Clinical Scorecard: Frequency of Metabolic Dysfunction-Related Steatotic Liver Disease and Associated Cardiometabolic Risk Factors in American Adolescents
Hepatic steatosis with at least one cardiometabolic risk factor (CMRF); synergistic interactions between overweight/obesity and dyslipidemia or elevated glucose increase liver steatosis
Target Population
US adolescents aged 12 to 19 years
Care Setting
Population-based screening and clinical evaluation in outpatient or primary care settings
Key Highlights
Prevalence of MASLD in US adolescents is 23.77%, with overweight/obesity as the most common cardiometabolic risk factor (35%).
Non-Hispanic Black adolescents have the highest proportion of overweight/obesity plus elevated glucose; Non-Hispanic Asians have the highest burden of dyslipidemia.
Overweight/obesity combined with dyslipidemia or elevated glucose shows positive additive interaction effects on liver steatosis measured by controlled attenuation parameter (CAP).
Guideline-Based Recommendations
Diagnosis
Use vibration-controlled transient elastography (VCTE) with median CAP ≥248 dB/m to define steatotic liver disease.
Identify significant fibrosis with median liver stiffness measurement (LSM) ≥7.0 kPa.
Assess presence of cardiometabolic risk factors including overweight/obesity, hypertriglyceridemia, low HDL-C, elevated glucose, and hypertension.
Management
Focus on addressing overweight/obesity as the primary cardiometabolic risk factor in adolescents with MASLD.
Manage dyslipidemia and elevated glucose to reduce liver steatosis severity.
Consider lifestyle interventions targeting weight reduction and metabolic control.
Monitoring & Follow-up
Regularly monitor liver steatosis and fibrosis using transient elastography in adolescents with multiple cardiometabolic risk factors.
Track changes in BMI, lipid profile, and glucose levels to assess risk progression.
Risks
Multiple overlapping cardiometabolic risk factors increase risk of MASLD and progression to advanced fibrosis.
MASLD in adolescence is linked to future metabolic syndrome and cardiovascular disorders in adulthood.
Patient & Prescribing Data
US adolescents aged 12 to 19 years with MASLD and cardiometabolic risk factors
Overweight/obesity is the most important modifiable risk factor; interventions should prioritize weight management and metabolic risk factor control to reduce liver steatosis.
Clinical Best Practices
Screen adolescents with overweight/obesity for MASLD using transient elastography.
Evaluate and manage coexisting cardiometabolic risk factors including dyslipidemia and elevated glucose.
Implement early lifestyle and metabolic interventions to prevent progression of liver disease and associated cardiometabolic complications.
