Abnormal glucose tolerance, especially prediabetes, was highly prevalent among children and adolescent patients with established nonalcoholic fatty liver disease, according to a recently published study.
Although central adiposity is the factor most strongly associated with progression from NAFLD to nonalcoholic steatohepatitis, Valerio Nobili, MD, from the Bambino Gesù Hospital in Italy, and colleagues explained that children with abnormal glucose tolerance also have an increased risk for NASH.
The researchers analyzed 599 Caucasian children and adolescents with overweight or obesity and biopsy-proven NAFLD, along with 118 children and adolescents without NAFLD as controls. Both groups had similar proportions of boys and girls with a mean age of approximately 11 years, BMI of approximately 27 kg/m2, and waist circumference around 85 cm.
Patients with NAFLD were more likely to have abnormal glucose tolerance (20.7% vs. 11%) including prediabetes (19.8%) and diabetes (0.8%), whereas none of those without NAFLD had diabetes.
Multivariate analysis adjusted for age, sex and waist circumference confirmed that the presence of NAFLD (OR = 1.98; 95% CI, 1.07-3.64) and increased waist circumference (OR = 1.02; 95% CI, 1.01-1.03) correlated independently with the risk for abnormal glucose tolerance.
Among those with NAFLD, definite NASH was more common among those with prediabetes or diabetes compared with those with normal glucose tolerance (48.4% vs. 29.9%; P < .001). Additionally, children and adolescents with NASH were more likely to be centrally obese, hypertensive and insulin resistant compared those without NASH.
“Our findings further emphasize the importance of lifestyle modifications to improve diet and increase physical activity, as the first-line treatment for all children [and] adolescents with NAFLD not only for improving liver disease severity, but also for reducing obesity-related metabolic complications (such as abnormal glucose tolerance) in childhood and adolescence,” Nobili and colleagues concluded. – by Talitha Bennett
Disclosures: The authors report no relevant financial disclosures.