In order to enhance lifestyle-based therapeutic strategies, this study aimed to investigate how an objectively measured healthier diet influenced pediatric metabolic-associated fatty liver disease (MAFLD).

Data on dietary food analysis were collected as part of the CyNCh RCT, which included pediatric patients aged 8–17 with confirmed MAFLD through biopsy. The Nutrition Data System for Research was utilized to evaluate diet, calculating the Healthy Eating Index (HEI, 0-100) and examining individual food components in children from ten tertiary clinical centers.

In total, 119 children were enrolled (mean age 13.3 ± 2.7 years), comprising 67% (n=80) males, 18% (n=67) White, and 76% (n=90) Hispanic individuals, with an average body mass index Z-score of 2.2 ± 0.5. Diets were categorized as high HEI (≥ 58.89, n=39), mid HEI (≥ 47.94 and < 58.89, n = 41), or low HEI (< 47.94, n = 39). Children with a high HEI (indicating a healthier diet) exhibited lower body weight and more favorable lipid profiles.

The mean serum triglycerides for low, mid, and high HEI groups were 163, 148, and 120 mg/dL, respectively. The mean high-density lipoprotein (HDL) levels were 38, 41, and 43 mg/dL, respectively. A lower severity of steatosis was witnessed when added sugar constituted ≤ 10% of calories. Higher lobular inflammation was linked to a greater percentage of calories from fat (Odds ratio [OR] = 0.95).

Among children with biopsy-proven MAFLD, a high HEI is related to reduced body weight and improved lipid profiles, whereas distinct histologic features are associated with individual intake levels of added sugar and fat. Varied consumption of key dietary components has the potential to alter both metabolic risk factors and histologic liver injury, underscoring the significance of precise diet evaluations in children with MAFLD.