Frequency of MASLD and Cardiometabolic Risk Factors in US Adolescents
Overview
This study found that metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 23.8% of US adolescents aged 12 to 19 years. Overweight/obesity was the most prevalent cardiometabolic risk factor (CMRF), and its combination with dyslipidemia or elevated glucose showed synergistic effects on liver steatosis severity.
Background
MASLD, formerly known as nonalcoholic fatty liver disease, is the leading cause of chronic liver disease in adolescents globally and is strongly linked to cardiometabolic risk factors. The condition is associated with increased risks of cirrhosis, metabolic syndrome, and cardiovascular disorders later in life. The new MASLD nomenclature emphasizes the metabolic dysfunction underlying liver steatosis and its epidemiological ties to CMRFs. While adult data on MASLD and overlapping CMRFs are well established, less is known about these associations in adolescents.
Data Highlights
Parameter
Value
MASLD Prevalence in Adolescents
23.77%
Isolated Overweight/Obesity Prevalence
35%
Overweight/Obesity + Elevated Glucose in Non-Hispanic Black Adolescents
The prevalence of MASLD among US adolescents aged 12-19 years is 23.77%.
Overweight/obesity is the most common cardiometabolic risk factor, present in 35% of adolescents.
Non-Hispanic Black adolescents have the highest prevalence of combined overweight/obesity and elevated glucose (24%).
Non-Hispanic Asian adolescents exhibit the highest burden of dyslipidemia subtypes.
Overweight/obesity, hypertriglyceridemia, low HDL-C, and elevated glucose are significantly associated with increased liver steatosis measured by CAP.
There are positive additive interactions between overweight/obesity and dyslipidemia or elevated glucose that amplify liver steatosis severity.
Clinical Implications
Clinicians should recognize the high prevalence of MASLD in adolescents, particularly in those with overweight/obesity and other cardiometabolic risk factors. Early identification and management of overweight/obesity, dyslipidemia, and elevated glucose may reduce liver steatosis progression and associated long-term complications. Screening strategies in adolescent populations should consider these overlapping risk factors to optimize prevention and intervention efforts.
Conclusion
MASLD is alarmingly prevalent in US adolescents, with overweight/obesity playing a central role in its development and severity. The synergistic effects of combined cardiometabolic risk factors underscore the need for comprehensive risk assessment and early intervention in this population.
References
NHANES 2017-2020 -- National Health and Nutrition Examination Survey Data
Delphi Consensus 2023 -- Definition and Nomenclature of MASLD
