Clinical manifestations, and oxidative stress imbalance in children with obesity and MASLD

Abstract

Introduction and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is often considered a multifactorial disease that has shown high incidence in recent years in both children and adults. To date, management criteria, diagnosis, and clinical characteristics are not fully defined in childhood. Objective: Evaluate anthropometric characteristics, biochemical data, clinical manifestations, and Redox balance status in pediatric patients with obesity. Materials and Patients: A cross-sectional study that included 300 pediatric patients (aged 8 to 17 years) from the obesity clinic of Iztapalapa Pediatric Hospital. Subjects were classified as with MASLD or without MASLD using hepatic ultrasonography. A thorough evaluation of anthropometric characteristics, clinical features, and blood levels of reduced glutathione (GSH) and oxidized glutathione (GSSG) was conducted. Data were reported as absolute and relative frequencies (%), while continuous variables were determined as mean ± SD and analyzed using Student's t-test and Mann-Whitney U test via SPSS V.22 software. Results: A total of 95 patients met the inclusion criteria, with 78 cases having MASLD and 17 without MASLD: 27% were aged 8-9 years and 73% were adolescents (10-17 years). Being children receiving care for obesity, anthropometric data (weight, BMI (WHO, CDC), waist/height ratio, waist/hip ratio, and % body fat) showed no significant differences between groups. Greater respiratory difficulty (p=0.037) and polyuria (p=0.047) were observed in patients with MASLD vs. those without MASLD. Additionally, AST, urea, and creatinine levels were elevated in MASLD (p<0.05). Finally, GSH was reduced in MASLD vs. non-MASLD (p=0.001), thus altering the GSH/GSSG ratio. Conclusions: Reduced glutathione indicates increased oxidation in children with MASLD, showing a clear association with liver damage even in the early stages of the disease. The incorporation of new tools in the diagnosis and management of obese children is a primary need to reduce the high prevalence and thus improve quality of life and life expectancy.