Non-alcoholic fatty liver disease in pediatric type 2 diabetes: Metabolic and histologic characteristics in 38 subjects

Ron S. Newfield, Carrie L. Graves, Robert O. Newbury, Jeffrey B. Schwimmer, James A. Proudfoot, Daphne Say, Ariel E. Feldstein

Research output: Contribution to journalArticle

Abstract

Background: Obesity and type 2 diabetes (T2D) is risk factors for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In children with T2D and liver biopsies, we investigated correlations between NAFLD/NASH and transaminase activity, A1c, lipids, and histologic changes in repeat biopsies. Methods: Liver histology of children with T2D was evaluated using the NASH CRN scoring system and NAFLD Activity Score (NAS). We included results ≤6 months from biopsy and A1c nearest biopsy. Results: Thirty-eight subjects (21 females, 17 males, 63.2% Hispanic, 15.8% Caucasian) had T2D diagnosed at 13.4 ± 2.7 years, 78.9% using metformin and 50% on insulin. Histological diagnosis of NAFLD occurred at mean age 14.3 ± 2.3 years, notable for NASH in 61%. Steatosis grade was higher in children with NASH than those without (mean 2.6 ± 0.7 vs 2.1 ± 0.5 (P < 0.001). Stage 3 fibrosis was noted only in subjects with NASH (26%). ALT was higher in NASH vs those without (112 ± 56 vs 85 ± 112, P = 0.016). NAS correlated with A1c (r = 0.51, P < 0.01) and triglycerides (r = 0.5, P < 0.01), and inversely with high-density lipoprotein (HDL) (r = −0.42, P = 0.04). Males had lower HDL and higher triglycerides (P < 0.04). In eight subjects with repeat biopsies, NAS was equal (37.5%) or improved (62.5%), and steatosis decreased (68.1% to 32.8%, P = 0.027). Conclusions: In children with T2D and NAFLD, NASH is common. Having advanced fibrosis in 26% of NASH cases at this age is concerning. Better control of lipids, weight, and diabetes may help avoid worsening in NAS.

Original languageEnglish (US)
Pages (from-to)41-47
Number of pages7
JournalPediatric Diabetes
Volume20
Issue number1
DOIs
StatePublished - Feb 1 2019

Fingerprint

Fatty Liver
Type 2 Diabetes Mellitus
Pediatrics
Biopsy
HDL Lipoproteins
Triglycerides
Fibrosis
Lipids
Non-alcoholic Fatty Liver Disease
Metformin
Liver
Transaminases
Hispanic Americans
Histology
Obesity
Insulin
Weights and Measures

Keywords

  • non-alcoholic fatty liver disease
  • obesity
  • pediatrics
  • steatohepatitis
  • type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism

Cite this

Newfield, R. S., Graves, C. L., Newbury, R. O., Schwimmer, J. B., Proudfoot, J. A., Say, D., & Feldstein, A. E. (2019). Non-alcoholic fatty liver disease in pediatric type 2 diabetes: Metabolic and histologic characteristics in 38 subjects. Pediatric Diabetes, 20(1), 41-47. https://doi.org/10.1111/pedi.12798

Non-alcoholic fatty liver disease in pediatric type 2 diabetes : Metabolic and histologic characteristics in 38 subjects. / Newfield, Ron S.; Graves, Carrie L.; Newbury, Robert O.; Schwimmer, Jeffrey B.; Proudfoot, James A.; Say, Daphne; Feldstein, Ariel E.

In: Pediatric Diabetes, Vol. 20, No. 1, 01.02.2019, p. 41-47.

Research output: Contribution to journalArticle

Newfield, RS, Graves, CL, Newbury, RO, Schwimmer, JB, Proudfoot, JA, Say, D & Feldstein, AE 2019, 'Non-alcoholic fatty liver disease in pediatric type 2 diabetes: Metabolic and histologic characteristics in 38 subjects', Pediatric Diabetes, vol. 20, no. 1, pp. 41-47. https://doi.org/10.1111/pedi.12798
Newfield, Ron S. ; Graves, Carrie L. ; Newbury, Robert O. ; Schwimmer, Jeffrey B. ; Proudfoot, James A. ; Say, Daphne ; Feldstein, Ariel E. / Non-alcoholic fatty liver disease in pediatric type 2 diabetes : Metabolic and histologic characteristics in 38 subjects. In: Pediatric Diabetes. 2019 ; Vol. 20, No. 1. pp. 41-47.
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abstract = "Background: Obesity and type 2 diabetes (T2D) is risk factors for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In children with T2D and liver biopsies, we investigated correlations between NAFLD/NASH and transaminase activity, A1c, lipids, and histologic changes in repeat biopsies. Methods: Liver histology of children with T2D was evaluated using the NASH CRN scoring system and NAFLD Activity Score (NAS). We included results ≤6 months from biopsy and A1c nearest biopsy. Results: Thirty-eight subjects (21 females, 17 males, 63.2{\%} Hispanic, 15.8{\%} Caucasian) had T2D diagnosed at 13.4 ± 2.7 years, 78.9{\%} using metformin and 50{\%} on insulin. Histological diagnosis of NAFLD occurred at mean age 14.3 ± 2.3 years, notable for NASH in 61{\%}. Steatosis grade was higher in children with NASH than those without (mean 2.6 ± 0.7 vs 2.1 ± 0.5 (P < 0.001). Stage 3 fibrosis was noted only in subjects with NASH (26{\%}). ALT was higher in NASH vs those without (112 ± 56 vs 85 ± 112, P = 0.016). NAS correlated with A1c (r = 0.51, P < 0.01) and triglycerides (r = 0.5, P < 0.01), and inversely with high-density lipoprotein (HDL) (r = −0.42, P = 0.04). Males had lower HDL and higher triglycerides (P < 0.04). In eight subjects with repeat biopsies, NAS was equal (37.5{\%}) or improved (62.5{\%}), and steatosis decreased (68.1{\%} to 32.8{\%}, P = 0.027). Conclusions: In children with T2D and NAFLD, NASH is common. Having advanced fibrosis in 26{\%} of NASH cases at this age is concerning. Better control of lipids, weight, and diabetes may help avoid worsening in NAS.",
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T2 - Metabolic and histologic characteristics in 38 subjects

