Liver Injury Biomarkers in Pediatric Metabolic Syndrome: Key Biochemical Associations

<b>Background</b>: The presence of metabolic syndrome (MetS) in children predisposes them to steatotic liver disease, with or without liver enzyme alterations. Early diagnosis of the degree of liver damage can stop the progression to more severe dysfunction. <b>Objectives</b>: This study aimed to establish the link between liver enzyme levels and triglyceride and cholesterol values in pediatric patients with obesity, grouped according to MetS status and metabolic dysfunction-associated fatty liver disease (MAFLD). <b>Methods</b>: The retrospective observational study included 261 pediatric patients aged between 0 and 18 years diagnosed with obesity, MetS, and MAFLD. Before initiating the study, approval was obtained from the hospital's Ethics Committee. The clinical and biochemical data were collected from the patients' histories. <b>Results</b>: Alanine aminotransferase showed a significant positive correlation with triglyceride levels in the overall cohort, which became stronger in children with MetS and was strongest in those with ultrasonographically confirmed MAFLD. Similarly, aspartate aminotransferase demonstrated a weak positive correlation with triglycerides in the overall population, which increased in patients with MetS and became strong in children with MAFLD. <b>Conclusions</b>: In children with MetS and ultrasound-diagnosed MAFLD, liver enzymes showed progressively stronger positive correlations with triglyceride levels, indicating a close link between dyslipidemia and liver damage. Associations between liver enzymes and total cholesterol further support metabolic dysregulation, rather than body mass index alone, as a key driver of pediatric steatotic liver disease and highlight the value of targeted liver enzyme assessment in children with MetS or hypertriglyceridemia.