Screening for non-alcoholic fatty liver disease in children and adolescents with type 1 diabetes mellitus: a cross-sectional analysis

Kummer, Sebastian; Klee, Dirk; Kircheis, G.; Friedt, Michael; Schaper, J.; Häussinger, Dieter; Mayatepek, Ertan; Meißner, Thomas

doi:10.1007/s00431-017-2876-1

Cited by 24 publications

(20 citation statements)

References 33 publications

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“…The most recent study from Turkey in 80 T1D patients [43] showed a positive correlation of fetuin A with HbA1c, intima media thickness of the carotid arteries, aminotransferases, and body fat content; however, the authors detected a 10% NAFLD rate, which is higher than what we expect in our population [37]. In accordance with two of the abovementioned studies, fetuin A was not positively correlated with HbA1c in our T1D cohort, while positive associations have been described in gestational diabetes, T2D, or the metabolic syndrome [13, 14, 55].…”

Section: Discussioncontrasting

confidence: 55%

“…While pubertal T1D patients are assumed to show some degree of insulin resistance [31-37, 49, 50], clinically evident from higher daily insulin doses, we could not find an overall association of fetuin A with higher insulin requirements, whereas only in overweight or obese T1D patients, daily insulin doses were positively associated with fetuin A levels. Obese patients with T2D showed distinctly higher levels of the hepatokine than T1D patients.…”

Section: Discussioncontrasting

confidence: 46%

“…The generalizability of our findings may be limited, as German T1D children and adolescents had a low prevalence of NAFLD when screening was performed with comprehensive laboratory evaluation, ultrasound, and transient elastography [37]. Most patients in our cohort showed decent glycemic control, and we would expect hepatic steatosis rates to be higher if metabolic control was worse.…”

Section: Discussionmentioning

confidence: 96%

“…Further, we did not have data available on liver/body fat content or waist to hip ratio, known to be associated with (pubertal) insulin resistance. We refrained from measuring aminotransferases, in particular against the background that a recent prospective study had shown only 1.1% of potential NAFLD cases in 93 German juvenile T1D patients in the DPV cohort [37]. One limitation of our study is that data on pubertal stage at the time of recruitment were not available.…”

Section: Discussionmentioning

confidence: 97%

“…Insulin resistance as well as NAFLD play a role in autoimmune type 1 diabetes (T1D) and potentially affect pediatric patients, particularly in puberty [31-37]. Insulin resistance may possibly impact on future diabetes complications in T1D [34, 38].…”

Section: Introductionmentioning

confidence: 99%

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Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes

et al. 2017

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Background and Aim: The hepatokine fetuin A is upregulated in the metabolic syndrome and in type 2 diabetes (T2D), while its role in adolescent type 1 diabetes (T1D) is unclear. We assessed the relationship between circulating fetuin A levels and metabolic control, comorbidities, and complications in adolescent T1D patients. Methods: We studied the relationship between serum fetuin A and clinical diabetes-related data from the DPV registry (Diabetes-Patienten-Verlaufsdokumentation) in 172 adolescent T1D patients with early-onset (<5 years) long-standing (>10 years) T1D. Fetuin A levels were further compared between adolescent T1D and T2D patients. Results: Serum fetuin A levels in T1D patients (mean 0.267 ± 0.043 g/L) did not correlate with age, diabetes duration, gender, body mass index (BMI), glycated hemoglobin, serum lipid levels, blood pressure, celiac or thyroid disease, nephropathy, or retinopathy. An association of fetuin A levels with insulin requirements was only evident within the subgroup of overweight T1D patients (r_s = 0.439, p = 0.028, n = 25, BMI >90th percentile), disappearing after adjustment for multiple testing. Adolescent T1D patients showed distinctly lower fetuin A levels than patients with T2D (p ≤ 0.001). Conclusion: Overall, we did not observe a clinically relevant association of fetuin A levels with surrogate parameters for insulin sensitivity in our juvenile T1D cohort. A correlation with insulin requirements was detectable in overweight patients only. We hypothesize that multiple factors, such as obesity, puberty, inadequate metabolic control, and hepatic steatosis, have to add up before a clinically relevant effect of fetuin A on insulin sensitivity becomes evident.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes

et al. 2017

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Estimated insulin sensitivity, cardiovascular risk, and hepatic steatosis after 12 years from the onset of T1D

