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The following is a summary of “Longitudinal Links between Changes in Body Composition and Liver Disease Severity in Children and Adolescents with Metabolic Dysfunction-Associated Steatotic Liver Disease,” published in the September 2024 issue of Pediatrics by Speakman et al.

This study aimed to elucidate the relationship between longitudinal alterations in body composition and liver disease severity in children diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD). As a longitudinal, single-center, retrospective analysis, the study included pediatric patients under 20 years of age who had undergone at least two bioelectrical impedance analyses (BIA). MASLD regression was operationally defined by either normalization of alanine aminotransferase (ALT) levels or a reduction exceeding 50% from baseline. We calculated fat and skeletal muscle mass indices by dividing their respective measurements by height squared, adjusting for size. Logistic and linear regression analyses were employed to determine the independent impact of body composition changes on serologic markers of liver disease severity. 

The cohort comprised 258 patients (75% male, 50% Hispanic) with a median age of 14 years (interquartile range [IQR]: 11, 16) at the time of the first BIA. The median body mass index (BMI) z-score at baseline was 2.33 (IQR: 2.04, 2.62), and the median follow-up period between the first and last BIA was 12 months (IQR: 6, 24). Our findings revealed that a decrease in the fat mass index was independently associated with reductions in ALT and gamma-glutamyl transferase (GGT) levels and was linked to an increased likelihood of MASLD regression (odds ratio [OR]: 0.55, p<0.001). Notably, changes in fat mass index were more predictive of MASLD regression than changes in BMI z-score. 

Conversely, alterations in skeletal muscle mass index did not correlate with changes in ALT or GGT levels. These results underscore that changes in fat mass, rather than skeletal muscle mass, are more closely associated with serologic indicators of liver injury in youth with MASLD. Furthermore, fat mass changes provide a more accurate prediction of MASLD regression than BMI z-score changes. This suggests that BIA could be a valuable adjunct biomarker for monitoring liver disease progression in this population.

Source: sciencedirect.com/science/article/abs/pii/S0022347624004049