ArticleJournal of pediatric gastroenterology and nutrition2026
Mid-upper arm circumference, steatosis indices, and elastography for screening liver steatosis in children with overweight/obesity: A prospective cross-sectional study.
Article in Journal of pediatric gastroenterology and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesMetabolic dysfunction-associated steatotic liver disease (MASLD) is common in children, and practical screening approaches are needed in populations with overweight/obesity. We aimed to evaluate mid-upper arm circumference (MUAC) as a simple marker for ultrasonography (US)-detected liver steatosis (LS) in children with overweight/obesity, to examine the performance of other non-invasive measures, and to assess MUAC-based composite cut-offs.
methodsIn this study, 194 children with overweight/obesity aged 5-17 years were evaluated at a pediatric gastroenterology clinic. US-detected LS was defined as US grade ≥1. Liver stiffness was measured by two-dimensional shear-wave elastography (2D-SWE). Fasting biochemistry was obtained, and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio, Hepatic Steatosis Index, and Framingham Steatosis Index were calculated. Associations between US-detected LS and anthropometric, biochemical, and liver stiffness measures were assessed using Spearman correlation, logistic regression, and receiver operating characteristic analyses; composite models used an odds ratio-rule approach.
resultsUS-detected LS was present in 55.2%. MUAC ≥ 30.0 cm yielded an area under the curve (AUC) of 0.738 for identifying US-detected LS. A composite rule of body mass index (BMI) z score ≥1.70 or MUAC ≥ 30.0 cm achieved 97.2% sensitivity and 54.0% specificity for identifying US-detected LS, with an AUC of 0.813, negative predictive value 94.0%, and positive predictive value 72.2%. Adding liver stiffness ≥5.68 kPa increased discrimination for identifying US-detected LS, with an AUC of 0.881.
conclusionMUAC is a low-cost adjunct for screening US-detected LS in children with overweight/obesity. Simple composite cut-offs integrating MUAC with BMI showed high sensitivity in this cohort and may support initial risk stratification before ultrasonographic evaluation; adding liver stiffness yielded the highest discriminative performance.
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