AU - Newfield, Ron S.

AU - Graves, Carrie L.

AU - Newbury, Robert O.

AU - Schwimmer, Jeffrey B.

AU - Proudfoot, James A.

AU - Say, Daphne

AU - Feldstein, Ariel E.

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N2 - Background: Obesity and type 2 diabetes (T2D) is risk factors for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In children with T2D and liver biopsies, we investigated correlations between NAFLD/NASH and transaminase activity, A1c, lipids, and histologic changes in repeat biopsies. Methods: Liver histology of children with T2D was evaluated using the NASH CRN scoring system and NAFLD Activity Score (NAS). We included results ≤6 months from biopsy and A1c nearest biopsy. Results: Thirty-eight subjects (21 females, 17 males, 63.2% Hispanic, 15.8% Caucasian) had T2D diagnosed at 13.4 ± 2.7 years, 78.9% using metformin and 50% on insulin. Histological diagnosis of NAFLD occurred at mean age 14.3 ± 2.3 years, notable for NASH in 61%. Steatosis grade was higher in children with NASH than those without (mean 2.6 ± 0.7 vs 2.1 ± 0.5 (P < 0.001). Stage 3 fibrosis was noted only in subjects with NASH (26%). ALT was higher in NASH vs those without (112 ± 56 vs 85 ± 112, P = 0.016). NAS correlated with A1c (r = 0.51, P < 0.01) and triglycerides (r = 0.5, P < 0.01), and inversely with high-density lipoprotein (HDL) (r = −0.42, P = 0.04). Males had lower HDL and higher triglycerides (P < 0.04). In eight subjects with repeat biopsies, NAS was equal (37.5%) or improved (62.5%), and steatosis decreased (68.1% to 32.8%, P = 0.027). Conclusions: In children with T2D and NAFLD, NASH is common. Having advanced fibrosis in 26% of NASH cases at this age is concerning. Better control of lipids, weight, and diabetes may help avoid worsening in NAS.

AB - Background: Obesity and type 2 diabetes (T2D) is risk factors for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In children with T2D and liver biopsies, we investigated correlations between NAFLD/NASH and transaminase activity, A1c, lipids, and histologic changes in repeat biopsies. Methods: Liver histology of children with T2D was evaluated using the NASH CRN scoring system and NAFLD Activity Score (NAS). We included results ≤6 months from biopsy and A1c nearest biopsy. Results: Thirty-eight subjects (21 females, 17 males, 63.2% Hispanic, 15.8% Caucasian) had T2D diagnosed at 13.4 ± 2.7 years, 78.9% using metformin and 50% on insulin. Histological diagnosis of NAFLD occurred at mean age 14.3 ± 2.3 years, notable for NASH in 61%. Steatosis grade was higher in children with NASH than those without (mean 2.6 ± 0.7 vs 2.1 ± 0.5 (P < 0.001). Stage 3 fibrosis was noted only in subjects with NASH (26%). ALT was higher in NASH vs those without (112 ± 56 vs 85 ± 112, P = 0.016). NAS correlated with A1c (r = 0.51, P < 0.01) and triglycerides (r = 0.5, P < 0.01), and inversely with high-density lipoprotein (HDL) (r = −0.42, P = 0.04). Males had lower HDL and higher triglycerides (P < 0.04). In eight subjects with repeat biopsies, NAS was equal (37.5%) or improved (62.5%), and steatosis decreased (68.1% to 32.8%, P = 0.027). Conclusions: In children with T2D and NAFLD, NASH is common. Having advanced fibrosis in 26% of NASH cases at this age is concerning. Better control of lipids, weight, and diabetes may help avoid worsening in NAS.

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