Abstract 4364127: Fatty Liver, Big Heart Risk: Prevalent Cardiovascular Risk among Young Children with Subclinical and Clinical Hepatic Steatosis

Background: Hepatic steatosis is closely linked to cardiometabolic risk factors (CMRF) in adults; however, less is known in childhood. In particular, data is lacking in younger children because of the challenges in the accurate measurement of liver fat. We investigated hepatic steatosis (HS) and cardiometabolic risks in pre-pubertal Hispanic/Latino children. Methods: This was a prospective cohort study including 130 Hispanic/Latino children aged 6–9 years old (NCT05292352). Eight binary cardiometabolic risk factors (CMRFs) were combined into one risk CMRFs score (range 0–8): waist-to-height ratio (WHR) ≥0.5, triglycerides ≥100 mg/dL, total cholesterol (TC) ≥170 mg/dL, HDL <45 mg/dL, LDL >110 mg/dL, fasting glucose ≥100 mg/dL, HbA1c ≥ 5.7% and insulin >15 μU/mL. High-risk was classified as ≥3 CMRFs. HS was measured via MRI-proton density fat fraction (MRI-PDFF) and was defined as low (<3%), subclinical (3-5%), and clinical (≥5%). Prevalences of individual CMRFs and high-risk classification were compared across HS categories using Fisher’s exact tests. Statistical analysis was performed using R v.4.3.2. Results: Mean (SD) age was 8.0 (1.1), 42.3% female, 56.2% had a BMI >95 th percentile. The most prevalent CMRFs were increased WHR (73.1%), elevated TC (33.1%), and low HDL (32.3%). Prevalence of several individual CMRFs rose with increasing HS (p-trend < 0.0003 for all). Among those with HS <3%, 3-<5%, and ≥5% respectively, prevalences were, 1) High triglycerides: 6.7%, 25.0%, and 54.3%, 2) Low HDL: 15%, 29.2%, 56.5%; 3) High WHR: 48.3%, 87.5%, and 97.8%, and 4) High insulin: 1.7%, 16.7%, 26.1%. There was no significant trend between elevated HS and prevalence of high LDL, TC, HbA1C, or fasting glucose. The prevalence of high-risk conditions (≥3 CMRFs) increased from 16.7% among those with low HS to 37.5% and 54.3% among those with subclinical and clinical HS, respectively. None of the patients had more than 6 CMRFs. Conclusion: Over one-third of children of Hispanic/Latino school-age with subclinical steatosis of 3 - <5 % had ≥3 CMRFs. These findings support re-evaluating current pediatric guidelines, which recommend screening beginning at age 10 and intervention only for HS ≥5%.