Serum vitamin C and beta (β) carotene levels in children and adolescents with metabolic dysfunction–associated steatotic liver disease (MASLD): a case-control study

Abstract Background Metabolic dysfunction associated steatotic liver disease (MASLD) represents the most common chronic liver disease among children and adolescents and is closely associated with the rising prevalence of obesity. MASLD pathogenesis has been linked to oxidative stress–mediated injury. Antioxidants in particular vitamin C and β- carotene might have a protective role. However, paediatric data remain limited. Aim To measure serum levels of vitamin C and β-carotene in children and adolescents with MASLD and their correlation with the disease severity and clinico-laboratory parameters. Methods Forty (40) overweight and obese children (36 were obese and 4 were overweight) with MASLD were enrolled as patients and thirty (30) children with BMI below 85th percentile and normal liver matched in age and sex were taken as controls confirmed by normal abdominal ultrasonography and normal liver function tests. Anthropometric measurements and abdominal ultrasonography for MASLD diagnosis and grading. All children underwent laboratory testing, including [liver function tests, fasting serum glucose and insulin, lipid profiles, HOMA-IR, serum vitamin C and beta carotene levels]. Results Patients with MASLD showed significantly higher BMI-z score (3.12 ± 1.12 vs. 1.13 ± 0.55, p < 0.001), waist circumference (93.28 ± 11.31 vs. 67.73 ± 4.14, p < 0.001) hip circumference (100.78 ± 11.86 vs. 85.40 ± 5.53, p < 0.001), waist to hip ratio (0.89 ± 0.05 vs. 0.79 ± 0.02, p < 0.001), liver enzymes, triglycerides, total cholesterol, fasting glucose and insulin and HOMA- IR ( p < 0.05 for all), but significantly lower serum vitamin C (2.94 ± 1.74 vs. 5.13 ± 1.47, p < 0.001) and β-carotene (1.69 ± 1.16 vs. 4.64 ± 2.01, p < 0.001) than control group. Increase in ALT, AST, total cholesterol, TG and HOMA-IR levels went with increase in degree of steatosis ( p < 0.05 for all). Serum vitamin C and β- carotene levels showed inverse correlations with ALT, AST, total cholesterol and HOMA-IR ( p < 0.05 for all). Moreover, decrease in their levels went with increase degree of steatosis. Conclusions Serum vitamin C and β-carotene levels were significantly reduced in pediatric MASLD and are negatively correlated with disease severity, liver enzymes, total cholesterol and insulin resistance. These findings highlight its potential role in pathophysiology and assessment of MASLD.