{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:50:57Z","timestamp":1773017457020,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"am","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["P20GM109096"],"award-info":[{"award-number":["P20GM109096"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000199","name":"U.S. Department of Agriculture","doi-asserted-by":"publisher","award":["6026\u201010700\u2010001\u2010000D"],"award-info":[{"award-number":["6026\u201010700\u2010001\u2010000D"]}],"id":[{"id":"10.13039\/100000199","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Obesity"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Youth with obesity are at risk for accumulating liver fat, even below the threshold for metabolic dysfunction\u2010associated steatotic liver disease (MASLD), defined as \u2265\u20095% by MRI. While prior studies suggest that sub\u2010threshold liver fat may carry metabolic risk, the role of fibroblast growth factor\u201021 (FGF21)\u2014a liver\u2010derived hormone responsive to metabolic stress\u2014has not been well characterised in this context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the association between liver fat &lt;\u20095% and metabolic markers in pubertal youth with obesity, with a focus on FGF21.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary cross\u2010sectional analysis included 58 pubertal adolescents with obesity (62% female; mean age 14.7\u2009\u00b1\u20091.7\u2009years) and liver fat &lt;\u20095% by MRI\u2010proton density fat fraction (PDFF). Fasting glucose, insulin, lipids, leptin, adiponectin and FGF21 were measured. Insulin sensitivity was estimated by homeostatic model assessment of insulin resistance (HOMA\u2010IR). Associations between PDFF and metabolic markers were analysed using Spearman correlations and multivariable regression, adjusted for age, sex, race, ethnicity and body mass index standard deviation score (BMI SDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median PDFF was 2.68%. PDFF correlated positively with BMI SDS, waist circumference, glucose, triglyceride\u2010to\u2010high\u2010density lipoprotein cholesterol ratio (TG\/HDL\u2010C) and FGF21. In adjusted models, PDFF remained independently associated with FGF21 (Beta\u2009=\u200952\u2009pg\/mL per 1% increase;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), even after log transformation. No associations were observed with HOMA\u2010IR, leptin, or adiponectin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among pubertal youth with obesity and liver fat below the MASLD threshold, modest increases in PDFF were independently associated with higher FGF21. These findings support the potential utility of FGF21 as a biomarker of early hepatic\u2010metabolic stress in the framework of \u2018pre\u2010MASLD\u2019 state\u2014similar to pre\u2010diabetes before the development of overt steatosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijpo.70092","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T12:54:04Z","timestamp":1770728044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Liver Fat Is Associated With Elevated\n                    <scp>FGF21<\/scp>\n                    in Youth With Obesity but Without\n                    <scp>MASLD<\/scp>"],"prefix":"10.1111","volume":"21","author":[{"given":"Emir","family":"Tas","sequence":"first","affiliation":[{"name":"UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Center for Pediatric Research in Obesity and Metabolism, Department of Pediatrics University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Center for Childhood Obesity Prevention Arkansas Children's Research Institute  Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva C.","family":"Diaz","sequence":"additional","affiliation":[{"name":"Center for Childhood Obesity Prevention Arkansas Children's Research Institute  Little Rock Arkansas USA"},{"name":"Arkansas Children's Nutrition Center  Little Rock Arkansas USA"},{"name":"Department of Pediatrics University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiawei","family":"Ou","sequence":"additional","affiliation":[{"name":"Arkansas Children's Nutrition Center  Little Rock Arkansas USA"},{"name":"Department of Pediatrics University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabet","family":"B\u00f8rsheim","sequence":"additional","affiliation":[{"name":"Center for Childhood Obesity Prevention Arkansas Children's Research Institute  Little Rock Arkansas USA"},{"name":"Arkansas Children's Nutrition Center  Little Rock Arkansas USA"},{"name":"Department of Pediatrics University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silva","family":"Arslanian","sequence":"additional","affiliation":[{"name":"UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Center for Pediatric Research in Obesity and Metabolism, Department of Pediatrics University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijpo.70003"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001482"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.739920"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29150"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2022.03.010"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31018"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab541"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012512"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI67353"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28449B"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmet.2015.04.002"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13121680"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20100879\u20102968"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.05.018"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013\u20101250"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16081"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012\u20101221"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00654"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.23887"},{"key":"e_1_2_10_21_1","first-page":"1","article-title":"CDC Growth Charts: United States","volume":"314","author":"Kuczmarski R. 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