Resolution of metabolic dysfunction improves liver health among Chinese children: evidence from two prospective cohorts.

Background & aims: New metabolic dysfunction-associated steatotic liver disease (MASLD) definition emphasizes the crucial role of metabolic dysfunction in MASLD pathogenesis. This study aimed to examine whether the resolution of metabolic dysfunction can mitigate the risk of hepatic steatosis in Chinese children.

Methods: Data were obtained from two prospective cohort studies in China, including 2,158 children aged 6-11 years at baseline, with a four-year follow-up. Based on metabolic status (normal vs. abnormal) at baseline and follow-up, children were categorized into four distinct groups. Hepatic steatosis was assessed by abdominal ultrasonography and/or serum alanine aminotransferase measurements.

Results: At follow-up, 10.4% (n=225) of children developed hepatic steatosis. Baseline metabolic dysfunction significantly increased the risk of incident hepatic steatosis (odds ratio [OR]: 3.31, 95% confidence interval [CI]: 2.42-4.52). Compared with children who kept metabolically healthy at both baseline and follow-up, those with persistent metabolic dysfunction (OR: 6.01, 95%CI: 3.96-9.12) and those who developed metabolic dysfunction at follow-up (OR: 1.99, 95%CI: 1.19-3.33) had significantly increased risks of hepatic steatosis. Notably, children whose metabolic dysfunction resolved to normal status at follow-up presented no increased risk (OR: 0.64, 95%CI: 0.26-1.57).

Conclusions: Metabolic dysfunction is a strong predictor of incident hepatic steatosis in children, and resolution of this dysfunction attenuates the attendant risk. These findings highlight the importance of primary and secondary interventions targeting metabolic risk factors to improve liver health in children.