Hepatic steatosis in young adulthood is independently associated with increased cardiovascular risk, and childhood steatosis relates to cIMT progression, supporting early MASLD detection and prevention.
Key Findings
Results
Adulthood hepatic steatosis was independently associated with increased carotid intima-media thickness (cIMT), a marker of cardiovascular risk.
Mean difference in cIMT was 0.035 mm (95% CI: 0.010–0.060 mm; p-adjusted = 0.008) in participants with adulthood steatosis compared to those without.
This association was independent of other factors, as indicated by the adjusted p-value.
Hepatic steatosis was measured using proton magnetic resonance spectroscopy and cIMT by ultrasound.
The study included 52 participants followed over approximately 10 years from childhood into young adulthood.
Results
Childhood hepatic steatosis was not independently associated with cIMT in adulthood.
Despite 46% of participants having steatosis in childhood ('diminishing' or 'persistent' trajectory groups), childhood steatosis did not show an independent association with adult cIMT.
This contrasts with adulthood steatosis, which was independently associated with increased cIMT.
Participants were children with severe obesity at baseline.
Results
Childhood steatosis was the only childhood metabolic factor associated with cIMT progression over the 10-year follow-up.
The association was statistically significant (β = 0.006, p = 0.030).
Other childhood metabolic factors evaluated were not associated with cIMT progression.
This suggests a specific long-term vascular relevance of early hepatic steatosis beyond other metabolic risk factors measured in childhood.
Results
Mean cIMT at follow-up increased progressively across the four steatosis trajectory groups.
The four trajectory groups were: 'absent' (no steatosis at either timepoint), 'diminishing' (steatosis in childhood only), 'adult-onset' (steatosis in adulthood only), and 'persistent' (steatosis at both timepoints).
The adjusted p-for-trend across trajectory groups was 0.003.
46% of participants had steatosis in childhood and 46% had steatosis in adulthood.
The progressive increase suggests a cumulative or sustained exposure effect of steatosis on vascular health.
Methods
The study followed children with severe obesity over 10 years, measuring metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular risk at both timepoints.
The total sample size was 52 participants.
Hepatic steatosis was quantified using proton magnetic resonance spectroscopy.
Cardiovascular risk was assessed using ultrasound carotid intima-media thickness (cIMT).
Participants were categorized into four trajectory groups based on the presence or absence of steatosis in childhood and/or adulthood.
What This Means
This research followed 52 children with severe obesity for about 10 years into young adulthood, tracking whether they had fatty liver disease (called MASLD) and measuring signs of early heart and blood vessel damage. The key measure of cardiovascular risk was the thickness of the carotid artery wall in the neck (called carotid intima-media thickness, or cIMT) — a thicker wall is an early sign of increased risk for heart disease. Participants were grouped based on whether they had fatty liver as children, as young adults, both, or neither.
This research suggests that having fatty liver disease as a young adult is independently linked to thicker carotid artery walls, a sign of greater cardiovascular risk. Interestingly, having fatty liver as a child alone was not independently linked to artery thickness in adulthood, but childhood fatty liver was the only childhood metabolic factor associated with how much the artery thickness changed (progressed) over the 10-year period. Additionally, those who had persistent fatty liver across both childhood and adulthood showed the greatest artery wall thickness.
These findings suggest that fatty liver disease in young people — even those who may improve over time — can have lasting effects on cardiovascular health. This supports the importance of detecting and addressing fatty liver disease early in life, particularly in children with obesity, as it may help reduce the risk of heart and blood vessel problems later on.
Stroes A, Kusters D, Draijer L, Bohte A, Nederveen A, de Groot E, et al.. (2026). Hepatic Steatosis and Cardiovascular Risk in Obesity: A 10-Year Follow-Up Study From Childhood Into Young Adulthood.. Pediatric obesity. https://doi.org/10.1111/ijpo.70148