Metabolic dysfunction-associated fatty liver disease MAFLD previously known as nonalcoholic fatty liver disease NAFLD represents a spectrum of progressive liver disorders ranging from simple steatosis to nonalcoholic steatohepatitis NASH fibrosis and cirrhosis. Recognized as the hepatic manifestation of metabolic syndrome MAFLD has demonstrated an increasing global prevalence including low and middle income countries traditionally considered at lower risk.

In the paediatric population MAFLD has emerged as one of the most prevalent causes of chronic liver disease. Its spectrum starts with isolated hepatic steatosis and may progress to NASH which involves hepatocellular inflammation and damage. This progression is particularly concerning in the context of the global surge in childhood obesity a principal risk factor for MAFLD across diverse socioeconomic and geographic settings.

Anthropometric indices including waist circumference WC waist to hip ratio WHR waist to height ratio WHtR and wrist circumference are practical and noninvasive tools to assess body fat composition and central adiposity in children. These indices have shown significant associations with liver fat accumulation and broader metabolic abnormalities.

Metabolic profiling typically comprising fasting blood glucose serum insulin lipid profile including total cholesterol HDL LDL and triglycerides and liver enzymes such as alanine aminotransferase ALT and aspartate aminotransferase AST offers critical insights into the metabolic health of obese children. These parameters often show derangements in the presence of MAFLD.

An international consensus in 2020 has proposed Metabolic dysfunction associated fatty liver disease MAFLD as a new name for NAFLD. Diagnosis of MAFLD is based on the radiological evidence of hepatic steatosis and the presence of at least one of the following criteria namely overweight obesity type 2 diabetes T2D or evidence of metabolic dysregulation defined as the presence of two or more of these conditions.

1 Waist circumference greater than 95th percentile for age and sex

2 Blood pressure greater than 95th for age sex and height

3 Triglycerides greater than 150 mg per dL

4 HDL less than 40 mg per dL

5 Prediabetes

6 Homeostasis model assessment insulin resistance HOMA IR score greater than 2.5

Given the invasiveness and risks associated with liver biopsy especially in paediatric populations noninvasive diagnostic modalities have become crucial for the early detection and staging of MAFLD.

Transient elastography FibroScan is a validated noninvasive imaging tool that measures liver stiffness LSM and the controlled attenuation parameter CAP allowing for the assessment of fibrosis and steatosis respectively. Although well established in adults its application in children remains underexplored despite promising early evidence.

FibroScan is used to measure stiffness in the right lobe of the liver. Speed of propagation of the wave in liver depends on its stiffness. The velocity of shear wave increases in proportion to the stiffness of the liver. The stiffness derived is in kilopascal KPa unit at a shear wave frequency of 50 Hz.

In India data on the prevalence and noninvasive assessment of MAFLD in overweight and obese children are scarce. This study aims to investigate the correlation between anthropometric indices and metabolic profiles with liver elastography FibroScan findings in overweight and obese children through which the research intends to study the associations between body fat composition metabolic status and liver health potentially guiding early screening and aiding intervention strategies in paediatric MAFLD.