Interplay of childhood metabolic dysfunction-associated steatotic liver disease and obesity in the development of youth-onset type 2 diabetes

Table 2 Key biomarkers and imaging techniques for pediatric metabolic dysfunction-associated steatotic liver disease

Biomarker/technique	Type	Utility in MASLD	Ref.
ALT	Serum enzyme	Indicates liver injury; used for screening but not specific to MASLD	Vos et al[72], Chan et al[73]
Aspartate aminotransferase	Serum enzyme	Complements ALT in screening for liver damage; like ALT, has low sensitivity	Vos et al[72], Chan et al[73]
Adiponectin	Serum hormone	Lower levels are associated with increased liver fat and inflammation; potential marker for metabolic dysfunction	De Silva et al[82], Mierzwa et al[83]
High-sensitivity C-reactive protein	Serum protein	Indicates systemic inflammation; elevated in obese children with MASLD	Fahed et al[44], Kim et al[84]
Cytokeratin-18	Serum marker	Marker of liver cell death; elevated in steatohepatitis, indicating disease severity	Chen et al[85], Garg et al[86], Jayasekera et al[87]
Ultrasound	Imaging	Detects liver fat but cannot determine disease severity; has low sensitivity	Jia et al[81], Hajibonabi et al[88]
FibroScan	Imaging	Measures liver stiffness to assess fibrosis; non-invasive alternative to biopsy	Kwon et al[80], Jayasekera et al[87]
Magnetic resonance imaging-proton density fat fraction	Imaging	Accurately measures liver fat content; useful for monitoring disease progression	Jia et al[81], Jayasekera et al[87]

ALT: Alanine aminotransferase; MASLD: Metabolic dysfunction-associated steatotic liver disease.