Metabolic Dysfunction-Associated Steatotic Liver Disease in Children with Obesity: Sex-Stratified Analysis of Hepatic Enzyme Profiles and Serum Uric Acid.

Sex differences in metabolic dysfunction-associated steatotic liver disease (MASLD) have been established in adult males; however, data on paediatric populations remain scarce. This study aimed to elucidate the sex-specific correlations of serum uric acid (SUA), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels with MASLD in children with obesity. Clinical data from 262 children with obesity were retrospectively analysed. Participants were categorised by sex and MASLD status (MASLD+ vs. MASLD-). Laboratory tests, including ALT, AST, SUA, fasting glucose, glycated haemoglobin, lipid profile, and insulin levels, were compared. Comparison of significant influencing factors of obesity in children with non-alcoholic fatty liver disease was conducted using multivariable logistic regression analysis by sex. Hyperinsulinemia was significantly associated with MASLD in all children. Sex-based analyses revealed differentiated patterns. In males, elevated SUA ( = 0.008) and ALT ( < 0.05) were independently associated with MASLD; however, in females, only elevated AST ( = 0.003) was significantly associated. While insulin resistance is a common risk factor for MASLD in all children with obesity, this study suggests that its manifestation may differ by sex. Elevated SUA and ALT levels may serve as sex-specific indicators in males, while elevated AST levels appear more relevant in females. These findings support the potential value of sex-specific metabolic markers in early MASLD screening, although further validation is needed.