High Prevalence of Metabolic-Associated Fatty Liver Disease (MAFLD) in Children and Adolescents with Severe Obesity.

: Severe obesity in children and adolescents presents a particular health burden due to high prevalence of complications and comorbidities, including metabolic-associated fatty liver disease (MAFLD). The aim of this study was to assess the prevalence of MAFLD in Polish children and adolescents with severe obesity, and assess its relation to anthropometric profiles and metabolic risk factors. : In 212 children and adolescents with severe obesity (aged 3-18 years), physical examination, body composition, liver ultrasound (US), and biochemical assessment were performed. MAFLD was diagnosed based on the presence of steatosis in US and/or persistently elevated alanine aminotransferase concentration. : MAFLD was present in 125 (59.0%) patients. Metabolic Syndrome (MetS) was diagnosed among 57.5% of patients without MAFLD, and in 66.5% of patients with MAFLD ( > 0.05). Impaired fasting glucose, impaired glucose tolerance, and high HOMA-IR occurred more frequently in MAFLD than in non-MAFLD patients ( < 0.05). In the MAFLD group, a higher number of patients with ≥4 components of MetS were observed than in the non-MAFLD group (33.6% vs. 12.6%, = 0.0004). : The prevalence of MAFLD among children and adolescents with severe obesity was 59%. These patients are characterised by more pronounced insulin resistance and higher number of MetS components.