Children with NASH showed significantly lower levels of IGF-1 SDS (−1.3 vs. 1.0, p < 0.05) and IGF-1/IGFBP-3 ratio (0.086 vs. 0.14, p < 0.02) and higher grades of steatosis (2.64 vs. 1.84, p < 0.001), lobular inflammation (1.64 vs. 1.14, p = 0.002), and ballooning (1.79 vs. 0.44, p < 0.001). Here, IGFBP3 is linked to metabolic dysfunction-associated steatohepatitis.