A new international study indicates that the waist-to-height ratio (WHtR) is a practical and effective screening tool for metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescents, performing consistently across diverse ethnic and genetic backgrounds. The findings, published (DOI: 10.1007/s12519-026-01084-9) in the World Journal of Pediatrics, suggest that a simple tape measure may be sufficient for initial screening, potentially eliminating the need for complex genetic testing in most cases.
MASLD has reached epidemic levels among young people, mirroring the global rise in childhood obesity. It is now the most common chronic liver disease in children and adolescents, yet many affected individuals are not identified early, leading to long-term health complications. While genetic factors are known to influence susceptibility to MASLD, it has been unclear whether inherited risk alters the performance of simple body measurements like WHtR in screening.
Led by researchers at Peking University in China, the study combined data from Chinese schoolchildren and the U.S. National Health and Nutrition Examination Survey (NHANES) to test WHtR across populations and genetic backgrounds. The team found that genetic variants differed only modestly, and while higher genetic risk slightly lowered theoretical thresholds for various screening indices, WHtR remained largely stable. In NHANES, a WHtR threshold of 0.48 performed well across most ethnic groups—including non-Hispanic White, Black, and Asian participants—with the exception of "other Hispanic" participants.
Adding genetic risk scores (GRS) provided little additional benefit, suggesting that a simple tape measure may suffice for initial screening. The authors noted that the effect of genetic risk was most dramatic for complex markers like the Visceral Adiposity Index (VAI) but remarkably stable for WHtR. "Our goal was to find a screening tool that works for everyone, not just those with access to advanced labs," the authors explained. "The fact that this simple ratio maintains its accuracy across diverse genetic backgrounds is very encouraging. A simple tape measure, combined with a clear cutoff, can help healthcare workers everywhere identify at-risk children and intervene early."
The implications for public health are significant. In high-income settings, the findings could refine risk stratification and support earlier, personalized interventions. In low- and middle-income countries, where genetic testing is often unavailable, WHtR could serve as a practical frontline screening tool for primary care physicians, school health programs, and community health workers. By offering a scalable approach to early detection, WHtR may help identify children who need further evaluation and timely follow-up, potentially reducing the long-term burden of pediatric MASLD.
However, the authors emphasize that WHtR is a screening measure, not a diagnostic test, and positive findings require clinical confirmation. The study was supported by grants from several organizations, including the National Natural Science Foundation of China and the China Scholarship Council. For more information on the journal, visit World Journal of Pediatrics.
