Cardiovascular risk of metabolic‐dysfunction‐associated steatotic liver disease in Mexican pediatric population

Abstract Objective This study examines the association between metabolic‐dysfunction‐associated steatotic liver disease (MASLD) and cardiovascular risk, focusing on the predictive value of anthropometric, metabolic, and hepatic markers. Methods A predictive cross‐sectional study was conducted in children aged 5–18 years with overweight, obesity, or metabolic alterations suggestive of hepatic steatosis, with and without MASLD, at a Mexican pediatric endocrine clinic. MASLD was diagnosed via ultrasound, while cardiovascular risk was assessed using carotid intima‐media thickness (CIMT) and metabolic markers. Multiple regression models were developed to evaluate the contribution of vascular (CIMT), anthropometric, metabolic, and hepatic variables to cardiovascular risk. Results Children with MASLD had significantly higher body mass index (BMI) percentiles (97.56 ± 2.93 vs. 68.91 ± 33.89, p < 0.01), systolic blood pressure (SBP): 113.93 ± 9.38 mmHg versus 101.41 ± 11.45 mmHg, p < 0.01), and Homeostasis Model Assessment of Insulin Resistance (HOMA‐IR): 7.55 ± 2.23 versus 3.62 ± 1.76, p < 0.01) compared to controls. CIMT was greater in MASLD patients (0.738 mm vs. 0.56 mm, p < 0.01), suggesting early vascular remodeling. Model 4, which incorporated CIMT, metabolic markers, and liver enzymes, demonstrated the highest predictive value ( R ² = 0.935, p < 0.001), reinforcing the multifactorial nature of MASLD‐related cardiovascular risk. Conclusions MASLD is strongly associated with subclinical atherosclerosis and cardiometabolic dysregulation in children. The progressive increase in predictive accuracy across models underscores the importance of a multifactorial approach to cardiovascular risk assessment. Early subclinical cardiovascular findings are detectable in children with MASLD, supporting the rationale for early risk stratification and further research in this population.