Medical and social significance of early detection of metabolic dysfunction-associated steatotic liver disease in children: development of a screening algorithm and formation of high-risk groups based on ultrasound steatometry, MRI, clinical and anamnestic and laboratory markers

Abstract

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) is gaining the status of a pressing issue in pediatrics due to the trend towards the spread of obesity and metabolic syndrome in the paediatric population. The disease is characterized by a prolonged latent course, which leads to late diagnosis under standard principles, progression to fibrosis, and the development of cirrhosis as early as young adulthood, thus forming a significant medical and social burden. Objective of the study. To objectify the medical and social significance of early diagnosis of MASLD in children by developing a screening algorithm and forming high-risk groups based on clinical-anamnestic, laboratory, and ultrasound data, with a comparative assessment of steatometry results against MRI-PDFF. Materials and methods. A prospective observational study (2023–2025, n=1200 children aged 10–18 years). Primary screening included liver ultrasound with steatometry and elastography. For in-depth analysis, 256 children were selected. Anthropometric and laboratory data (lipid and carbohydrate metabolism, liver function tests) were assessed, and steatometry results were compared with MRI-PDFF (reference standard). Statistical analysis was performed using ROC analysis, correlation analysis, and comparative analysis. Results and discussion. The prevalence of liver steatosis among the examined subjects was 21,3% (n=256), including stage I steatosis (S1) detected in 52,4%, stage II (S2) – in 35,7%, and stage III (S3) – in 11,9%. Fibrotic changes (elastography) were diagnosed in 5% of adolescents. A strong correlation was established between ultrasound steatometry parameters and MRI-PDFF (r=0,89–0,91; p<0,001). Optimal cut-off values for the diagnosis of steatosis were determined: for Soneus P7 – ≥2.3 dB/cm, for Samsung fat fraction – ≥5,2%, GE UGAP 0,65 dB/cm/MHz. S1 steatosis was found to have an asymptomatic course without laboratory abnormalities. Progression of steatosis was associated with early-onset obesity (especially at 0–3 years of age), family history, insulin resistance (HOMA-IR >3,0; for S2 – approximately 8,0; for S3 – >10,0), hypertriglyceridemia, and vitamin D deficiency. Prior COVID-19 infection acted as an additional trigger of metabolic decompensation: in 67% of obese patients following COVID-19, progression of steatosis and combined hepatocellular-cholestatic injury were observed. Lifestyle modification over 3–6 months led to a reduction in steatometry parameters and improvement in metabolic markers in 40% of children. Based on the obtained data, a six-stage early screening algorithm was developed. Conclusions. MASLD is a significant medical and social problem with a high prevalence (21.3%) among children. Ultrasound steatometry is a highly accurate, accessible, non-invasive method of early diagnosis that correlates with MRI-PDFF. Early onset of obesity, family history, insulin resistance, and prior COVID-19 are key predictors of disease progression. The proposed screening algorithm allows for timely identification of high-risk children, prevention of fibrosis development, reduction of healthcare costs, and minimization of early disability risks.