Longitudinal assessment of liver stiffness and risk factors for advanced fibrosis in adolescents with metabolic dysfunction-associated steatotic liver disease: A retrospective observational study

Wenshu CaoCongcong FengJizhong YeJianfeng Zhou^*Lin WangYanling Lian^*

• Tianlin Community Health Center of Xuhui District, Shanghai, China

BACKGROUND: The global incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) in adolescents is steadily increasing. This research aims to characterize adolescents diagnosed with MASLD clinically and evaluate their long-term outcomes in community and tertiary medical centers located in Shanghai. Furthermore, the investigation assesses the diagnostic efficacy of vibration-controlled transient elastography (VCTE) among adolescents with MASLD. METHODS: We retrospectively analyzed data from adolescent patients (10-18 years) diagnosed with MASLD referred to Shanghai hospitals during the period 2019-2023. Diagnostic criteria included sustained alanine transaminase elevations exceeding twice the upper normal threshold or radiological confirmation of hepatic steatosis, following exclusion of alternative etiologies. VCTE-derived liver stiffness measurements (LSMs) were classified as normal (≤7.0 kPa, F0-F1), significant fibrosis (7.1-9.0 kPa, F2), and advanced fibrosis (≥9.1 kPa, F3-F4), to distinguish fibrosis severity. RESULTS: A total of 140 adolescents were enrolled (67.9% male), with an average age of 13.8 years. Dyslipidemia was common (48.6%; n=68), followed by impaired glucose tolerance or diabetes (27.1%; n=38) and hypertension (21.4%; n=30). Following a mean follow-up duration of 2.1 years, remission of MASLD occurred in only 8.6% of patients (n=12). Among the 50 patients evaluated by VCTE, 22 (44%) exhibited normal LSM values, whereas significant fibrosis and advanced fibrosis were suspected in 11 (22%) and 17 (34%) individuals, respectively. Independent risk factors significantly associated with advanced fibrosis included age ≥16 years (OR, 7.18), presence of IGT/DM (OR, 10.16), and elevated aspartate aminotransferase levels exceeding 70 U/L (OR, 17.33). CONCLUSIONS: There is a rapid increase in adolescent MASLD incidence in Shanghai. According to LSM assessments, adolescents diagnosed with MASLD may have heightened risks of advanced hepatic fibrosis as they approach late adolescence.