Prevalence of MASLD and fibrosis assessed by transient elastography in U.S. adolescents: insights from NHANES 2017-2023.

BACKGROUND/AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common but understudied disease in adolescents. We aimed to estimate the updated prevalence of MASLD and related fibrosis among US adolescents using transient elastography. METHODS: This study analyzed data from the National Health and Nutrition Examination Survey 2017 to March 2020 and August 2021 to August 2023 among adolescents ages 12-19 years. Steatotic liver disease was assessed using the median controlled attenuation parameter (CAP) and fibrosis by median liver stiffness measurement. RESULTS: A total of 2588 participants were included in the analysis (mean [SD] age, 15.4 [2.3] years; 1366 male participants [52.8%]). The overall age-adjusted prevalence of MASLD was 21.0% (95% CI: 19.1-23.0) using a CAP threshold of ≥ 248 dB/m and 16.1% (95% CI: 14.4-17.8) using ≥ 263 dB/m. The prevalence of MASLD-related fibrosis was 9.0% and 9.7% using CAP thresholds of 248 dB/m and 263 dB/m, respectively. Higher prevalence of MASLD and fibrosis was observed among adolescents with overweight, obesity, and prediabetes. Between the two survey cycles, the age-standardized prevalence of MASLD remained stable, with a non-significant decline observed in the prevalence of fibrosis. Multivariable analysis identified male sex, non-Hispanic Asian ethnicity, increased waist circumference, overweight, and obesity as independent risk factors for MASLD, while waist circumference was the only independent factor associated with MASLD-related fibrosis. CONCLUSIONS: In this cross-sectional study, MASLD and MASLD-related fibrosis were highly prevalent among US adolescents, with significant disparities observed by sex, race, and ethnicity. These findings highlight the substantial burden of MASLD in the adolescent population and underscore the need for continued public health focus.