Supplementary Material for: Risk scores for metabolic dysfunction-associated fatty liver disease in pediatric obesity

Introduction: Early non-invasive detection of incipient liver damage is crucial to prevent long-term adverse health outcomes. A variety of scores to assess liver status have been proposed, mostly for adult populations. Validation of non-invasive hepatic scores to identify children at risk of metabolic dysfunction-associated fatty liver disease (MAFLD) is a gap in research, particularly in youth with severe obesity considering pubertal stage and sex. Methods: In a well-characterized pediatric population aged 9 to 19 years (n=115) 19 published liver scores were analyzed. AUROC for determination of MAFLD as assessed by magnetic resonance imaging was calculated. Results: The pediatric indices PNFI, B-AST and M-APRI and several scores developed in adults significantly differed in children with MAFLD compared to children without, while some established indices did not. Only NAFLD-LFS and the model by Cao et al. showed acceptable predictive accuracy (AUROC > 0.8) independently of pubertal stage and sex. When stratifying for pubertal stage and sex, the GSG-Index was superior in pubertal girls, and NAFLD-LFS performed best in pubertal boys. Conclusion: NAFLD-LFS and the model by Cao et al. were well suited to predict MAFLD in youth with severe obesity. In pubertal children, GSG-Index and NAFLD-LFS performed best in girls and boys, respectively.

Introduction: 早期无创检测初始肝损伤，对于预防远期不良健康结局至关重要。目前已提出多种用于评估肝脏状态的评分体系，其中多数针对成人人群。针对存在代谢功能障碍相关脂肪性肝病（metabolic dysfunction-associated fatty liver disease, MAFLD）风险儿童的无创肝脏评分验证研究仍存在研究空白，尤其是在需考虑青春期阶段与性别的重度肥胖青少年群体中。
Methods: 本研究纳入115名年龄介于9至19岁的特征明确的儿科队列受试者，对19种已发表的肝脏评分体系展开分析，并计算以磁共振成像为金标准的MAFLD诊断的受试者工作特征曲线下面积（Area Under the Receiver Operating Characteristic Curve, AUROC）。
Results: 儿科评分指标PNFI、B-AST与M-APRI，以及数种源自成人的评分体系，在合并MAFLD与未合并MAFLD的儿童中存在显著差异，而部分成熟临床指标则无此差异。仅非酒精性脂肪性肝病肝纤维化评分（NAFLD Liver Fibrosis Score, NAFLD-LFS）与Cao等人提出的模型，可不受青春期阶段与性别的影响，展现出可接受的预测效能（AUROC＞0.8）。当按青春期阶段与性别进行分层分析时，GSG-指数在青春期女孩中表现最优，而NAFLD-LFS则在青春期男孩中展现出最佳诊断效能。
Conclusion: NAFLD-LFS与Cao等人提出的模型，可较好地预测重度肥胖青少年的MAFLD发病风险。在青春期儿童群体中，GSG-指数与NAFLD-LFS分别在女孩与男孩群体中表现最优。