How Common Is Suspected MASLD Among US Adolescents?

TOPLINE:

More than 11% of US adolescents had suspected metabolic dysfunction–associated steatotic liver disease (MASLD), and 77.2% with elevated alanine aminotransferase (ALT) levels met the criteria for suspected MASLD.

METHODOLOGY:

• Using data from a nationally representative survey (2011-2020), researchers conducted a cross-sectional study to assess the prevalence of suspected MASLD among the US adolescent population (aged 12-19 years) and the burden of MASLD by examining the association between elevated ALT levels and cardiometabolic risk factors.
• Elevated ALT levels were defined using sex-specific thresholds: > 26 U/L for men and > 22 U/L for women.
• Suspected MASLD was defined by the presence of elevated ALT levels and at least one cardiometabolic risk factor.
• Adolescents with elevated ALT levels were divided into three groups: Suspected MASLD, elevated ALT levels due to known causes, and cryptogenic ALT elevation (due to no identifiable causes or cardiometabolic risk factors).

TAKEAWAY:

• Researchers included 5012 adolescents (mean age, 15.4 years; 51.7% men).
• Among US adolescents, the overall prevalence of suspected MASLD and elevated ALT levels was 11.3% and 14.6%, respectively.
• Among adolescents with elevated ALT levels, 77.2% had suspected MASLD and 20.2% had cryptogenic ALT elevation.
• Body mass index ≥ 85th percentile was the strongest predictor of elevated ALT levels (odds ratio [OR], 3.55; P < .0001), followed by elevated triglyceride levels (OR, 2.09; P = .0001), low high-density lipoprotein cholesterol levels (OR, 2.05; P < .0001), and elevated blood pressure (OR, 1.93; P = .005).
• The odds of elevated ALT levels increased by 19% with every 1-year increase in age (P < .0001).
• Men had a 62% higher likelihood of having elevated ALT levels than women (P < .0001).

IN PRACTICE:

“Our finding that most of the cardiometabolic risk factors assessed were strongly associated with elevated ALT shows the importance of comprehensive metabolic screening in the adolescent population,” the authors wrote.

SOURCE:

This study was led by Sheila L. Noon, University of California, San Diego School of Medicine. It was published online in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

Dependence on ALT levels as a marker for hepatic steatosis without confirmatory imaging may have led to diagnostic misclassification. Lack of data on alcohol consumption by participants aged less than 18 years limited the ability to identify cases of alcohol-associated liver disease. The dataset also lacked a thorough assessment of other possible causes of elevated ALT levels. The cross-sectional study design prevented the evaluation of causality.

DISCLOSURES:

This study did not receive any specific funding. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.