Prevalence of Metabolic Dysfunction-associated Steatotic Liver Disease and Cardiometabolic Risk Factor in US Adolescents

Context Metabolic dysfunction-associated steatotic liver disease (MASLD) is widespread worldwide, and a strong link between MASLD and cardiometabolic risk factors (CMRFs) was highlighted in this study.Objective This study characterized the prevalence of MASLD in adolescent population and overlapping CMRFs conditions in MASLD.Methods This is a cross-sectional study of US adolescents aged 12 to 19 years in the 2017 through 2020 cycles of the National Health and Nutrition Examination Survey. The relationship between CMRFs and liver steatosis, evaluated by the median controlled attenuation parameter (CAP), was assessed.Results The prevalence of MASLD in adolescents was 23.77%. Isolated overweight/obesity (35%) was the top CMRF. Non-Hispanic Black patients had the highest proportion of overweight/obesity plus elevated glucose (24%), whereas non-Hispanic Asians had the highest burden of dyslipidemia (2%, 14%, and 19%). Except for hypertension, overweight/obesity (beta = 48.7; 95% CI, 43.4-54.0), hypertriglyceridemia (beta = 15.5; 95% CI, 7.2-28.3), low HDL-C (beta = 10.0; 95% CI, 3.1-16.9), elevated glucose (beta = 6.9; 95% CI, 0.6-13.2) were all significantly associated with increased CAP values. Increased CAP was linked to the synergistic interactions between overweight/obesity and dyslipidemia or elevated glucose (overweight/obesity and elevated glucose: relative excess risk due to interaction [RERI] = 8.21, attributable proportion due to interaction [AP] = 0.45, synergy index [SI] = 1.91; overweight/obesity and hypertriglyceridemia: RERI = 19.00, AP = 0.69, SI = 3.53; overweight/obesity and low high-density lipoprotein cholesterol: RERI = 10.83, AP = 0.58, SI = 2.61). Adolescents with combination of overweight/obesity, dyslipidemia (beta = 15.1; 95% CI, 0.1-30.2) and combination of overweight/obesity, dyslipidemia and elevated glucose (beta = 48.0; 95% CI, 23.3-72.6) had a significantly higher CAP values.Conclusion The prevalence of MASLD was alarmingly high in adolescents, and overweight/obesity was the most important CMRF. Overweight/obesity and dyslipidemia or elevated glucose had positive additive interaction effects on liver steatosis.