Global prevalence of metabolic dysfunction-associated fatty liver disease in children and adolescents with overweight and obesity: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational prevalence studies
PubMed 41053609 · doi:10.1186/s12876-025-04314-y
What was done
A systematic review and meta-analysis searched PubMed, Embase, Medline, CENTRAL, and Web of Science through May 10, 2024. The authors included studies assessing metabolic dysfunction-associated fatty liver disease (MAFLD) in children and adolescents aged 1 to 19 years with overweight or obesity using histological, imaging, or biomarker diagnostic criteria. Subgroup analyses evaluated geographic region, development status, time period, clinical setting, diagnostic technique, and BMI category.
What was found
The meta-analysis included 176 studies with 57,058 participants. The global pooled prevalence of MAFLD among children and adolescents with overweight or obesity was 41.2% (95% CI: 39.7%–44.6%). Prevalence differed by geography, with the highest rates in North America (43.6%) and lowest in Africa (31.1%). Prevalence was higher in post-2010 studies (42.5%) compared to pre-2010 studies (38.2%), in hospital-based settings (42.5%) versus community settings, and when assessed by liver biopsy (51.2%) compared to other diagnostic modalities.
Why it matters
This review establishes that roughly two out of five youths with overweight or obesity globally meet criteria for MAFLD, with prevalence trending upward in recent years. It highlights the widespread pediatric burden of hepatic metabolic dysfunction and the need for standardized diagnostic protocols.
Limits
The included studies used varying diagnostic methods (biopsy, imaging, and biomarkers) and sampling frames (hospital vs. community), introducing significant methodological heterogeneity. The abstract does not report formal heterogeneity metrics (such as I²), risk of bias ratings, or confidence intervals for subgroup estimates.
Cited by
- context Twenty-five percent of children have fatty liver disease when evaluated by MRI.