Endocrine Abstracts

Introduction: Transient elastography (TE), commonly known as Fibroscan, is a quick, non-invasive technique that employs pulse-echo ultrasound to evaluate liver fibrosis. While its effectiveness is well-established in adults, limited research has explored its application in children. The controlled attenuation parameter (CAP), a component of TE, identifies hepatic steatosis >10% and grades its severity in adults. This study aimed to assess the feasibility and clinical utility of TE-CAP in identifying metabolic dysfunction-associated steatotic liver disease (MASLD: altered liver enzymes, fatty liver in ultrasound & metabolic risk factor) among paediatric patients with obesity at our centre.

Methods: Fibroscan was performed over a 6-month period in our outpatient clinics. Controlled Attenuation Parameter (CAP, in dB/m) was used to assess liver fat content, while Liver Stiffness Measurement (LSM, in kPa) was used to evaluate fibrosis.

Results: 111(53male) patients, mean age 11.7 years (8.3-16.7) patients, mean BMI SDS 3.6±0.6 underwent the fibroscan. Average scan time 8.60 minutes. BMI SDS was significantly higher in patients with steatosis (3.6±0.6) v/s those without (3.2±0.9, P = 0.047). LSM values were higher in the MASLD patients (7.01±2.6 v/s 6.15±2.2 kPa, P = 0.065), suggesting an increasing trend towards liver stiffness. Patients with MASLD exhibited significantly higher CAP scores (285.5±46.5) compared to those without MASLD (265.3±54.8; p=0.048), reflecting increased hepatic fat accumulation. Weight SDS (r = 0.314, P = 0.001) and BMI SDS (r = 0.236, P = 0.013) showed significant and positive correlation with CAP. Similarly, LSM demonstrated positive correlations with weight SDS (r = 0.322, P = 0.001) and BMI SDS (r = 0.187, P = 0.049), suggesting a positive relationship between elevated anthropometric indices and increased liver stiffness. The scan was well tolerated by children with neurodevelopmental and learning difficulty concerns.

Conclusion: CAP emerged as a promising marker of hepatic steatosis in children with obesity. Fibroscan proved to be a practical, reliable tool for screening steatosis and fibrosis in paediatric patients with obesity. Large scale studies are required to define the relationship between liver biomarkers and fibroscan measurements as potential predictors of MASLD in children with obesity.