Cumulative metabolic, behavioral, and early-life factors for MASLD in Chinese children with U.S. adolescent validation

Aim: The purpose of this study was to explore the cumulative metabolic, behavioral, and early-life risk factors for MASLD.

Methods: We used data from a school-based longitudinal survey conducted in Beijing in 2023. Logistic regression models were used to explore the independent effects, construct a risk score, and examine the cumulative effects of risk factors on pediatric MASLD. The risk score was further validated in the National Health and Nutrition Examination Survey (NHANES) 2017-2020 cycles.

Results: The prevalence of MASLD in Chinese children was 4.4% and 7.6% at baseline and follow-up, respectively. Exposure to secondhand smoking (OR = 2.36) and sedentary behavior (SB, OR = 3.21) were significantly associated with baseline MASLD, while we found that the risk of MASLD increased by 73% for each unit increase in the score. The cumulative effect also existed in the NHANES population. The risk of follow-up MASLD increased by 263% for each unit increase in the score. We found that the risk of MASLD incidence and persistent MASLD increased by 150% and 111%, respectively, for each unit increase in the score.

Conclusion: On the basis of framework conceptualizing the levels of factors that increase the risk of MASLD, we found that metabolic, behavioral, and early-life risk factors had cumulative effects on the risk of pediatric MASLD, and the effects were evident despite the substantial differences between the Chinese and U.S. populations. Implementing targeted intervention strategies based on this framework - namely, creating a better early-life environment, adopting healthier lifestyle habits, and maintaining a healthier metabolic state - is be essential for the management of pediatric MASLD.