Current status survey and risk factor analysis of metabolic dysfunction-associated steatotic liver disease among adolescents in Hainan Province

To investigate the prevalence and associated risk factors of MASLD among adolescents in Hainan Province, providing a scientific basis for formulating targeted prevention and control strategies. A stratified random sampling method was employed to select junior and senior high school students from eight middle schools across five cities in Hainan Province from May to October 2024. A total of 1,750 questionnaires were distributed, with 1,611 valid responses collected (effective recovery rate: 92.06%). Demographic information, lifestyle habits, dietary patterns, fasting abdominal B-ultrasound and FibroScan® CAP detection results were collected to diagnose MASLD. Univariate analysis was performed using the χ² test, and multivariate analysis was conducted.All participants underwent both examinations, with CAP values only used for severity grading of MASLD-positive cases. The prevalence of MASLD among adolescents in Hainan Province was 7.64%. Multivariate analysis revealed that obesity and overweight (OR = 1.46, 95% CI = 1.38–1.56, P < 0.001), family history of MASLD (OR = 9.92, 95% CI = 4.37–22.54, P < 0.001), (a result with potential overestimation due to small exposed subgroup sample size, n = 60), frequent dining out (OR = 4.72, 95% CI = 2.73–8.16, P < 0.001), and regular consumption of hot dogs/grilled skewers (OR = 2.46, 95% CI = 1.39–4.37, P = 0.002) were independent risk factors for MASLD among adolescents. Conversely, regular consumption of fresh vegetables and fruits (OR = 0.23, 95% CI = 0.13–0.42, P < 0.001) was identified as a protective factor. Interactive effect analysis showed that frequent dining out × frequently staying up late (OR = 1.34, 95%CI:0.114–1.73, P = 0.023) and overweight × exercising < 3 times a week (OR = 1.01, 95%CI:0.379-2.70, P = 0.032) suggest synergistic risk effects, but the 95% CIs cross 1, indicating limited statistical stability; family history of MASLD × light diet (OR = 0.14, 95%CI:0.018-1.00, P = 0.050) had a definite protective effect. The overall prevalence of MASLD among adolescents in Hainan Province was 7.64%. Obesity and overweight, family history of MASLD, and frequent dining out were identified as independent risk factors, while regular consumption of fresh vegetables and fruits served as a protective factor.