Application of 13C Methacetin Breath Test in Longitudinal Monitoring of Metabolic Dysfunction-Associated Fatty Liver Disease, Progression in Children, Adolescents, and Young Adults with History of Childhood Obesity

Authors: P. Boon-yasidhi (1), W. Karmasakul (2)

Affiliations: (1) Department of Pharmacology, Faculty of Medicine, Chulongkorn University, (2) Pediatric Liver Center, Department of Pediatric Gastroenterology, Hepatology and Nutrition Johns Hopkins University School of Medicine 

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Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) represents an increasingly recognized spectrum of liver pathology associated with obesity, insulin resistance, and metabolic syndrome in pediatric and asolescent populations. The condition encompasses non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), and advanced stages such as compensated and decompensated cirrhosis. 

In children and young adults, the progression of MAFLD can lead to chronic liver disease and elevated risks for hepatocellular carcinoma (HCC). Current tools for assessing disease progression and liver function, including APRI, FIB4, AST/ALT, GGT platelet ratio, and transient elastography have limitations in sensitivity and specificity. Liver biopsy remains the gold standard for diagnosing NASH and staging fibrosis. However, it’s invasive nature carries potential risks, making it not feasible for frequent monitoring in children and adolescents.

13C Methacetin Breath Test (13C-MBT), a non-invasive test that measures liver function through exhaled breath after the administration of 13C-labeled methacetin, may offer a promising solution. 13C-MBT reflects metabolic capacity of cytochrome P450 1A2, potentially indicating subtle impairments in liver function before clinical symptoms manifest.