The prevalence and predictors of metabolic dysfunction-associated steatotic liver disease and fibrosis/cirrhosis among adolescents/young adults

ObjectivesWe investigated the current prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and fibrosis/cirrhosis and identified at-risk populations for MASLD and MASLD-related fibrosis among US adolescents and young adults in the United States.MethodsUtilizing the National Health and Nutrition Examination Survey 2017-2020, the prevalence of MASLD and fibrosis/cirrhosis was assessed via controlled attenuation parameter (CAP) score and liver stiffness measurements by transient elastography in participants aged 12-29 years with at least one cardiometabolic criteria and absence of other chronic liver disease. Multivariable logistic regression was performed to determine predictors of MASLD and MASLD-related fibrosis.ResultsThe overall prevalence of MASLD was 23.9% (95% CI: 21.3-26.5 for CAP >= 263 dB/m) and 17.3% (95% CI: 14.7-20.0 for >= 285 dB/m), respectively. The prevalence of fibrosis and cirrhosis in MASLD was 11.0% and 3.1%, respectively. When categorized by age, the prevalence of MASLD varied from 16.8% (of which 6.2% [fibrosis], 1.8% [cirrhosis]) in early and middle adolescents (12-17 years), to 25.5% (11.8% [fibrosis], 4.8% [cirrhosis]) in late adolescents and young adults (18-24 years), and to 30.4% (of which 13.2% [fibrosis] and 2.1% [cirrhosis]) in older young adults (25-29 years). The independent predictors for MASLD included male sex, Hispanic, non-Hispanic Asian, body mass index, and low HDL-cholesterol. In contrast, diabetes and body mass index were associated with an increased risk of fibrosis in individuals with MASLD.ConclusionsThe prevalence of MASLD and related fibrosis in adolescents and young adults in the United States has reached a significant level, with a substantial proportion of cirrhosis. What is Known Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent among adolescents and young adults. MASLD-related fibrosis had a higher risk of all-cause/cardiovascular mortality.What is New We noted a significant disease burden of MASLD via transient elastography, affecting approximately 23.9% of the United States adolescent and young adult population (12-29 years). The prevalence of fibrosis and cirrhosis in adolescents and young adults with MASLD in the United States was 11.0% and 3.1%, respectively. Diabetes and BMI were noted to be predictors of MASLD and MASLD-related fibrosis, while non-Hispanic Black was associated with a lower risk for fibrosis.