Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children and is associated with insulin resistance and diabetes. In accordance with these findings, the present study compared the prevalence of prediabetes and diabetes in children/adolescents with and without NAFLD. In addition, investigators also evaluated the role of abnormal glucose tolerance as a predictor of the severity of liver disease.

A total of 599 children or adolescents with biopsy-proven NAFLD, and 118 children or adolescents without NAFLD, were included. Children with NAFLD were similar for age, sex, body mass index and waist circumference to those without NAFLD. The diagnosis of prediabetes and diabetes was performed by either hemoglobin A1c, fasting plasma glucose or 2 h post-load glucose concentrations.

The results demonstrated that children or adolescents with NAFLD (26%) showed higher prevalence of abnormal glucose tolerance in comparison to those without NAFLD (11%). Among the total children or adolescents, 20.6% patients with NAFLD reported abnormal glucose tolerance. Moreover, 19.8% children or adolescents fulfilled the diagnostic criteria for prediabetes and 0.8% satisfied the criteria for diabetes. Furthermore, the presence of prediabetes and diabetes, in combination was found to be related with a nearly 2.2-fold augmented risk of its progressive form, non-alcoholic steatohepatitis (NASH). Although, this relationship was further reduced after adjusting age, sex, waist circumference, and the PNPLA3 rs738409 polymorphism. It was also revealed that both PNPLA3 polymorphism and waist circumference showed a positive association with NASH.

Thus, the evidences establish high prevalence of abnormal glucose tolerance, specifically prediabetes, among children/adolescents with biopsy-proven NAFLD. Although these children also have an augmented risk of NASH, it is believed to be significantly associated with central adiposity.  

Source: Nobili V, Mantovani A, Cianfarani S, et al. Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease. J Hepatol. 2019;71(4):802-810.