NAFLD linked to heightened type 2 diabetes risk

Children with nonalcoholic fatty liver disease (NAFLD) are at an increased risk of type 2 diabetes (T2D), a study reports. Other risk factors for T2D include severity of liver histology, body mass index, and female sex.

A total of 892 children (mean age 12.8 years) with NAFLD enrolled in the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network were followed longitudinally. Researchers determined incidence of T2D with the use of clinical history and fasting laboratory values. They also developed cumulative incidence curves for time to T2D.

Of the children, 281 (32 percent) had mild disease with NAFLD but not NASH, 297 (33 percent) had borderline zone 1 NASH, 134 (15 percent) had borderline zone 3 NASH, and 180 (20 percent) had definite NASH. Overall, 12 percent of children had stage 3 fibrosis and 1 percent had cirrhosis).

Over a follow-up of 3.8 years (3,234 person-years at risk), T2D occurred at a rate of 3,000 new cases per 100,000 person-years at risk. There were 63 children who already had T2D at baseline, and an additional 97 developed diabetes during follow-up. The corresponding period prevalence of T2D was 16.8 percent.

The risk of developing T2D was significantly elevated in females vs males (hazard ratio [HR], 1.8, 95 percent confidence interval [CI], 1.0–2.8). The risk was also associated with BMI z-score (HR, 1.8, 95 percent CI, 1.0–3.0), more severe liver histology including steatosis grade (HR, 1.3, 95 percent CI, 1.0–1.7), and fibrosis stage (HR, 1.3, 95 percent CI, 1.0–1.5).

The findings underscore the need for targeted strategies to prevent T2D in children with NAFLD.