Biochemical-Anthropometric Indices Assessing Liver Steatosis Identified in Elastography in Children with Metabolic DysFunction-Associated Steatotic Liver Disease

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of liver pathology in children. Hepatic fat content can be assessed by a transient elastography, but this method is not widely used. Therefore, the aim of this study was to evaluate the usefulness of a simple, surrogate biochemical-anthropometric indices of liver steatosis: FLI (Fatty Liver Index), HSI (Hepatic Steatosis Index), and LAP (Lipid Accumulation Product) in children with MASLD. Methods: The retrospective study included a group of 103 obese/overweight children. MASLD was diagnosed according to criteria developed by a multisociety statement published in Journal of Pediatric Gastroenterology and Nutrition in 2024. Liver steatosis (controlled attenuation parameter /CAP/) was assessed in elastography. HSI, FLI, and LAP were calculated according to their mathematical formulas. ROC analysis and multivariate logistic regression were performed to calculate the power of the studied indices in diagnostics of liver steatosis in children with MASLD. Results: MASLD was diagnosed in 72 children (70%). Children with MASLD had significantly higher levels of ALT, AST, GGT, uric acid, value of BMI, waist circumference, HOMA-IR, and indices HSI, FLI, LAP compared to the group of non-hepatopathic controls (n = 31). HSI, FLI, and LAP significantly correlated with CAP. All indices identified MASLD in the ROC analysis (AUC = 0.77, 0.76, 0.68 resp.). However, only HSI remained a significant independent predictor of hepatic steatosis in overweight/obese children. Conclusions: Although HSI, FLI, and LAP can be considered as useful biochemical-anthropometric indicators of MASLD in obese/overweight children, only HSI remained an independent predictor of hepatic steatosis in this group of children.