One of the most important emerging complications associated with diabetes is the Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD). The liver fibrosis index-4 (FIB-4) is proposed, as a first approach, to screening for cirrhosis in these patients.

All unique patients attended by diabetes in the EDN department of our hospital from 1 January 2022 to 31 December 2022 were included. The FIB-4 value for each patient was obtained retrospectively from the laboratory programme of our hospital.

1259 unique patients with type 2 diabetes were attended, and the prevalence of advanced FIB-4 in these patients was 4.77% [95%CI: 3.66-6.09%]. 580 unique patients with type 1 diabetes were attended, and the prevalence of advanced FIB-4 in these patients was 1.72% [95%CI: 0.83-3.15%].

Our study confirms the importance of FIB-4 in people with diabetes to identify patients at higher risk of advanced liver fibrosis. We must highlight that 10.9% of patients with type 2 diabetes and 9.5% of patients with type 1 diabetes had an indeterminate FIB-4 result.

Over recent years, the nomenclature of non-alcoholic fatty liver disease has undergone significant changes. Indeed, in 2020, an expert consensus panel proposed the term "Metabolic (dysfunction) associated fatty liver disease" (MAFLD) to underscore the close association of fatty liver with metabolic abnormalities, thereby highlighting the cardiometabolic risks (such as metabolic syndrome, type 2 diabetes, insulin resistance, and cardiovascular disease) faced by these patients since childhood. More recently, this term has been further replaced with metabolic associated steatotic liver disease. It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments. However, comparable pediatric data remain limited. Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications, this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.