Obesity and MASLD increase risk for youth-onset type 2 diabetes
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Key takeaways:
- The risk for type 2 diabetes is more than two times higher for children with obesity and MASLD than those with obesity alone.
- Reducing BMI standard deviation score was linked to a lower type 2 diabetes risk.
Children with obesity have increased risk for type 2 diabetes if they are diagnosed with metabolic dysfunction-associated steatotic liver disease, according to findings published in Diabetes Care.
Researchers reviewed data from the Swedish Childhood Obesity Treatment Register of 10,346 children aged 9 to 18 years with obesity and without diabetes at baseline. At age 30 years, the cumulative incidence rate of type 2 diabetes was 22.7% for people with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) compared with 9.9% for those with obesity but without MASLD. The incidence rate for 59,336 matched controls without obesity at baseline was 0.7%.
“Our findings emphasize the importance of comprehensive care, including glucose and liver screening, in pediatric obesity treatment,” Resthie R. Putri, MD, PhD student in the department of clinical science, intervention and technology at Karolinska Institutet in Sweden, and colleagues wrote.
Researchers linked data from the Swedish Childhood Obesity Treatment Register to other Swedish national registries. Individuals were followed until type 2 diabetes diagnosis, age 30 years, death, emigration or the end of the study in July 2023.
Of the study group, 1,102 were diagnosed with MASLD based on alanine transaminase levels. Median age at type 2 diabetes diagnosed was 16.9 years for children with obesity and 22.8 years for those without obesity.
Type 2 diabetes incidence rates were 131.1 per 10,000 patient-years for children with obesity and MASLD compared with 41.2 per 10,000 patient-years for those with obesity alone. Children with obesity and MASLD had a significantly higher risk for developing type 2 diabetes at any point during the follow-up than those without MASLD (HR = 2.71; 95% CI, 2.14-3.43). The risk for developing type 2 diabetes at age 9 to 19 years was nearly four times higher in those with MASLD compared with children without MASLD (HR = 3.99; 95% CI, 2.99-5.32). There was no significant difference in type 2 diabetes risk between participants with MASLD and those without MASLD at age 20 to 30 years.
The findings were similar when researchers used diagnostic codes to identify MASLD.
Compared with children with obesity alone, those who had MASLD and intermediate hyperglycemia had a significantly greater risk for developing type 2 diabetes (HR = 9.04; 95% CI, 6.38-12.79). The increased risk with both MASLD and intermediate hyperglycemia was much higher than what was observed in those who only had MASLD (HR = 2.16; 95% CI, 1.63-2.87) or only had intermediate hyperglycemia (HR = 1.79; 95% CI, 1.22-2.6).
Among children who received obesity treatment for at least 6 months, every 0.1 U decline in BMI standard deviation score lowered the risk for type 2 diabetes (HR = 0.91; 95% CI, 0.88-0.93). Those who had a decline in BMI standard deviation score of at least 0.25 U had a further reduction in type 2 diabetes risk (HR = 0.23; 95% CI, 0.09-0.57). The researchers cautioned, however, that most children are unable to achieve a BMI standard deviation score reduction of 0.25 U.
“The proportion of children obtaining the optimal target is henceforth likely to be higher given the availability of incretin-based medications for the pediatric population,” the researchers wrote. “Nevertheless, the current study further indicates that even a modest BMI standard deviation score reduction of 0.1 units, compared with zero reduction, is associated with relative risk reduction for type 2 diabetes.”
The researchers stated health care professionals should focus on achieving a reduction in BMI standard deviation score for children with obesity to lower the risk for type 2 diabetes and other cardiometabolic diseases.
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Putri RR, et al. Diabetes Care. 2024;doi:10.2337/dc24-1236.
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