Correlating neighborhood-level deprivation and pediatric metabolic dysfunction-associated steatotic liver disease

ObjectivesThe primary objective of this study is to further explore associations between social influencers of health and markers of disease severity at the time of presentation of patients with pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) using neighborhood-level Area Deprivation Index (ADI) scores.MethodsA retrospective cross-sectional study was conducted among 344 pediatric MASLD patients. Each patient received an ADI score based on their 9-digit zip code. Groups were defined as low (<= 5) and high (6 >=) ADI. Associations between ADI and symptomatology and laboratory values at presentation, as well as initial liver biopsy pathology were tested via analyses of covariance, chi 2 testing, and logistic regressions.ResultsThe mean ADI was 6.54 (SD = 2.09). ADI groups did not significantly differ in age of presentation, type of presentation, or associated conditions, except for the higher ADI group having on average lower vitamin D levels (26.70 vs. 29.91, p = 0.02) and being two times more likely to also be diagnosed with low HDL levels (p = 0.04, 95% CI 1.04-3.89). Mean transaminases and histopathologic nonalcoholic fatty liver disease (NAFLD) Activity Scores did not significantly differ between ADI groups.ConclusionsPediatric patients with MASLD in this study span the entire spectrum of neighborhood deprivation. There were no differences in presentation characteristics or severity of MASLD, aside from lower HDL-cholesterol and vitamin D values in the high ADI group. Area deprivation was not predictive of more severe disease as assessed by serum transaminases and liver biopsy NAFLD activity scores. What is Known Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with many of the clinical components of metabolic syndrome including obesity, diabetes mellitus, and dyslipidemia. The social influencers of health can increase one's risk for the components of metabolic syndrome.What is New Patients with higher levels of neighborhood-level socioeconomic deprivation do not have more severe MASLD at the time of initial presentation. MASLD patients with higher neighborhood-level deprivation present with lower vitamin D levels at the time of presentation and may benefit from supplementation.