Endocrine Abstracts

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), a term used to describe the spectrum of liver features associated with obesity, is seen in one third of adults living in the UK. The persistent accumulation of liver steatosis can lead to scarring causing the development of Metabolic Dysfunction-Associated Steatohepatitis (MASH). MASH is linked to genetic predisposition and ethnicity, with higher rates in South Asians. FibroScans are being increasingly used as a non-invasive, quick ultrasound-like test to detect MASLD in adults. Its use in paediatrics is limited. We assessed the utility of FibroScans in a single tier 3 paediatric Complications of Excess Weight (CEW) clinic in East London.

Methods: Over the last 6 months, we offered FibroScans to patients attending CEW (referral criteria BMI SDS>3.3 with associated co-morbidity). MASLD was indicated by a result of CAP≥248dB/m and stiffness <7.5kPa, and MASH was indicated by CAP≥248 dB/m and stiffness >7.5kPa. Results were obtained from routine blood tests (including liver function tests and HbA1C).

Results: Out of the 9 children (3 females, 6 males) aged 9-17 yr (mean = 12 yr) with BMIs from 28.2-42.6 kg/m² (mean = 34.9), 8 presented had Fibro-Scan measurements consistent with MASLD/MASH. CAP scores ranged from 210-348 dB/m (mean = 289.3) and liver stiffness ranged from 4.4-19.6 kPa (mean = 7.7). 5/9 children had Fibro-Scan results representing steatosis alone and 3/9 representing fibrosis. In contrast, only 2/9 patients showed deranged LFTs, ALT ranged from 17–244 U/l (mean = 65). Ethnicities of the children were Black, Asian and Middle Eastern.

Conclusion: Our findings indicate that MASLD is likely an underrecognized condition within the diverse paediatric obesity cohort of East London. Our findings demonstrate that LFTs do not consistently capture steatosis or fibrosis. Hence FibroScans may offer an alternative/ adjunctive non-invasive clinical tool in paediatric obesity clinics to enable early detection of MASLD.