Mid-upper arm circumference, steatosis indices, and elastography for screening liver steatosis in children with overweight/obesity: A prospective cross-sectional study.

OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in children, and practical screening approaches are needed in populations with overweight/obesity. We aimed to evaluate mid-upper arm circumference (MUAC) as a simple marker for ultrasonography (US)-detected liver steatosis (LS) in children with overweight/obesity, to examine the performance of other non-invasive measures, and to assess MUAC-based composite cut-offs. METHODS: In this study, 194 children with overweight/obesity aged 5-17 years were evaluated at a pediatric gastroenterology clinic. US-detected LS was defined as US grade ≥1. Liver stiffness was measured by two-dimensional shear-wave elastography (2D-SWE). Fasting biochemistry was obtained, and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio, Hepatic Steatosis Index, and Framingham Steatosis Index were calculated. Associations between US-detected LS and anthropometric, biochemical, and liver stiffness measures were assessed using Spearman correlation, logistic regression, and receiver operating characteristic analyses; composite models used an odds ratio-rule approach. RESULTS: US-detected LS was present in 55.2%. MUAC ≥ 30.0 cm yielded an area under the curve (AUC) of 0.738 for identifying US-detected LS. A composite rule of body mass index (BMI) z score ≥1.70 or MUAC ≥ 30.0 cm achieved 97.2% sensitivity and 54.0% specificity for identifying US-detected LS, with an AUC of 0.813, negative predictive value 94.0%, and positive predictive value 72.2%. Adding liver stiffness ≥5.68 kPa increased discrimination for identifying US-detected LS, with an AUC of 0.881. CONCLUSION: MUAC is a low-cost adjunct for screening US-detected LS in children with overweight/obesity. Simple composite cut-offs integrating MUAC with BMI showed high sensitivity in this cohort and may support initial risk stratification before ultrasonographic evaluation; adding liver stiffness yielded the highest discriminative performance.