Elevated LECT2 and PEDF in Pediatric MAFLD: Diagnostic Performance and Metabolic Correlations

Lanshu Yang,1– 3,* Hongbing Ni,4,* Meiling Deng,1,2 Tuo Guo,1 Jie Zhang,1,5 Baolan Sun,6 Weixia Yang1 1Department of Pediatrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, Jiangsu, People’s Republic of China; 2Dalian Medical University, Dalian, Liaoning, People’s Republic of China; 3Department of Pediatrics, Chongzhou Maternal and Child Health Care Hospital, Chengdu, Sichuan, People’s Republic of China; 4Department of Public Health, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 5Department of Pediatrics, Zhongda Hospital Southeast University, Nanjing, Jiangsu, People’s Republic of China; 6Department of Laboratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Weixia Yang; Baolan Sun, Email [email protected]; [email protected]: To evaluate the diagnostic value of serum hepatokines, leucocyte cell-derived chemotaxin 2 (LECT2) and pigment epithelium-derived factor (PEDF), for pediatric metabolic-associated fatty liver disease (MAFLD), and to assess their correlations with metabolic/liver injury indices and diagnostic utility.Patients and methods: A total of 198 patients were included in the study (78 in the MAFLD group, 60 in the obese non-MAFLD and 60 in the control group). Serum LECT2 and PEDF levels were measured in all three groups. Group comparisons were performed, and LECT2/PEDF levels were correlated with metabolic parameters, and liver injury markers. ROC curve analyses and logistic regression were also conducted.Results: Serum LECT2 and PEDF levels exhibited stepwise elevations (control < obese non-MAFLD < MAFLD; both P < 0.001), with significant correlations in MAFLD patients to BMI, insulin resistance (HOMA-IR), and liver injury markers (ALT/AST). For MAFLD versus controls, PEDF showed superior diagnostic accuracy (AUC = 0.804, 95% CI: 0.731– 0.877) to LECT2 (AUC = 0.734, 0.651– 0.817), while combined PEDF with LECT2 further improved discrimination (AUC = 0.849; sensitivity 79.5%, specificity 78.3%). For MAFLD versus obese non-MAFLD, both hepatokines had modest utility (LECT2 AUC = 0.623; PEDF AUC = 0.668), though their combination enhanced performance (AUC = 0.712; sensitivity 60.3%, specificity 73.9%). Multivariable analysis confirmed LECT2 and PEDF as independent MAFLD predictors.Conclusion: LECT2 and PEDF are elevated in pediatric MAFLD and correlate with metabolic dysfunction. While their combination effectively distinguishes MAFLD from healthy controls, it shows moderate efficacy in differentiating MAFLD from simple obesity. Nevertheless, the LECT2/PEDF panel represents a promising risk-stratification tool to identify high-risk obese children for further diagnostic evaluation.Plain Language SummaryMetabolic-associated fatty liver disease (MAFLD) is the most common long-term liver problem in children, especially those who are obese. Diagnosing it can be hard—doctors usually need invasive tests like liver biopsies or expensive scans. So, researchers wanted to find simple blood tests that could help diagnose MAFLD in kids.The team studied 198 children, split into three groups: 78 with MAFLD, 60 who were obese but did not have MAFLD, and 60 healthy kids. They measured two substances in the children’s blood—LECT2 (a factor linked to inflammation) and PEDF (a factor linked to fat regulation).They found:Levels of both LECT2 and PEDF rose step by step: lowest in healthy kids, higher in obese kids without MAFLD, and highest in kids with MAFLD.Higher levels of these substances correlated with bigger weight problems, worse insulin resistance (when the body does not use insulin well), and more liver damage.PEDF was better at telling MAFLD apart from healthy kids than LECT2. Using both together worked even better—catching 79.5% of MAFLD cases and correctly ruling out 78.3% of healthy kids.These results mean LECT2 and PEDF could become simple, non-invasive blood markers to help doctors spot MAFLD in children early, especially before the disease gets serious.Keywords: children, obesity, MAFLD, LECT2, PEDF