Hepatic Steatosis in Overweight/Obese Children despite Normal Transaminase Levels: A Cross-sectional Study

Background: The objective is to determine the liver involvement among children who are overweight or obese in relation to serum transaminases, biochemical parameters, liver ultrasound, and shear wave elastography. Material and Methods: This cross-sectional study included 80 overweight and obese children aged 5–15 years attending a tertiary care hospital. Anthropometric measurements, liver function tests, fasting blood sugar, HbA1c, serum insulin, lipid profile, abdominal ultrasonography, and elastography (SWE) were performed. Statistical comparisons were performed between normal and abnormal USG groups. Results: The mean age was 10.4 ± 2.3 years, with 70.0% males. Forty-eight (60.0%) children were overweight and 32 (40.0%) were obese. Normal liver echogenicity was observed in 51 (63.7%), while fatty liver was detected in 29 (36.3%) children. The mean SWE was 5.41 ± 2.52 kPa and was significantly higher in children with abnormal USG than in those with normal USG (8.1 ± 1.9 vs. 3.9 ± 1.2 kPa, p<0.001). LDL was also significantly higher in the abnormal-USG group (70.7 ± 20.8 vs. 61.7 ± 9.9 mg/dL, p=0.010). Liver enzymes, fasting blood sugar, HbA1c, and serum insulin were statistically comparable between groups. Conclusion: Combining anthropometric evaluation with liver enzyme testing, ultrasonography, and elastography may enable earlier detection of hepatic abnormalities in obese children and facilitate identification of those requiring more comprehensive metabolic and hepatological assessment.

Keywords: elasticity imaging techniques, fatty liver, glycated hemoglobin, liver function tests, overweight, pediatric obesity.