Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease

JOURNAL OF HEPATOLOGY

卷:71

Article

Nobili, Valerio^1,2  Mantovani, Alessandro^3,4  Cianfarani, Stefano^5,6  Alisi, Anna⁷  Mosca, Antonella¹  Sartorelli, Maria Rita⁸  Maffeis, Claudio⁹  Loomba, Rohit¹⁰  Byrne, Christopher D.^11,12  Targher, Giovanni^3,4 

[1] IRCCS Bambino Gesu Childrens Hosp, Hepatol Gastroenterol & Nutr Unit, Rome, Italy

[2] Univ Roma La Sapienza, Dept Pediat, Rome, Italy

[3] Univ Verona, Sect Endocrinol Diabet & Metab, Dept Med, Piazzale Stefani 1, I-37126 Verona, Italy

[4] Azienda Osped Univ Integrata Verona, Piazzale Stefani 1, I-37126 Verona, Italy

[5] Tor Vergata Univ, Dipartimento Pediatr, Univ Osped Bambino Gesu Childrens Hosp IRCCS, Rome, Italy

[6] Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden

[7] IRCCS Bambino Gesu Childrens Hosp, Res Unit Mol Genet Complex Phenotypes, Rome, Italy

[8] IRCCS, Hepatometab Dis Unit, Bambino Gesu Childrens Hosp, Rome, Italy

[9] Univ Hosp Verona, Pediat Diabet & Metab Disorders Unit, Dept Surg Dent Pediat & Gynaecol, Verona, Italy

[10] Univ Calif San Diego, NAFLD Res Ctr, Div Gastroenterol, San Diego, CA 92103 USA

[11] Univ Southampton, Nutr & Metab, Fac Med, Southampton, Hants, England

[12] Univ Hosp Southampton, Southampton Gen Hosp, Southampton Natl Inst Hlth Res, Biomed Res Ctr, Southampton, Hants, England

关键词: Glucose intolerance;    Prediabetes;    Diabetes;    NAFLD;    Pediatrics;    NASH;    Metabolic syndrome;   

DOI  :  10.1016/j.jhep.2019.06.023

来源: Elsevier

【 摘 要 】

Background & Aims: We undertook a cross-sectional study of children/adolescents with and without non-alcoholic fatty liver disease (NAFLD) to compare the prevalence of prediabetes and diabetes, and to examine the role of abnormal glucose tolerance as a predictor of liver disease severity. Methods: We recruited a cohort of 599 Caucasian children/adolescents with biopsy-proven NAFLD, and 118 children/adolescents without NAFLD, who were selected to be similar for age, sex, body mass index and waist circumference to those with NAFLD. The diagnosis of prediabetes and diabetes was based on either hemoglobin A1c, fasting plasma glucose or 2 h post-load glucose concentrations. Results: Children/adolescents with NAFLD had a significantly higher prevalence of abnormal glucose tolerance (prediabetes or diabetes) than those without NAFLD (20.6% vs. 11%, p = 0.02). In particular, 124 (20.6%) children/adolescents with NAFLD had abnormal glucose tolerance, with 19.8% (n = 119) satisfying the diagnostic criteria for prediabetes and 0.8% (n = 5) satisfying the criteria for diabetes. The combined presence of prediabetes and diabetes was associated with a nearly 2.2-fold increased risk of non-alcoholic steatohepatitis (NASH; unadjusted odds ratio 2.19; 95% CI 1.47-3.29; p <0.001). However, this association was attenuated (but remained significant) after adjustment for age, sex, waist circumference (adjusted odds ratio 1.69, 95% CI 1.06-2.69, p = 0.032), and the PNPLA3 rs738409 polymorphism. Both this PNPLA3 polymorphism and waist circumference were strongly associated with NASH. Conclusions: Abnormal glucose tolerance (especially prediabetes) is highly prevalent among children/adolescents with biopsy-proven NAFLD. These children also have a higher risk of NASH, though central adiposity is the factor that is most strongly associated with NASH. Lay summary: Children with biopsy-proven non-alcoholic fatty liver disease (NAFLD) have a higher prevalence of abnormal glucose tolerance (prediabetes or type 2 diabetes) than children without NAFLD. Children with biopsy-proven NAFLD and abnormal glucose tolerance also have a higher prevalence of the progressive form of disease, non-alcoholic steatohepatitis, than those with normal glucose tolerance, though central adiposity is the factor that is most strongly associated with nonalcoholic steatohepatitis. (C) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free