Children with nonalcoholic fatty liver disease (NAFLD) are at risk of subsequent type 2 diabetes, according to a recent study published in the journal Clinical Gastroenterology and Hepatology suggesting the need for “targeted strategies” to prevent development of type 2 diabetes.¹

Researchers from across the United States undertook a multicenter study to examine the incidence of type 2 diabetes in children with NAFLD. For this they enrolled 892 children who were a part of the Nonalcoholic Steatohepatitis Clinical Research Network between 2004 to 2017. Of these, 73% were boys. The participants were followed-up for a mean period of 3.8 years with a total of 3234 person-years at risk. Their mean age was 12.8 years, the mean BMI was 31.8 kg/m² and mean BMI z-score was 2.2. Data was collected at the time of study entry and on yearly visits. Fasting blood glucose and HbA1c were measured to determine the incidence of type 2 diabetes. Children with known diabetes were excluded from the trial.

Sixty-three children were found to have type 2 diabetes at baseline. Over the course of the study, 97 more children had new-onset type 2 diabetes leading to period prevalence of 16.8%. It took 3.1 years (mean) for these children to develop type 2 diabetes from when they were first diagnosed with NAFLD. 3000 new cases of type 2 diabetes per 100,000 person-years at risk were identified in children with NAFLD in the NASH Clinical Research Network (NASH CRN). Female children were more likely to develop incident type 2 diabetes with a hazard ratio of 1.8. The HR for the association of BMI z-score with type 2 diabetes was 1.8, for severe liver histology, it was 1.3 and for fibrosis stage, the HR was 1.3.

NAFLD is now recognized as a lifestyle disorder and is fast becoming a major public health disorder. This study has shown high incidence of type 2 diabetes, both existing and incident, in children with NAFLD and also identified female sex, severity of obesity and severity of liver histology (steatosis grade and fibrosis stage) at baseline as the risk factors for diabetes.

While obesity and female sex are well-recognized as risk factors, this study has additionally highlighted liver histology grade at the time of NAFLD diagnosis as an independent risk factor for development of type 2 diabetes. Hence, clinicians should be aware of this association and also educate the patients and their parents about the potential risk. Such children should be screened and advised lifestyle modifications and also be closely followed-up for development of type 2 diabetes.

Reference

1. Kimberly P Newton, et al; Nonalcoholic Steatohepatitis Clinical Research Network. Incidence of type 2 diabetes in children with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2022 Jun 13;S1542-3565(22)00556-0. doi: 10.1016/j.cgh.2022.05.028.