Non-alcoholic fatty liver disease (NAFLD) spectrum in children with type 1 diabetes mellitus evaluated with non-invasive fibrosis score and instrument: A cross-sectional study

Abstract

The aim of the study was to evaluate NAFLD spectrum in children with type 1 of diabetes mellitus (T1DM) by simple fibrosis scores and advanced biochemical markers in association with abdominal ultrasonography (US), Acoustic radiation force impulse elastography (ARFI) and comparing their results. Material and methods: A case-control study was conducted on 142children and adolescents with T1DM and79 subjects as controls. Through medical history, clinical examination, and laboratory assessment including glycosylated hemoglobin (HbA1c) levels and liver enzymes including AST and ALT were carried out. Calculation of simple fibrosis scores (AST/ALT ratio, AST to platelet ratio index (APRI), fibrosis (FIB)-4 index, paediatric NAFLD fibrosis index (PNFI) were done. Assessment of advanced biochemical markers including hyaluronic acid (HA) , amino terminal pro peptide of type III collagen (PIIINP) and tissue inhibitor of metalloproteinase 1 (TIMP-1) levels. Also, ELF test were calculated. Results: Data of non-invasive fibrosis score, there were statistically significant difference between cases and controls in fibrosis 4 score, Discriminant score also ratio of AST to ALT value (p = 0.009, 0.000 and 0.019) respectively. Also, regarding advanced biochemical markers and ELF score, there were a high statistically significant difference in TMP, Hyaluronic acid and ELF(p = 0.00, 0.044 and 0.00) respectively. Conclusions: Our results support that there are available non-invasive biomarkers for hepatic affection in children with T1DM. Obtained results support that there is a going on process in diabetic children could be assessed by AST/ALT ratio, FIB-4 index and ELF Score with performing abdominal sonography while ARFI needed in more advanced stage.

Clinical and diagnostic characteristics of non-alcoholic fatty liver disease among Egyptian children and adolescents with type1 diabetes

“…Whereas, Al-Hussaini et al detected hepatic affection in 10% of 106 children with type 1 diabetes in an Indian study [ 25 ], and El-Karaksy et al (a larger study of 692 Egyptian children with type 1 diabetes) declared a prevalence of 4.5% of liver affection [ 26 ]. On the other hand, Farhan et al, reported abnormal hepatic findings in (26%) of children with type 1 diabetes [ 7 ] and ElBaki et al in their study detected 37.3% of cases with NAFLD [ 27 ] . The high prevalence of hepatic affection in our study could be attributed to poorer glycemic control of the included patients.…”

“…ElBaky et al concluded that it is essential to do abdominal ultrasound in type I diabetic pediatric patients as an early non-invasive evaluation of liver affection, whereas ARFI is required in more progressive stages [ 27 ]. Moreover, Farhan et al, concluded that NAFLD is significant as an early alarming sign of future result of diabetes mellitus in the form of progression to hepatic fibrosis, cirrhosis and failure [ 7 ]…”

“…While in our study; 10.8% of NAFLD cases had stage 3 and 4 liver fibrosis. Moreover, ElBaki et al reported ARFI results in 7.7% of patients with different stages of fibrosis [ 27 ].…”