Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease

Kimberly P. Newton, Jiayi Hou, Nancy A. Crimmins, Joel E. Lavine, Sarah E. Barlow, Stavra A. Xanthakos, Jonathan Africa, Cynthia Behling, Michele Donithan, Jeanne M. Clark, Jeffrey B. Schwimmer

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Abstract

IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown. OBJECTIVE To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH). DESIGN, SETTING, AND PARTICIPANTS Thiswas a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network. MAIN OUTCOMES AND MEASURES The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values. RESULTS There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4%(95%CI, 20.2%-26.6%), and the estimated prevalence of type 2 diabetes was 6.5%(95%CI, 4.6%-8.4%). Girls with NAFLD had 1.6 (95%CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95%CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2%) compared with prediabetes (34.2%) or normal glucose (22%) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95%CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95%CI, 1.5-6.2) compared with those with normal glucose. CONCLUSIONS AND RELEVANCE In this study, nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.

Original languageEnglish (US)
Article numbere161971
JournalJAMA Pediatrics
Volume170
Issue number10
DOIs
StatePublished - Oct 1 2016

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Prediabetic State
Type 2 Diabetes Mellitus
Non-alcoholic Fatty Liver Disease
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
Glucose
Hispanic Americans
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Newton, K. P., Hou, J., Crimmins, N. A., Lavine, J. E., Barlow, S. E., Xanthakos, S. A., ... Schwimmer, J. B. (2016). Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease. JAMA Pediatrics, 170(10), [e161971]. https://doi.org/10.1001/jamapediatrics.2016.1971

Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease. / Newton, Kimberly P.; Hou, Jiayi; Crimmins, Nancy A.; Lavine, Joel E.; Barlow, Sarah E.; Xanthakos, Stavra A.; Africa, Jonathan; Behling, Cynthia; Donithan, Michele; Clark, Jeanne M.; Schwimmer, Jeffrey B.

In: JAMA Pediatrics, Vol. 170, No. 10, e161971, 01.10.2016.

Research output: Contribution to journalArticle

Newton, KP, Hou, J, Crimmins, NA, Lavine, JE, Barlow, SE, Xanthakos, SA, Africa, J, Behling, C, Donithan, M, Clark, JM & Schwimmer, JB 2016, 'Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease', JAMA Pediatrics, vol. 170, no. 10, e161971. https://doi.org/10.1001/jamapediatrics.2016.1971
Newton, Kimberly P. ; Hou, Jiayi ; Crimmins, Nancy A. ; Lavine, Joel E. ; Barlow, Sarah E. ; Xanthakos, Stavra A. ; Africa, Jonathan ; Behling, Cynthia ; Donithan, Michele ; Clark, Jeanne M. ; Schwimmer, Jeffrey B. / Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease. In: JAMA Pediatrics. 2016 ; Vol. 170, No. 10.
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abstract = "IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown. OBJECTIVE To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH). DESIGN, SETTING, AND PARTICIPANTS Thiswas a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network. MAIN OUTCOMES AND MEASURES The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values. RESULTS There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4{\%}(95{\%}CI, 20.2{\%}-26.6{\%}), and the estimated prevalence of type 2 diabetes was 6.5{\%}(95{\%}CI, 4.6{\%}-8.4{\%}). Girls with NAFLD had 1.6 (95{\%}CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95{\%}CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2{\%}) compared with prediabetes (34.2{\%}) or normal glucose (22{\%}) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95{\%}CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95{\%}CI, 1.5-6.2) compared with those with normal glucose. CONCLUSIONS AND RELEVANCE In this study, nearly 30{\%} of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.",
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AU - Newton, Kimberly P.

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AU - Crimmins, Nancy A.

AU - Lavine, Joel E.

AU - Barlow, Sarah E.

AU - Xanthakos, Stavra A.

AU - Africa, Jonathan

AU - Behling, Cynthia

AU - Donithan, Michele

AU - Clark, Jeanne M.

AU - Schwimmer, Jeffrey B.

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N2 - IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown. OBJECTIVE To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH). DESIGN, SETTING, AND PARTICIPANTS Thiswas a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network. MAIN OUTCOMES AND MEASURES The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values. RESULTS There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4%(95%CI, 20.2%-26.6%), and the estimated prevalence of type 2 diabetes was 6.5%(95%CI, 4.6%-8.4%). Girls with NAFLD had 1.6 (95%CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95%CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2%) compared with prediabetes (34.2%) or normal glucose (22%) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95%CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95%CI, 1.5-6.2) compared with those with normal glucose. CONCLUSIONS AND RELEVANCE In this study, nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.

AB - IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown. OBJECTIVE To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH). DESIGN, SETTING, AND PARTICIPANTS Thiswas a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network. MAIN OUTCOMES AND MEASURES The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values. RESULTS There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4%(95%CI, 20.2%-26.6%), and the estimated prevalence of type 2 diabetes was 6.5%(95%CI, 4.6%-8.4%). Girls with NAFLD had 1.6 (95%CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95%CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2%) compared with prediabetes (34.2%) or normal glucose (22%) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95%CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95%CI, 1.5-6.2) compared with those with normal glucose. CONCLUSIONS AND RELEVANCE In this study, nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.

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