Type 2 diabetes incidence '30 times greater' for children with NAFLD vs. high-risk groups
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Researchers reported an increased risk for type 2 diabetes in children with nonalcoholic fatty liver disease, highlighting the need for targeted prevention and screening, according to a study in Clinical Gastroenterology and Hepatology.
“There is a growing public health crisis as children with diabetes mature into adults with diabetes,” Jeffrey Schwimmer, MD, professor of pediatrics at University of California San Diego School of Medicine and director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego, said in a related university press release. “We need to better understand how NAFLD contributes to type 2 diabetes risk in children so that we can actively work to prevent it.”
Schwimmer and colleagues studied 892 children with NAFLD who were enrolled in cohort studies of the Nonalcoholic Steatohepatitis Clinical Research Network between 2004 to 2017 to determine their risk for developing type 2 diabetes (T2D).
Researchers collected demographic, anthropometric and laboratory data for participants at baseline and annual visits, which included review of medical history and measurement of fasting glucose and HbA1C. Cox regression models were developed for time to incident T2D.
At baseline, the mean age of participants was 12.8 years and the majority were boys (73%). The mean follow-up time was 3.8 years with a total 3,234 person-years at risk. Mean BMI was 31.8 kg/m2 and mean BMI z-score was 2.2.
During follow-up, 97 children (11%) developed T2D. When combined with the 63 children (6.6%) diagnosed with T2D at initial assessment, the period prevalence of T2D was 16.8% of children.
The T2D incidence rate in children with NAFLD was 3,000 new cases per 100,000 person-years at risk, which equated to “one in every six children” developing T2D by the end of the study, according to the press release.
Researchers also reported that female sex (HR = 1.8; 95% CI, 1-2.8) and higher BMI z-score (HR = 1.8; 95% CI, 1-3) were associated with an increased risk for T2D. More severe histologic liver disease, including steatosis grade (HR = 1.3; 95% CI, 1-1.7), ballooning grade (HR = 1.3; 95% CI, 1-1.8) and fibrosis stage (HR = 1.3; 95% CI, 1-1.5) were also linked to a higher risk for developing T2D.
“Children with NAFLD represent a high-risk group for both existing and incident T2D,” Schwimmer and colleagues wrote. “The incidence rate of T2D in children with NAFLD is 30 times greater than previously reported in other pediatric populations at increased risk for T2D related to overweight/obesity status and/or race or ethnicity.”
They added: “Children with NAFLD should be provided anticipatory guidance and closely monitored for T2D development. Targeted prevention strategies of T2D development in children with NAFLD are urgently required.”
Reference:
- Pediatric liver disease increases risk of developing type 2 diabetes. https://www.newswise.com/articles/pediatric-liver-disease-increases-risk-of-developing-type-2-diabetes?sc=cwhr&xy=10007702/?ad2f=1&aid=772740. Published June 13, 2022. Accessed June 21, 2022.
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