Prevalence of hepatopathy in type 1 diabetic children

BMC Pediatrics

Mannan Khan³  Ahmed S Alenizi²  Musa D AlZahrani²  Nimer M Sulaiman²  Abdulrahman A Al-Hussaini¹ 

[1] Division of Pediatric Gastroenterology, Hepatology & Nutrition, University of King Saud bin Abdulaziz for Health sciences Children's Hospital, PO box 59046, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia;Division of pediatric Endocrinology Unit, Children Hospital, PO box 87341, King Saud, Medical City, Riyadh, 11642, Kingdom of Saudi Arabia;Department of Radiology, Children's hospital, PO box 7855, King Saud, Medical City, Riyadh, 11117, Kingdom of Saudi Arabia

关键词: Ultrasound;    Diabetes mellitus;    Type 1 diabetes;    Hepatic glycogenosis;    Hepatomegaly;    Fatty liver;   

Others  :  1170637
DOI  :  10.1186/1471-2431-12-160

 received in 2012-05-14, accepted in 2012-10-01,  发布年份 2012

【 摘 要 】

Background

The Prevalence of liver disease among diabetics has been estimated to be between 17% and 100%. Most of these data were obtained from adult studies. The aim of our study was to screen for liver disease among type 1 diabetic children.

Methods

Children with type 1 diabetes following in clinic have been examined for existence of liver disease, from November 2008 to November 2009. All were subjected to the following: History, physical examination, liver function tests, fasting lipid profile, HbA1C, and ultrasound of the liver. A hyperechogenic liver and/or hepatomegaly on ultrasound were attributed most likely to excess glycogen or fat in the liver, after negative extensive work-up to rule out other underlying liver disease.

Results

106 children with type 1 diabetes were studied: age ranged between 8 months to 15.5 years, sixty two patients were females. Twenty two patients (21%) were identified to have abnormal findings on ultrasound of the liver: 10 patients had hepatomegaly and 12 had hyperechogenic liver. The group with hyperechogenic liver had poorer glycemic control than patients with normal liver (Mean HbA1c 12.14% Vs 10.7%; P value = 0.09). Hyperechogenic liver resolved in 60% at 6 months follow-up upon achieving better glycemic control.

Conclusions

Hyperechogenic liver and/or hepatomegaly are not uncommon in children with type 1 diabetes and tend to be more prevalent among children with poor glycemic control. Type 1 diabetes related hepatopathy is reversible by optimizing glycemic control. Because of its safety, and reliability, ultrasound can be used to screen for hepatopathy in type 1 diabetic child.

【 授权许可】

   
2012 Al-Hussaini et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bradford GS, David HV: Diabetes mellitus and the liver. Liver Dis 1985, 5:8-28.
• [2]Wasastjerna C, Reissell P, Karjalainen J, Ekelund P: Fatty liver in diabetes. Acta med scand 1972, 191:225-228.
• [3]Creutzfeldt W, Frerchs H, Sickinger K: Progress in liver diseases: Liver diseases and diabetes mellitus. 3rd edition. H Popper and F Schaffner, New York; 1970:371-407.
• [4]Falchuk KR, Conlin D: The intestinal and liver complications of diabetes mellitus. Adv Intern Med 1993, 38:269.
• [5]Silverman JF, Pories WJ, Caro JF: Liver pathology in diabetes mellitus and morbid obesity: clinical, pathologic, and biochemical considerations. Pathol Annu 1989, 24:275-302.
• [6]Munns CF, McCrossin RB, Thomsett MJ, Batch J: Hepatic glycogenosis: Reversible hepatomegaly in type 1 diabetes. J Pediatr Child Health 2000, 36:449-452.
• [7]Lorenz G, Barenwald G: Histologic and electron-microscopic liver changes in diabetic children. Acta Hepatogastroenterol (Stuttg) 1979, 26:435-438.
• [8]Goodman JI: Hepatomegaly and diabetes mellitus. Ann Intern Med 1953, 39:1077-1087.
• [9]Mohsin R, Roberts E: Nonalcoholic steatohepatitis in children. J Pediatr Gastroenterol Nutr 2000, 30:48-53.
• [10]Lecomte M, Gottrand F, Stuckens C, Lecomte-Houcke M: Acute steatosis in an 8year old boy with insulin dependent diabetes mellitus. J Pediatr Gastroenterol Nutr 1997, 25:98-100.
• [11]Carcione L, Lombardo F, Messina MF, Rosano M, De Luca F: Liver glycogenosis as early manifestation in type 1 diabetes mellitus. Diabet Nutr Metabol – Clin & Exp 2003, 16:182-184.
• [12]El-Karaksy HM, Anwar G, Esmat G, Mansour S, Sabry M, Helmy H, El-Hennawy A, Fouad H: Prevalence of hepatic abnormalities in a cohort of Egyptian children with type 1 diabetes mellitus. Pediatric Diabetes 2010, 11:462-470.
• [13]Konus OL, Ozdemir A, Akkaya A, Erbas G, Celik H, Isik S: Normal liver, spleen and kidney dimensions in neonates, infants and children: evaluation with sonography. Am J Roentgenol 1998, 171:1693-1698.
• [14]Marsh MN: The immunopathology of the small intestinal reaction in gluten-sensitivity. Immunol Invest 1989, 18:509-531.
• [15]Thompson EW, Parks WC, Darke RL: Rapid alterations induced by insulin in hepatocyte ultrastructure and glycogen levels. Am J Anat 1981, 160:449-460.
• [16]Nakamuta M, Ohashi M, Goto K, Tanabe Y, Hiroshige K, Nawata H: Diabetes mellitus –associated hepatomegaly: report of a case and review of the Japanese literature. Fukuoka-Igaku-Zasshi 1993, 84:354-358.
• [17]Targher G, Bertolini L, Padovani R, Rodella S, Zoppini G, Pichiri I, Sorgato C, Zenari L, Bonora E: Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease in patients with type 1 diabetes. J Hepatol 2010, 53:713-718.
• [18]Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, Clark JM: Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011, 54:1082-1090.
• [19]Tak PP, Ten Kate FJW: Remission of active diabetic hepatitis after correction of hyperglycemia. Liver 1993, 13:183-187.
• [20]Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA: Nonalcoholic steatohepatitis: an expanced clinical entity. Gastroenterology 1994, 107:1103.
• [21]Teli MR, James OFW, Burt AD, Bennett MK, Day CP: The natural history of non-alcoholic fatty liver: a follow up study. Hepatology 1995, 22:1714-1719.
• [22]Bardella MT, Valenti L, Pagliari C, Peracchi M, Fare M, Fracanzani AL, Fargion S: Searching for celiac disease in patients with nonalcoholic fatty liver disease. Dig Liv Dis 2004, 36:333-336.
• [23]Riley TR 3rd, Mendoza A, Bruno MA: Bedside ultrasound can predict nonalcoholic fatty liver disease in the hands of clinicians using a prototype image. Dig Dis Sci 2006, 51:982-985.