{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:44:21Z","timestamp":1788414261750,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T00:00:00Z","timestamp":1726444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Metabolic dysfunction\u2010associated steatotic liver disease (MASLD) is common in children. We hypothesized environmental toxins could drive progression to metabolic dysfunction\u2010associated steatohepatitis (MASH), and assayed serum toxins and metabolites in children with histologically characterized MASLD\/MASH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Environmental chemicals, common in household items, perfluoroalkyl substances (PFAS), polybrominated flame retardants (polybrominated diphenyl ethers [PBDEs]), and metabolic profiles were assayed in children enrolled in the multicenter NASH Clinical Research Network Pediatric Database 2. Mixture models, using repeated holdout weighted quantile sum regression (WQS<jats:sub>rh<\/jats:sub>) were run in addition to single chemical\/metabolite logistic regression. For metabolomic analyses, random subset version of WQS<jats:sub>rh<\/jats:sub> was used for the large number of predictors versus participants. Nominal and false discovery rate (FDR) <jats:italic>p<\/jats:italic>\u2010values (two\u2010sided) were computed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four hundred and thirty\u2010five children distributed across MASH (<jats:italic>n<\/jats:italic>\u2009=\u2009293) and MASLD (<jats:italic>n<\/jats:italic>\u2009=\u2009142), with 304 (69.9%) males. Mean (standard deviation) for Nonalcoholic Steatohepatitis Score (NAS) and alanine aminotransferase (ALT) for MASLD were 3.1 (1.0), 67.9 (43.4), and for MASH 4.2 (1.4), 144 (121). There was an inverse association between PFAS\/PBDE mixture and MASH versus MASLD, lobular inflammation (<jats:italic>p<\/jats:italic>\u2009=\u20090.026), NAS (<jats:italic>p<\/jats:italic>\u2009=\u20090.009, FDR <jats:italic>p<\/jats:italic>\u2009=\u20090.04), and log\u2010transformed ALT (<jats:italic>p<\/jats:italic>\u2009=\u20090.005, FDR <jats:italic>p<\/jats:italic>\u2009=\u20090.025) driven by perfluorohexane sulfonate (PFHXS). Metabolites from positive hydrophilic interaction liquid chromatography mode, biliverdin (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) and 1\u2010methylhistidine (associated with meat ingestion, <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and reverse phase negative mode, hippuric acid (solvent exposure, <jats:italic>p<\/jats:italic>\u2009=\u20090.022) significantly associated with MASH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Significant negative PFAS\/PBDE mixture effect and odds of MASH were dominated by PHFXS. Several metabolites are significantly associated with MASH which inform mechanistic pathways and could drive key therapeutic and diagnostic strategies in children.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.12346","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T10:46:08Z","timestamp":1726483568000},"page":"943-953","source":"Crossref","is-referenced-by-count":9,"title":["Environmental toxicants modulate disease severity in pediatric metabolic dysfunction\u2010associated steatohepatitis"],"prefix":"10.1002","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9420-5722","authenticated-orcid":false,"given":"Ajay K.","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition Saint Louis University St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie 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