SPARC and obesity due to melanocortin 4 receptor deficiency: To summarize, the main findings of this study are as follows: (1) Confirmation of Osteonectin as a diagnostic biomarker for pediatric MAFLD and as an important biomarker for obesity-related risk stratification as it may be significantly expressed only in an obesogenic milieu or profoundly dyslipidemic one, while the TG/HDL ratio seems to be an accurate marker for organ impairment associated with metabolic dysregulation even before obesity has developed.