Preliminary evidence of improved liver biomarkers in adolescents with obesity and suspected metabolic dysfunction-associated steatotic liver disease treated with semaglutide: A case series.

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 30%-40% of youth with obesity and lacks approved pharmacologic therapies. In this single-center retrospective case series at a tertiary care safety-net children's hospital, we evaluated five adolescents (mean age: 17.0 years; 100% Hispanic; 60% male; mean body mass index: 50.8 kg/m²) treated with semaglutide for ≥3 months. Baseline liver enzymes and fibrosis marker (mean ± standard deviation) included alanine aminotransferase (ALT): 107.4 ± 26.8 IU/L, aspartate aminotransferase (AST): 64.6 ± 16.2 IU/L, and AST to platelet ratio index (APRI): 0.41 ± 0.07. After treatment, values decreased to ALT: 69.0 ± 17.9 IU/L, AST: 43.6 ± 8.8 IU/L, and APRI: 0.28 ± 0.05. Reduction in ALT ( < 0.01), AST ( < 0.01) and APRI ( = 0.01) were all statistically significant. These findings suggest semaglutide may improve hepatic inflammation and fibrosis in adolescents with MASLD. Larger prospective studies are needed to confirm these early signals in high-risk pediatric populations.