Physical examination in a child or adolescent with suspected metabolic dysfunction-associated steatotic liver disease

Finding	Implications
Findings associated with conditions that could lead to MASLD
Overweight (BMI ≥85^th percentile) or obesity (BMI >95^th percentile)
Goiter, decreased height velocity, short stature	Suggests hypothyroidism
Abnormal fat distribution	Suggests partial lipodystrophy
Papilledema, neurologic deficits, short stature, and/or severe obesity	Panhypopituitarism, eg, related to craniopharyngioma or its treatment
Xanthelasmata	Suggests lysosomal acid lipase deficiency
Findings associated with risk of advanced MASLD
Increased waist circumference	Abdominal obesity
Acanthosis nigricans	Insulin resistance, diabetes
Splenomegaly	Portal hypertension
Sarcopenia (muscle wasting)	Possible advanced liver disease

BMI: body mass index; MASLD: metabolic dysfunction-associated steatotic liver disease (formerly known as nonalcoholic fatty liver disease [NAFLD]).

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