IGF-1 SDS levels were inversely related to the steatosis grade (r = −0.37), ballooning (r = −0.47), and NAS (r = −0.49). IGF-I/IGFBP-3 ratio was a significant predictor of liver inflammation (β = −0.285). ↓ levels of IGF-1 SDS and IGF-1/IGFBP-3 ratio in children with NASH and higher grades of steatosis. Here, IGF1 is linked to metabolic dysfunction-associated steatohepatitis.