{
  "abstract": "Objectives and Study The clinical spectrum of paediatric MASLD is poorly understood. We aimed to characterise a large tertiary paediatric MASLD cohort, with emphasis on transient elastography findings and extrahepatic comorbidities.Methods We retrospectively reviewed 288 children with MASLD managed at the Paediatric Hepatology Service at King’s College Hospital over an 18-month period. Inclusion required imaging evidence of hepatic steatosis following exclusion of other aetiologies. Demographic, anthropometric, transient elastography, ultrasonographic and comorbidity data were collected. Fibrosis staging was based on liver stiffness measurement (LSM: F1 <8 kPa, F2 8–10.9 kPa, F3-4 ≥11 kPa), and steatosis grading by controlled attenuation parameter (CAP: S1 <248 dB/m, S2 248–279 dB/m, and S3 ≥280 dB/m). Differences across categories was assessed using Kruskal–Wallis test, and associations among markers using Spearman correlations.Results Median age was 15 years (IQR 4), with a male predominance (71.2%). Median CAP was 299 dB/m (IQR 73.8), with severe steatosis (S3) in 63.7% of patients. Median LSM was 7 kPa (IQR 2.8), with significant fibrosis (F2) in 28% and advanced fibrosis (F3-4) in 11%. Splenomegaly was detected in 32.6%. ALT, AST, GGT, and CAP were significantly higher in fibrosis stages F2 and F3-4 compared to F1, although F2 and F3-4 did not differ. No biochemical marker independently predicted LSM in multivariable analysis. Correlations were seen between BMI z-score, LSM, CAP, spleen stiffness measurement, ALT, and uric acid (table 1), while platelet count showed no correlation with fibrosis or steatosis. Extrahepatic comorbidities were frequent, including neurodevelopmental/behavioural disorders (13.8%), hypothyroidism (3.8%) and hypogonadal abnormalities (6.6%). Alpha-1-antitrypsin heterozygosity was seen in 10%, and isolated autoantibody positivity in 15.2%. Metabolic complications were common; including acanthosis (19%), elevated HbA1c (16.3%), treated diabetes (11.1%), hypertension (5.9%), sleep-related issues (17.7%), and menstrual irregularities in 60% of adolescent girls.Conclusions In this large tertiary paediatric MASLD cohort, severe steatosis and significant fibrosis were common, alongside a broad burden of metabolic and extrahepatic comorbidities. The findings emphasise the need for integrated multidisciplinary management.Abstract LBA16 Table 1Spearman rank correlation coefficient between BMI z-score, fibroscan and biochemical parametersVariable pairBMI z-scoreLSMCAPBMI z-scorer 0.24p 0.001r 0.36 p <0.001LSMr 0.24p 0.001r 0.40p <0.001CAPr 0.36p <0.001r 0.40p <0.001Platelet countr 0.18p 0.007r 0.34p 0.67r 0.092p 0.216SSMr 0.46p 0.004r 0.37p 0.025r 0.65 p <0.001ALTr 0.18p 0.007r 0.37p <0.001r 0.38p <0.001Uric acidr 0.24p 0.032r 0.24p 0.016r 0.34p 0.04",
  "authors": [
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Jessica Eldredge"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Caitlin Murphy"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Zuzanna Dulnikiewicz"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Giuliana Alcivar"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Valeria Gulli"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Nafisha Sultanamili"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital",
        "Department of Gastroenterology, Hepatology and Nutrition, Children’s Health Ireland and University College Dublin"
      ],
      "name": "Emer Fitzpatrick"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital"
      ],
      "name": "Sanjay Bansal"
    },
    {
      "affiliations": [
        "Paediatric Liver, GI and Nutrition Centre, King’s College Hospital",
        "Roger Williams Institute of Liver Studies, Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King’s College London"
      ],
      "name": "Eirini Kyrana"
    }
  ],
  "title": "LBA16 Clinical spectrum of paediatric MASLD: fibrosis burden, steatosis severity, and extrahepatic comorbidities in a large tertiary cohort",
  "uid": "ee8da8a9-9346-5d2d-a97a-226bb1161698"
}