Development and validation of an online nomogram for screening metabolic-associated fatty liver disease in obese children

Development and validation of an online nomogram for screening metabolic-associated fatty liver disease in obese children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and validation of an online nomogram for screening metabolic-associated fatty liver disease in obese children Hu Jia qian, Mengqin Wang, Xi Wang, Mingwei Guo, Yaqing Lu, Zixia Zhang, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6392727/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Nov, 2025 Read the published version in Italian Journal of Pediatrics → Version 1 posted 5 You are reading this latest preprint version Abstract Background Metabolic-associated fatty liver disease (MAFLD) has emerged as a critical pediatric health concern, particularly among children with obesity. However, its diagnosis poses substantial challenges, especially in the use of non-invasive methods. Our goal was to construct an online nomogram for screening MAFLD in obese children. Methods We designed a retrospective cross-sectional study involving 2,512 obese children. Detailed anthropometric data and laboratory parameters were collected. The study dataset was randomly allocated into training (n = 1758) and validation (n = 754) sets at a 7:3 ratio. To identify MAFLD risk factors, we conducted logistic regression analyses, from which a web-based predictive nomogram was constructed. Using receiver operating characteristic (ROC) curves and area under the curve (AUC), the nomogram's performance was assessed and contrasted with the triglyceride glucose (TyG) index, Zhejiang University (ZJU) index, and Korean NAFLD (K-NAFLD) score. The goodness-of-fit of the nomogram was evaluated using calibration plots, and the nomogram's clinical value was assessed using decision curve analysis (DCA). Results A total of 1,344 participants (53.50%) were diagnosed with MAFLD by ultrasound. Age, gender, BMI Z-score, waist circumference (WC), homeostatic model assessment for insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) were identified as independent factors influencing MAFLD in obese children. These six variables were selected for the construction of the nomogram. ROC analysis revealed that the nomogram had superior diagnostic performance for MAFLD detection compared to the other three models, with AUC values of 0.874 (95% confidence interval [CI]: 0.858-0.890) in the training set and 0.870 (95% CI: 0.845-0.895) in the validation set. Calibration plots indicated a good fit of the nomogram in both datasets. Furthermore, DCA demonstrated its strong clinical applicability. Conclusions This study developed an online nomogram that demonstrates robust diagnostic accuracy and clinical utility for assessing obese children's MAFLD risk. Obesity children Metabolic-associated fatty liver disease Online nomogram Prediction model Full Text Cite Share Download PDF Status: Published Journal Publication published 24 Nov, 2025 Read the published version in Italian Journal of Pediatrics → Version 1 posted Editorial decision: Major revision 14 Jul, 2025 Reviewers agreed at journal 04 Jun, 2025 Reviewers invited by journal 04 Jun, 2025 Editor assigned by journal 14 Apr, 2025 First submitted to journal 07 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6392727","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466323329,"identity":"1a8c1a3c-e970-41ad-9abe-8df227f1c295","order_by":0,"name":"Hu Jia 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children","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obesity children, Metabolic-associated fatty liver disease, Online nomogram, Prediction model","lastPublishedDoi":"10.21203/rs.3.rs-6392727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6392727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background\n\nMetabolic-associated fatty liver disease (MAFLD) has emerged as a critical pediatric health concern, particularly among children with obesity. However, its diagnosis poses substantial challenges, especially in the use of non-invasive methods. Our goal was to construct an online nomogram for screening MAFLD in obese children.\n\nMethods\n\nWe designed a retrospective cross-sectional study involving 2,512 obese children. Detailed anthropometric data and laboratory parameters were collected. The study dataset was randomly allocated into training (n = 1758) and validation (n = 754) sets at a 7:3 ratio. To identify MAFLD risk factors, we conducted logistic regression analyses, from which a web-based predictive nomogram was constructed. Using receiver operating characteristic (ROC) curves and area under the curve (AUC), the nomogram's performance was assessed and contrasted with the triglyceride glucose (TyG) index, Zhejiang University (ZJU) index, and Korean NAFLD (K-NAFLD) score. The goodness-of-fit of the nomogram was evaluated using calibration plots, and the nomogram's clinical value was assessed using decision curve analysis (DCA).\n\nResults\n\nA total of 1,344 participants (53.50%) were diagnosed with MAFLD by ultrasound. Age, gender, BMI Z-score, waist circumference (WC), homeostatic model assessment for insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) were identified as independent factors influencing MAFLD in obese children. These six variables were selected for the construction of the nomogram. ROC analysis revealed that the nomogram had superior diagnostic performance for MAFLD detection compared to the other three models, with AUC values of 0.874 (95% confidence interval [CI]:\n0.858-0.890) in the training set and 0.870 (95% CI: 0.845-0.895) in the validation set. Calibration plots indicated a good fit of the nomogram in both datasets. Furthermore, DCA demonstrated its strong clinical applicability.\n\nConclusions\n\nThis study developed an online nomogram that demonstrates robust diagnostic accuracy and clinical utility for assessing obese children's MAFLD risk.","manuscriptTitle":"Development and validation of an online nomogram for screening metabolic-associated fatty liver disease in obese children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-06 06:33:21","doi":"10.21203/rs.3.rs-6392727/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2025-07-14T06:44:09+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-06-04T09:19:40+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-04T09:06:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-14T13:20:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Italian Journal of Pediatrics","date":"2025-04-07T05:47:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7014cf41-1779-49e3-b00b-2476d1366db1","owner":[],"postedDate":"June 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T15:59:57+00:00","versionOfRecord":{"articleIdentity":"rs-6392727","link":"https://doi.org/10.1186/s13052-025-02151-z","journal":{"identity":"italian-journal-of-pediatrics","isVorOnly":false,"title":"Italian Journal of Pediatrics"},"publishedOn":"2025-11-24 15:57:05","publishedOnDateReadable":"November 24th, 2025"},"versionCreatedAt":"2025-06-06 06:33:21","video":"","vorDoi":"10.1186/s13052-025-02151-z","vorDoiUrl":"https://doi.org/10.1186/s13052-025-02151-z","workflowStages":[]},"version":"v1","identity":"rs-6392727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6392727","identity":"rs-6392727","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}