Introduction: The global rise in paediatric obesity has led to an increasing burden of metabolic comorbidities, including metabolic dysfunction–associated steatotic liver disease (MASLD). Obstructive sleep apnea (OSA), characterized by chronic intermittent hypoxia, has been implicated in the pathogenesis of liver injury. This study aimed to evaluate the prevalence of MASLD and its association with OSA among children and adolescents in a tertiary centre. Methodology: A retrospective cross-sectional study was conducted involving children aged 6–15 years who were admitted for polysomnography at Sarawak General Hospital between 2024 and 2025. Clinical, biochemical, and lifestyle data were obtained from medical records and parental questionnaires. Hepatic steatosis was assessed using hepatobiliary ultrasound in a subset of patients. Results: A total of 132 children (mean age 10.8 ± 2.7 years; 87.5% male) were included. The median BMI SDS was 2.50 (IQR: 2.29– 2.93). The mean apnea–hypopnea index (AHI) was 12.0 ± 7.9, with 60% classified as severe OSA. Among the 16 children who underwent liver ultrasound, MASLD was identified in 81.2%, including five cases of grade 1 and eight cases of grade 2 steatosis. Liver transaminitis was present in six patients. Metabolic comorbidities were common, with 43.8% requiring metformin for insulin resistance or impaired glucose tolerance, and four patients requiring antihypertensive therapy. Unhealthy lifestyle behaviors were prevalent: 64.2% consumed sugary drinks ≥3 times weekly, 42.9% consumed fast food ≥3 times weekly, and only 24.3% reported daily fruit or vegetable intake. Physical inactivity (≤2 times/week) was observed in 71.4%, while 64.3% had screen time exceeding 2 hours daily. Conclusion Children and adolescents with moderate-to-severe OSA exhibit a high burden of metabolic dysfunction, including MASLD. The findings support a potential contributory role of OSA-related hypoxia in paediatric fatty liver disease and highlight the need for integrated screening and early intervention in this high-risk population.
Adolescent ; Child ; Malaysia ; Liver Diseases

Introduction: Central precocious puberty (CPP) is the premature activation of the hypothalamic-pituitary-gonadal axis, often compromising adult height and psychosocial well-being. Timely treatment with gonadotropin-releasing hormone agonists (GnRHa) such as triptorelin is critical to halt pubertal progression and preserve growth potential. This study evaluated the clinical outcomes of triptorelin therapy in CPP at Sarawak General Hospital (SGH). Methodology: A retrospective cross-sectional study was conducted among patients with CPP treated with triptorelin at the Paediatric Endocrine Clinic, SGH, including those currently receiving therapy and those who had discontinued treatment. Demographic and clinical data were extracted from medical records and analyzed using SPSS version 25. Descriptive statistics summarized patient characteristics, while t-tests and non-parametric equivalents assessed treatment outcomes (p <0.05 significant). Results: Eleven patients were included (mean age 6.88 ± 2.21 years; 90.9% female). Two patients (18.2%) were obese at initial diagnosis, and the mean baseline body mass index was 17.64 ± 2.25 kg/m². Most cases were idiopathic (54.5%), while pituitary microadenoma was identified in 36.4%. At diagnosis, the bone age was advanced by a mean of 3.51 ± 1.39 years. Six patients discontinued therapy: four after completion and two at parental request. Among completers, mean treatment duration was 3.21 ± 2.42 years, ending at a mean age of 10.13 ± 0.95 years. Final height did not differ significantly from mid-parental height (p = 0.225). Triptorelin significantly improved final height standard deviation score (SDS) (p = 0.005) and reduced the bone age/ chronological age ratio (p = 0.049), though predicted adult height gains were not statistically significant (p = 0.321). No adverse effects were reported. Conclusion GnRHa therapy slowed pubertal progression and preserved growth potential in children with CPP, with favorable safety outcomes. Larger prospective studies are warranted to validate long-term benefits and identify predictors of optimal response.
Child ; Puberty, Precocious ; Gonadotropin-Releasing Hormone