Association Between Non-invasive Diagnostic Methods of Liver Fibrosis and Type 2 Diabetes in Pediatric Patients With Non-alcoholic Fatty Liver Disease.

Aram Yang,Nayoung Jung,Sinae Kim,Ji-Eun Lee

doi:10.3389/fped.2022.825141

Abstract

Background and PurposeThe prevalence of non-alcoholic fatty liver disease (NAFLD) in children has been increasing associated with insulin resistance. However, there is a scarcity of related studies in children with NAFLD with type 2 diabetes mellitus (T2DM) compared to adults. We conducted this study to investigate the association between non-invasive diagnostic methods of liver fibrosis and T2DM in pediatric patients with NAFLD.MethodsWe enrolled a total of 152 patients aged <18 years with NAFLD, and compared their data according to the presence of T2DM. We evaluated fibrosis by transient elastography (TE, FibroScan®), and calculated the following fibrosis scores for each patient: NAFLD fibrosis score (NFS), AST: platelet ratio index (APRI), Fibrosis-4 (FIB-4) index, and pediatric NAFLD fibrosis index (PNFI).ResultsIn the NAFLD–T2DM group, the NFS and mean controlled attenuation parameter in FibroScan were significantly higher than those in the nondiabetic group. The receiver operating characteristic (ROC) curve values for predicting the presence of T2DM were 0.78 for NFS, 0.64 for FIB-4, 0.62 for PNFI, and 0.61 for APRI. The cutoff HbA1c levels for predicting fibrosis progression in APRI, NFS, and PNFI were 5.7% [area under the curve (AUC) 0.74], 6.4% (AUC 0.71), and 6.4% (AUC 0.55), respectively. In the multivariate analysis, hepatosteatosis on abdomen sonography, NFS, FibroScan F, and APRI were independently associated with T2DM risk.ConclusionsWe significantly characterized non-invasive fibrosis markers and elastography in pediatric NAFLD with T2DM compared with the nondiabetic group. We suggest evaluating the progression of fibrosis in the prediabetic stage in children using a combination of these non-invasive methods.

Highlights

With the increasing prevalence of childhood obesity, nonalcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease in children and adolescents [1]
NAFLD includes a broad range of disease severity, ranging from the mildest form of isolated steatosis to non-alcoholic steatohepatitis (NASH) with advanced fibrosis and cirrhosis [3]
The mean waist-to-height ratio (WHtR) was 0.6 ± 1.0 with no difference between the groups according to the presence or absence of type 2 diabetes mellitus (T2DM)

Summary

Introduction

With the increasing prevalence of childhood obesity, nonalcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease in children and adolescents [1]. NAFLD includes a broad range of disease severity, ranging from the mildest form of isolated steatosis to non-alcoholic steatohepatitis (NASH) with advanced fibrosis and cirrhosis [3]. NAFLD, the hepatic manifestation of metabolic syndrome, is associated with an elevated risk for serious extrahepatic manifestations, including cardiovascular disease, insulin resistance, and type 2 diabetes mellitus (T2DM) [5]. The comorbid existence of diabetes in adult NAFLD is an important leading cause of advanced fibrosis and cirrhosis and is further a predictor of liver-related mortality [1, 9]. The prevalence of non-alcoholic fatty liver disease (NAFLD) in children has been increasing associated with insulin resistance. We conducted this study to investigate the association between non-invasive diagnostic methods of liver fibrosis and T2DM in pediatric patients with NAFLD

Methods

Results

Conclusion