Petrelli

Ravà

Mascali

et al. 2021

Diabetes Metabolism Res

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Aim: To test the hypothesis that intensive insulin treatment and optimal glycaemic control are not fully protective against reduction of insulin sensitivity in children with type 1 diabetes. Material and methods:Cohort study of 78 normal-weight patients with prepubertal onset (T 0 ) and follow-up waves at 1 (T 1 ), 5 (T 5 ), 10 (T 10 ), and 12 (T 12 ) years; matched for age and sex to 30 controls at T 12 . Estimated insulin sensitivity (eIS) by three formulae; ultrasound evaluation of para and perirenal fat thickness; hepatic steatosis (HS); carotid intima media thickness (cIMT) at T 12 .Results: At T12, the 36 patients (46%) who had constantly or prevalently haemoglobin A1c (HbA1c) < 58 mmol/l during follow-up showed better eIS indexes (p = 0.049 to <0.0001); lipid profile (p = 0.042 to <0.0001), reduced fat mass (p = 0.012) and required lower insulin dose (p = 0.032) than the 42 patients (54%) with HbA1c ≥ 58 at T12. Patients (N = 25) with eIS EDC < 8.77 mg kg −1 min −1 showed higher cIMT (p < 0.0001). HS was found in 6 patients (∼8%). In patients and normal-weight controls, fat mass (p = 0.03), age (p = 0.03), cIMT (p = 0.05) predicted HS; eIS indexes (p from 0.04 to <0.0001) predicted cIMT. Body mass index, perirenal fat, fat mass, and triglycerides to high density lipoprotein cholesterol ratio were associated with eIS indexes (p from 0.03 to <0.0001). Conclusions:Young T1D patients have reduced insulin sensitivity and higher cIMT.Adiposity, glucose, and lipid control over follow-up are likely to influence both.

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Poorly controlled pediatric type 1 diabetes mellitus is a risk factor for metabolic dysfunction associated steatotic liver disease (MASLD): An observational study

Koutny,

Wiemann,

Eckert

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesRecent studies have suggested a link between type 1 diabetes mellitus (T1D) and metabolic dysfunction associated steatotic liver disease (MASLD) in children and adolescent, but longitudinal evidence is lacking. This study aimed to investigate the potential association between poorly controlled T1D and elevated alanine aminotransferase (ALT), serving as a proxy for MASLD in children and adolescents over time.MethodsThe study included 32,325 children aged 2−17 years with T1D from Germany, Austria, and Switzerland who had undergone at least one assessment of liver enzyme levels recorded in the Diabetes‐Patienten‐ Verlaufsdokumentation registry. Multivariable logistic and Cox regression models were calculated to show possible associations between T1D and elevated ALT values (>26 U/L in males, >22 U/L in females) as a proxy for MASLD.ResultsChildren with poorly controlled T1D (HbA1c > 11%) exhibited increased odds of elevated ALT values, after adjustment for age, sex, diabetes duration and overweight (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.10–3.10; p < 0.01). This finding is substantiated by a longitudinal analysis, which reveals that inadequately controlled T1D was associated with a higher hazard ratio (HR) of elevated ALT values compared to children with controlled T1D over an observation period extending up to 5.5 (HR: 1.54; 95% CI, 1.19–2.01; p < 0.01).ConclusionIn conclusion, the current study strongly links poorly controlled T1D in children and adolescents to MASLD irrespective of overweight. This association is not only present cross‐sectionally but also increases over time. The study underscores the critical role of effective diabetes management in reducing the risk of MASLD in this population.

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Screening for non-alcoholic fatty liver disease in children and adolescents with type 1 diabetes mellitus: a cross-sectional analysis

Cited by 24 publications

References 33 publications

Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes

Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes

Estimated insulin sensitivity, cardiovascular risk, and hepatic steatosis after 12 years from the onset of T1D

Poorly controlled pediatric type 1 diabetes mellitus is a risk factor for metabolic dysfunction associated steatotic liver disease (MASLD): An observational study

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