Clinical Report: The Relationship Between Estradiol Levels and MASLD in Pediatrics

Overview

This study investigates the associations between sex hormones and metabolic dysfunction-associated steatotic liver disease (MASLD) in children with overweight and obesity. Key findings indicate that estradiol, Anti-Müllerian hormone (AMH), and sex hormone-binding globulin (SHBG) are inversely associated with MASLD parameters, while androgens show a positive association.

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in children and adolescents, with a reported prevalence of 34.2% in obese children. Understanding the role of sex hormones in MASLD is crucial, as differences in prevalence between sexes suggest hormonal influences on disease development. Limited pediatric research exists on this topic, necessitating further investigation.

Data Highlights

Key Findings

• Estradiol, AMH, and SHBG inversely associate with ALT levels in children with MASLD.
• Free testosterone, bioavailable testosterone, and DHEAS positively associate with ALT levels.
• AMH and SHBG inversely associate with hepatic steatosis (HS).
• Free testosterone, bioavailable testosterone, and DHEAS positively associate with HS.
• AMH and SHBG inversely associate with Controlled Attenuation Parameter (CAP).
• Follicle stimulating hormone and total testosterone positively associate with CAP.

Clinical Implications

The findings suggest that monitoring estradiol, AMH, and SHBG levels may provide insights into the risk of MASLD in pediatric patients with obesity. Additionally, the positive associations of androgens with MASLD parameters highlight the need for further investigation into their role in disease progression.

Conclusion

This study emphasizes the complex relationship between sex hormones and MASLD in children, indicating that both estrogen and androgen levels may influence disease parameters. Further research is warranted to explore these associations in diverse pediatric populations.

Related Resources & Content

1. Frontiers in Pediatrics, 2026 -- Gut microbiota and pediatric metabolic dysfunction–associated steatotic liver disease: clinical evidence and therapeutic implications
2. BMJ Paediatrics Open, 2026 -- Paediatric metabolic dysfunction-associated steatotic liver disease (MASLD): a growing health concern in the age of childhood obesity
3. Endocrine Reviews, 2023 -- The Impact of Estrogen Deficiency on Liver Metabolism: Implications for Hormone Replacement Therapy
4. BMJ Open Gastroenterology, 2023 -- Liver fibrosis in metabolic dysfunction-associated steatotic liver disease: epidemiology, risk stratification and therapeutics
5. JCI, 2023 -- MASLD in children: integrating epidemiological trends with mechanistic and translational advances
6. Pediatric Research, 2025 -- Screening and diagnosis of metabolic dysfunction-associated steatotic liver disease in children within public healthcare
7. Frontiers, 2026 -- Estradiol negatively associates with metabolic dysfunction-associated steatotic liver disease in children
8. JCI - MASLD in children: integrating epidemiological trends with mechanistic and translational advances
9. Screening and diagnosis of metabolic dysfunction-associated steatotic liver disease in children within public healthcare | Pediatric Research
10. Frontiers | Estradiol negatively associates with metabolic dysfunction-associated steatotic liver disease in children