Title: Liver function indicators as risk factors of pediatric metabolic (dysfunction)-associated fatty liver disease: a systematic review and meta-analysis
Source: Translational Pediatrics 2026, 15 (2): 49
Date of publication: February 2026
Publication type: Systematic review and meta-analysis
Abstract: Background: Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is the most common chronic liver disorder in children and adolescents, with its prevalence rising alongside the global childhood obesity epidemic. Liver function indicators offer a potential non-invasive screening alternative, but existing evidence on their association with pediatric MAFLD is inconsistent due to heterogeneous study designs and populations. Therefore, this systematic review and meta-analysis aimed to synthesize global evidence to definitively evaluate liver function indicators as risk factors for MAFLD in children and adolescents.
Methods: Four databases-The Cochrane Library, Embase, Web of Science, and PubMed-were searched from inception to July 5, 2025. The eligible studies were observational in design and focused on children and adolescents (<18 years), comparing MAFLD prevalence/risk between those with abnormal versus normal liver function indicators. Two independent researchers performed literature screening, information collection, and quality evaluation per the eligibility criteria. The ‘meta’ package in R was adopted to compute the odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between liver function indicators and MAFLD. Heterogeneity and publication bias were also assessed.
Results: This meta-analysis incorporated 27 studies, involving 3,237 confirmed MAFLD cases. Levels of alanine aminotransferase (ALT) [OR (95% CI): 1.15 (1.01, 1.30)], gamma-glutamyl transferase (GGT) [1.30 (1.09, 1.56)], and high-density lipoprotein (HDL) [0.97 (0.96, 0.98)] were associated with MAFLD risk. Elevated ALT [OR (95% CI): 20.63 (2.39, 178.09)], total cholesterol (TC) [3.36 (1.15, 9.82)], triglycerides (TG) [4.86 (2.37, 9.98)], low-density lipoprotein (LDL) [3.74 (1.15, 12.19)], and decreased HDL [2.77 (1.97, 3.91)] were identified as potential risk factors for MAFLD in children and adolescents. Overall, subgroup analyses (by confounder adjustment status and study design), sensitivity analyses, and meta-regression did not identify potential sources of heterogeneity. No significant publication bias was observed.
Conclusions: Liver function indicators show promise as screening tools for the early detection of MAFLD susceptibility. This study has several limitations, including a small number of included studies, resulting in heterogeneity, as well as the inherent risk of bias (ROB) in observational designs and the imprecision of some results.
