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. 2025 Jul;114(7):1709-1719.
doi: 10.1111/apa.70026. Epub 2025 Feb 13.

Sex Differences in Body Composition and MASLD in Children With Overweight and Obesity

Adi Uretzky  1   2 , Eyal Cohen-Sela  1   2 , Michal Yackobovitch-Gavan  3 , Asaf Ben Simon  1   2 , Eyas Midlij  1 , Hussein Zaitoon  1   2 , Ophir Borger  1   4 , Hagar Interator  1   4 , Achiya Z Amir  2   5 , Hadar Moran-Lev  2   5 , Avivit Brener  1   2 , Yael Lebenthal  1   2
Affiliations

Sex Differences in Body Composition and MASLD in Children With Overweight and Obesity

Adi Uretzky et al. Acta Paediatr. 2025 Jul.

Abstract

Aim: To explore the relationships between body composition, indices of hepatic fibrosis, and sonographic evidence of hepatic steatosis in children with overweight and obesity.

Methods: One hundred and seventy individuals (age 12.7 ± 3.4 years, 38.2% boys) with overweight/obesity (BMI z-score 2.02 ± 0.54) underwent bioelectrical impedance analysis (fat percentage, truncal-to-total fat ratio, muscle-to-fat ratio [MFR]). Hepatic assessments included ultrasonography to detect liver steatosis, alanine transaminase (ALT), aspartate aminotransferase (AST)/ALT ratio, and nonalcoholic fatty liver disease fibrosis score (NFS). A forward logistic regression model, adjusting for sex, age, and socio-economic position, was conducted.

Results: The odds for sonographic hepatic steatosis increased by 3.8-fold for each SD decrease in MFR z-score (OR = 0.263, 95% CI [0.067-1.031], p = 0.05). The strongest correlation among boys was between MFR z-score and AST/ALT ratio (r = 0.530, p < 0.001), whereas the strongest correlation among girls was between fat percentage and NFS (r = 0.503, p < 0.001). Individuals with sonographic hepatic steatosis had higher fat mass (p = 0.003), lower MFR z-score (p = 0.020), greater insulin resistance (p = 0.018), and atherogenic dyslipidemic index (p = 0.037) compared to those without.

Conclusions: We identified sex differences in the association between body composition and hepatic fibrosis indices. The relationship between adverse body composition and increased odds of hepatic steatosis underscores the importance of its assessment within this at-risk population.

Keywords: bioelectrical impedance analysis (BIA); hepatic steatosis; indices of hepatic fibrosis; muscle‐to‐fat ratio (MFR); nonalcoholic fatty liver disease (NAFLD).

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study design and patient selection.
FIGURE 2
FIGURE 2
Body composition parameters in boys and girls. Violin plots (distributions of numeric data using probability density curves) in boys and girls illustrate that (a) the fat percentage was lower in boys than girls (p = 0.007); (b) the truncal‐to‐total fat ratio was higher in boys than girls (p < 0.001); and (c) the muscle‐to‐fat ratio [MFR] z‐score was lower in boys compared to girls (p < 0.001). Wider regions indicate more frequent values. The black bold bar represents the median value, and the box indicates the interquartile range.
See this image and copyright information in PMC

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