In MHO children with NAFLD, adiponectin levels correlated negatively with NAS and SAF score (<i>r</i> = -0.668, -0.641), whereas all other factors showed positive correlations (<i>r</i> = 0.468-0.681, all <i>P</i> < 0.001).<h4>Conclusion</h4>MHO children exhibit dysregulation of adipose-inflammatory factors and a considerable risk for NAFLD. Here, ADIPOQ is linked to metabolic dysfunction-associated steatotic liver disease.