Overweight pediatric patients must be routinely screened for NAFLD, Finds study

Researchers have recently found out that prevalence of nonalcoholic fatty liver disease (NAFLD) in children and young adults with T1D was comparable to that in the general population and that routine screening should be performed for such individuals.

The study is published in the Journal of Pediatrics.

Type 1 diabetes (T1D) is an increasingly recognized disease worldwide, associated with enhanced risk of micro- and macrovascular complications, comorbidities, reduced life expectancy, and higher health care costs.One of the morbidities recently described in this disease is obesity, whose incidence is also increasing worldwide. However, a higher prevalence of associated comorbidities is expected, such as non-alcoholic fatty liver disease (NAFLD) and its report in children has seldom been studied in the literature.

Therefore, Janejira Sae-wong and colleagues from the Division of Endocrinology, Department of Pediatrics, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand conducted this study with the main objective to determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and its associated risk factors in children and young adults with type 1 diabetes (T1D).

The authors carried out a cross-sectional study at a tertiary care center in children and young adults with T1D. Fifty patients with T1D (28 females, 13 with overweight/obesity) were included. The median age and duration of T1D were 16.9years (IQR, 13.6-20years) and 6.5years (IQR, 4-11years), respectively. Liver fat quantification and hepatic fibrosis were assessed by magnetic resonance imaging proton density fat fraction and magnetic resonance elastography (MRE). Logistic regression analysis was performed to examine the associated risk factors for NAFLD.

The results showed that-

a. The prevalence of NAFLD was 10%.

b. Four out of 5 patients with NAFLD were overweight/obese, and 2 had an and elevated alanine aminotransferase (ALT) level.

c. None had liver fibrosis (defined as MRE >2.9 kPa).

d. Compared with patients without NAFLD, patients with NAFLD had significantly higher body mass index standard deviation score (BMI-SDS) (median, 0.94 [IQR, 1.30-2.62] vs 0.13 [IQR, −0.69 to 0.84]; P = .01), ALT (median, 17 IU/L [IQR, 16-52 IU/L] vs 12 IU/L [IQR, 10-14 IU/L]; P = .02), and lower high-density lipoprotein cholesterol (median, 49 mg/dL [IQR, 41-51 mg/dL] vs 57 mg/dL [IQR, 52-69 mg/dL]; P = .039).

e. Multivariate logistic regression analysis identified high BMI-SDS as the sole independent risk factor associated with NAFLD (OR, 5.79; 95% CI, 1.04-32.18).

Hence, it was concluded that "the prevalence of NAFLD in children and young adults with T1D was comparable to that in the general population."

The study suggests that routine screening for NAFLD in patients with T1D might not be necessary but should be performed in those patients with T1D who are overweight/obese, they further added.