Obesity strong predictor of liver steatosis in children with type 1 diabetes

U.S.A.: According to a study reported in the Journal of Diabetes and its Complications, obesity is the significant risk factor for non-alcoholic fatty liver disease in children with type 1 diabetes and it also poses an independent risk for cardiovascular morbidity and mortality and is closely linked to insulin resistance and type 2 diabetes.

The most prevalent liver illness in children is nonalcoholic fatty liver disease (NAFLD), which has a strong link to insulin resistance and obesity. Although insulin insufficiency is a hallmark of type 1 diabetes (T1D), rising childhood obesity rates among T1D patients are a significant risk factor for NAFLD in this patient population. There are no established risk factors for NAFLD in children with T1D.

The researchers said, "Given the paucity of NAFLD prevalence data on age and BMI-matched reference groups in children and the strong relationship between obesity and NAFLD, a more appropriate control group, one with similar risk characteristics, is needed to unravel the influence of insulin reliance and glycemic management on liver fat in patients with T1D."

Using an age-matched control group of obese children without T1D, the study aimed to characterize the prevalence of NAFLD in children with T1D with or without obesity using FibroScan. It also examined the relationships between FibroScan CAP score and clinical markers and determined the best cutoff values for common clinical markers in predicting NAFLD in children with T1D.

A cross-sectional study that compared obese children without T1D to children with T1D across the body mass index (BMI) range was carried out. The vibration-controlled transient elastogram (VCTE) technique was used to detect hepatic steatosis in a semi-quantitative manner. The link between controlled-attenuated parameter (CAP) scores and clinical parameters was examined using linear regression analysis. Evaluation of the diagnostic performance of a number of clinical markers versus NAFLD status as indicated by CAP was done using receiver-operator curve (ROC) analysis.

Conclusive points of the study:

• While 16% (n = 6) of T1D patients without obesity had increased CAP, two-thirds of individuals with obesity had CAP values that were indicative of NAFLD.
• Regardless of T1D diagnosis, obese participants differed from non-obese subjects in numerous laboratory and clinical features.
• In all individuals including the T1D-only subgroup, CAP score was substantially correlated with BMI, HDL-Cholesterol (HDL-c), and HbA1c.
• The most important predictors were age, HDL-c, and ALT among participants who only had obesity.
• All individuals' BMI, HDL-c, and BMI/HDL ratio diagnostic performance for predicting NAFLD was in the good to excellent range, although performance varied for T1D-only or obesity-only groups.

The authors asserted that children with T1D and obesity had clinical and imaging findings that were identical to those of children without diabetes who had similar levels of obesity.

Children with T1D, especially those who are obese, may benefit from additional workup for NAFLD based on their BMI, HDL-c, and BMI/HDL ratio. Also, screening for NAFLD should be taken into account in kids who have T1D and obesity, they concluded.

REFERENCE

Emir Tas, Shasha Bai, Daniel Mak, Eva C. Diaz, Jonathan A. Dranoff, Obesity, but not glycemic control, predicts liver steatosis in children with type 1 diabetes, Journal of Diabetes and its Complications, Volume 36, Issue 12,2022,108341, ISSN 1056-8727, https://doi.org/10.1016/j.jdiacomp.2022.108341