Waist circumference has been identified as a significant predictor for pediatric steatotic liver disease, surpassing body mass index in early detection, according to a study.

The cross-sectional study, published in Annals of Hepatology, examined 10,776 children aged 10 to 15 years in Shanghai, with 543 children (287 with normal body mass index (BMI) and 256 with high BMI) selected for detailed analysis. Researchers collected anthropometric, biochemical, and ultrasound data to investigate the associations of waist circumference (WC), BMI, and high-sensitivity C-reactive protein (hs-CRP) with steatotic liver disease (SLD), and its related metabolic abnormalities.

Significant correlations were found between Z-scores for WC (ZWC), BMI (ZBMI), and hs-CRP with SLD severity and metabolic markers. The high BMI group exhibited elevated levels of total cholesterol (4.31 vs 4.23 mmol/L, p = 0.043), triglycerides (0.96 vs 0.78 mmol/L, p < 0.001), and LDL cholesterol (2.51 vs 2.25 mmol/L, p < 0.001) compared with normal BMI peers. SLD prevalence was notably higher in the high BMI group (31.64% vs 3.16%, p < 0.001).

Regression analysis revealed that ZWC (OR 23.431, 95% CI, 7.253–75.697) and male sex (OR 7.927, 95% CI, 2.766–22.713) were independent risk factors for SLD. The optimal ZWC cut-offs for predicting SLD were 1.494 for boys and 1.541 for girls, achieving sensitivities of 92.54% and 95.65%, respectively. No significant interactive effects were found between ZWC with hs-CRP or ZBMI with hs-CRP.

The study’s findings highlight WC as a reliable, non-invasive screening tool for early detection of SLD in children. However, the authors caution that the use of ultrasonography instead of liver biopsy may limit diagnostic accuracy. Additionally, the findings are specific to a Chinese pediatric population, which may impact generalizability.

Ethical compliance and informed consent were ensured per the Declaration of Helsinki. Full details are available in the original publication.