. Median SDI score was 85 (65-93). Median ALT was significantly higher in patients with MASH compared with MASLD (136 vs. 92 IU/L, p < 0.001) or with fibrosis compared with no fibrosis (120 vs. 68 IU/L, p < 0.001). High SDI group patients had a significantly higher median AST (60 vs. 47 IU/L, p = 0.022), NAS score (4 vs. 3, p = 0.026) and rates of bridging fibrosis (24% vs. 10%, p = 0.023) compared with the lower SDI group.

Conclusion: Within a cohort of predominantly Hispanic children with MASLD and high socioeconomic disadvantage, there are significant laboratory and histologic differences in patients with higher SDI scores, suggesting increased MASLD severity.