{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:12:03Z","timestamp":1791313923487,"version":"4.3.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["MOST 109\u20102314\u2010B\u2010182A\u2010100"],"award-info":[{"award-number":["MOST 109\u20102314\u2010B\u2010182A\u2010100"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation","doi-asserted-by":"publisher","award":["CMRPG6P0241"],"award-info":[{"award-number":["CMRPG6P0241"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Obesity"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rising sedentary behaviour and consumption of sugar\u2010sweetened beverages and ultra\u2010processed foods have increased the risk and earlier onset of obesity in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To define controlled attenuation parameter (CAP) cut\u2010off values in healthy children, assess the prevalence of metabolic dysfunction\u2010associated steatotic liver disease (MASLD) in children with overweight and obesity, and establish an appropriate starting age for MASLD screening in our population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Healthy primary school children were recruited. Hepatic steatosis was assessed using CAP, and body composition data were collected during two periods: August 2020\u2013March 2021 and February 2023\u2013May 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1653 participants (mean age 9.5\u2009\u00b1\u20091.7\u2009years), 976 children with normal weight were used to establish reference intervals. Hepatic steatosis was defined as a CAP above 247\u2009dB\/m (97.5th percentile). The prevalences of MASLD in children with overweight and obesity were 0% and 16%, respectively, in school grade 1, which increased to 19% and 75% in school grade 6 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Screening for hepatic steatosis associated with obesity should begin as early as school grade 1, while screening for children with overweight may be more appropriate by school grade 6. These findings emphasise the need for age\u2010 and weight\u2010specific screening strategies for children with overweight and obesity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijpo.70080","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T06:47:56Z","timestamp":1766472476000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Starting Age for Screening Metabolic Dysfunction\u2010Associated Steatotic Liver Disease in Children Using Controlled Attenuation Parameter on Transient Elastography"],"prefix":"10.1111","volume":"21","author":[{"given":"Li\u2010Wen","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology Chang Gung Memorial Hospital  Chiayi Taiwan"},{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jrhau","family":"Lung","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Department of Medical Research and Development Chang Gung Memorial Hospital  Chiayi Taiwan"},{"name":"General Education Center Chang Gung University of Science and Technology  Chiayi Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju\u2010Bei","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chang Gung Memorial Hospital  Chiayi Taiwan"},{"name":"School of Traditional Chinese Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6111-2602","authenticated-orcid":false,"given":"Chao\u2010Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chang Gung Memorial Hospital  Chiayi Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010San","family":"Liao","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Department of Diagnostic Radiology Chang Gung Memorial Hospital  Yunlin Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"issue":"4","key":"e_1_2_12_2_1","first-page":"374","article-title":"EASL\u2013EASD\u2013EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction\u2010Associated Steatotic Liver Disease (MASLD)","volume":"17","author":"Tacke F.","year":"2024","journal-title":"Journal of Hepatology"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140908"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12519-024-00814-1"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001482"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318252a13f"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(99)70506-8"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43066-020-00043-x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20170959"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10396-022-01196-5"},{"key":"e_1_2_12_11_1","first-page":"49","article-title":"Liver Stiffness: A Novel Parameter for the Diagnosis of Liver Disease","volume":"2","author":"Mueller S.","year":"2010","journal-title":"Hepatology, Medicine and Policy"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.210736"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.043497"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0171568"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010030\u201050423\u20106_35"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-8981(03)00133-5"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2021.010502"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/17.4.275"},{"key":"e_1_2_12_19_1","volume-title":"Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory: Approved Guideline","author":"Horowitz G. 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