Dihydroxyacetone phosphate is a novel predictor of hepatic fibrosis in Latino adolescents with obesity

Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common pediatric liver disease and can progress to liver fibrosis. Latino adolescents have increased MASLD and fibrosis risk. While fibrosis is diagnosed by biopsy or imaging, more accessible, noninvasive, and economical screening methods are needed. We aimed to use plasma metabolomics/lipidomics to identify potential fibrosis biomarkers in Latino adolescents with obesity. Liver stiffness (LS) was measured in 93 Latino adolescents with obesity using magnetic resonance elastography. Metabolites and lipids were extracted from plasma and identified on Compound Discoverer. Associations between metabolites/lipids and fibrosis (LS > 2.73 kPa) were determined using linear regression models after covariate adjustment. False discovery rate (FDR) adjusted Pearson's correlations were performed. Analytes yielding significant FDR‐adjusted correlations were examined further by receiver operator curve analysis. Mean (±standard deviation) alanine transaminase (ALT) was 45.7(±65.2) IU/L, hepatic fat fraction was 12.7(±9.1)%, and LS was 2.4(±0.3) kPa. We identified 795 metabolites and 413 lipids in plasma, but only one single metabolite, dihydroxyacetone phosphate (DHAP), a marker of triglyceride synthesis, was significantly associated with fibrosis after FDR adjustment (p< 0.05). In terms of predicting fibrosis, ALT had an area under the curve (AUC) of 0.79, and DHAP had an AUC of 0.79. When combined, ALT + DHAP had an AUC of 0.89. The combination of ALT + DHAP may have the potential as an accurate, noninvasive test for liver fibrosis. Our data are limited to Latino children with obesity, and a larger cohort should be examined to further validate this novel biomarker. Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common cause of pediatric liver disease and can progress to liver fibrosis in advanced disease.Two well‐known risk factors for adolescent MASLD are Latino ethnicity/race and obesity.Liver biopsies, the gold standard for diagnosis of liver fibrosis, are invasive, expensive, and prone to sampling error. Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common cause of pediatric liver disease and can progress to liver fibrosis in advanced disease. Two well‐known risk factors for adolescent MASLD are Latino ethnicity/race and obesity. Liver biopsies, the gold standard for diagnosis of liver fibrosis, are invasive, expensive, and prone to sampling error. The combination of alanine transaminase + dihydroxyacetone phosphate, a marker of triglyceride synthesis, may have the potential as an accurate, noninvasive test for liver fibrosis in Latino adolescents with obesity. The combination of alanine transaminase + dihydroxyacetone phosphate, a marker of triglyceride synthesis, may have the potential as an accurate, noninvasive test for liver fibrosis in Latino adolescents with obesity.