Non-alcoholic fatty liver disease in children can lead to diabetes, with far-reaching consequences

Non-alcoholic fatty liver disease (NAFLD) is the most common pediatric liver disease, affecting 5 to 8 million children in the United States. In NAFLD, liver cells store large droplets of fat, which can affect liver function. Doctors have long observed a relationship between NAFLD and type 2 diabetes in adults, but much less is known about a similar relationship in children.

Rates of type 2 diabetes have doubled in children over the past 20 years. Children with NAFLD have features of insulin resistance, a key feature of type 2 diabetes, and therefore may be at risk of developing the disease.

“There is a growing public health crisis as children with diabetes become adults with diabetes. We need to better understand how NAFLD contributes to the risk of type 2 diabetes in children so that we can actively work to prevent it,” said Jeffrey Schwimmer, MD, professor of pediatrics at the University of California San Diego School of Medicine and director of the fatty liver clinic at Rady Children’s Hospital in San Diego.

In a new study, published on June 13, 2022 in Clinical gastroenterology and hepatologya national team of researchers, led by lead author Schwimmer, provides hard numbers describing the link between NAFLD and diabetes risk, finding that among 892 children with NAFLD enrolled in the Non-Alcoholic Steatohepatitis Clinical Research Network, type 2 diabetes was present in 6.6% of the children at initial assessment, with the incidence rate increasing by 3% per year over the following four years.

By the end of the study, one in six children had developed type 2 diabetes.

“This is alarming because type 2 diabetes in young people is a much more aggressive disease than in adults, with more immediate and severe complications and outcomes,” Schwimmer said.

The authors also identified specific factors that increase the risk of type 2 diabetes in children with NAFLD: gender (women were more likely to develop type 2 diabetes), severity of obesity, and amount fat and scar tissue in the liver.

“These findings have clinical implications for gastroenterologists caring for children with NAFLD,” Schwimmer said. “They need to be aware of the risk and provide monitoring, preventive counseling and lifestyle interventions that help their patients avoid developing type 2 diabetes.”

Co-authors include: Kimberly P. Newton and Cynthia Behling, UC San Diego; Laura Wilson, Johns Hopkins University; Nancy A. Crimmins and Stavros Xanthakos, Cincinnati Children’s Hospital Medical Center and University of Cincinnati; Mark Fishbein, Ann & Robert H. Lurie Children’s Hospital of Chicago; Jean Molleston, Riley Children’s Hospital, Indianapolis.

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Materials provided by University of California – San Diego. Original written by Scott LaFee. Note: Content may be edited for style and length.

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