Evaluation of tri-ponderal mass index in predicting metabolic associated fatty liver disease in obese children.

BACKGROUND

This study aimed to evaluate the effectiveness of the tri-ponderal mass index (TMI) in identifying metabolic dysfunction-associated fatty liver disease (MAFLD) in obese children and adolescents.

METHODS

A total of 238 obese children and adolescents were included in the study. Evaluations included anthropometric measurements, liver function tests, lipid parameters, fasting glucose, insulin, and HOMA-IR. Logistic regression analysis was performed to determine the predictive value of TMI for MAFLD.

RESULTS

MAFLD was diagnosed in 55.5% of participants. TMI values were significantly higher in the MAFLD group compared to those without MAFLD (mean TMI: 21.01 ± 3.05 vs. 20.14 ± 2.90, p = 0.026). In logistic regression analyses, male sex was an independent predictor in both models (OR = 3.10, p = 0.003 in the BMI-SDS model; OR = 2.63, p = 0.008 in the TMI model). HOMA-IR (OR = 1.10, p = 0.042; OR = 1.11, p = 0.029) and ALT (OR = 1.04, p = 0.002; OR = 1.05, p = 0.002) were also significant in both models. TMI was not independently associated with MAFLD (p = 0.249). TMI showed positive correlations with age, weight-SDS, BMI-SDS, fasting insulin, HbA1c, HOMA-IR, and the grade of hepatosteatosis.

CONCLUSION

While TMI values were higher in patients with MAFLD, TMI was not an independent predictor of MAFLD in obese children. Male sex, HOMA-IR, and ALT were consistently associated with MAFLD, suggesting greater predictive value. These findings suggest that TMI may have limited utility as a screening tool for MAFLD in pediatric clinical practice.