#2277 Trends and associations between decreased estimated glomerular filtration rate, metabolic syndrome, and non-alcoholic fatty liver disease in children and adolescents: a 15-Year data analysis

Abstract Background and Aims Metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) are well-known risk factors for decreased estimated glomerular filtration rate (eGFR) in adults. However, studies on their association and prevalence trends in children and adolescents are limited. This study aims to investigate the trends and associations between decreased eGFR, metabolic syndrome, and NAFLD in Korean children and adolescents aged 10–18 years from 2007 to 2021. Method This cross-sectional study analyzed data from 8,971 youths aged 10–18 years with an eGFR of less than 90 mL/min/1.73 m2 using data from the Korea National Health and Nutrition Examination Survey (KNHANES). The study examined the association between low eGFR and various factors, including age, sex, height, weight, body mass index (BMI), waist circumference, fasting glucose, triglycerides, blood pressure, alanine aminotransferase (ALT), and nutritional intake (calories, carbohydrates, protein, and fat). Results The prevalence of low eGFR showed a decreasing pattern, with a 24.5% reduction from 2008–2010 compared to the previous year and a 6.1% reduction from 2013–2021 (P = 0.037, 0.018). In contrast, NAFLD showed an increasing trend since 2010 with a 7.5% increase (P < 0.0001), although no significant change was observed from 2008–2010 (P = 0.281). This pattern was more pronounced in children aged 10–12 years, with no significant findings in other age groups. Carbohydrate intake showed an increasing trend until 2011, followed by a decline until 2021 (P = 0.0118, 0.0354). Protein intake increased (P < 0.0053), while fat intake also increased (P = 0.0017). Correlation analysis revealed that an increase in fat intake was associated with a decrease in low eGFR (P < 0.001), while greater carbohydrate intake was linked to a reduced prevalence of NAFLD (P = 0.0081). Conclusion Although a positive correlation between low GFR and NAFLD is generally reported, this study observed an inverse correlation in adolescents aged 10–12 years. In contrast to adult chronic kidney disease (CKD) where protein and fat intake are restricted, the trends in this study suggest that protein and fat intake do not directly influence the prevalence of low GFR in children. However, increased fat intake may be associated with NAFLD. These findings indicate that children with low eGFR may adopt different dietary patterns compared to the general population, possibly due to cautious dietary habits.