Zhang Tian, Qian Yi, Zhang Jin, Wan Naijun
Department of Pediatric Internal Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
Healthcare (Basel). 2025 Sep 4;13(17):2219. doi: 10.3390/healthcare13172219.
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.
代谢功能障碍相关脂肪性肝病（MASLD）在成年男性中的性别差异已得到证实；然而，关于儿科人群的数据仍然很少。本研究旨在阐明肥胖儿童血清尿酸（SUA）、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）水平与MASLD的性别特异性相关性。对262名肥胖儿童的临床资料进行回顾性分析。参与者按性别和MASLD状态（MASLD+与MASLD-）分类。比较了包括ALT、AST、SUA、空腹血糖、糖化血红蛋白、血脂谱和胰岛素水平在内的实验室检查结果。采用多变量逻辑回归分析按性别对非酒精性脂肪性肝病儿童肥胖的显著影响因素进行比较。高胰岛素血症在所有儿童中均与MASLD显著相关。基于性别的分析揭示了不同的模式。在男性中，SUA升高（=0.008）和ALT升高（<0.05）与MASLD独立相关；然而，在女性中，只有AST升高（=0.003）与MASLD显著相关。虽然胰岛素抵抗是所有肥胖儿童发生MASLD的常见危险因素，但本研究表明其表现可能因性别而异。SUA和ALT水平升高可能是男性MASLD的性别特异性指标，而AST水平升高在女性中似乎更相关。这些发现支持了性别特异性代谢标志物在早期MASLD筛查中的潜在价值，尽管还需要进一步验证。
