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Updated: Aug 22, 2025
An Advanced Murine Model for Nonalcoholic Steatohepatitis in Association with Type 2 Diabetes
Published on: April 26, 2019
Obesity, but not glycemic control, predicts liver steatosis in children with type 1 diabetes
Emir Tas1, Shasha Bai2, Daniel Mak3
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Endocrinology and Diabetes, Arkansas Children's Hospital, Little Rock, AR, USA; Arkansas Children's Nutrition Center, Little Rock, AR, USA; Arkansas Children's Research Institute, Little Rock, AR, USA.
Insights
Obesity is the primary driver of nonalcoholic fatty liver disease (NAFLD) in children with type 1 diabetes (T1D). Body Mass Index (BMI) and HDL-Cholesterol (HDL-c) can help identify children needing further NAFLD evaluation.
Area of Science:
- Pediatric Endocrinology
- Hepatology
- Metabolic Disorders
Background:
- Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver condition in children, closely linked to obesity and insulin resistance.
- While type 1 diabetes (T1D) involves insulin deficiency, rising obesity rates in T1D patients significantly increase NAFLD risk.
- Predisposing factors for NAFLD in pediatric T1D remain largely unknown.
Purpose of the Study:
- To investigate the prevalence and predisposing factors of NAFLD in children with T1D.
- To compare NAFLD characteristics in children with T1D and obesity to those without T1D but with obesity.
- To identify clinical markers for predicting NAFLD in this population.
Main Methods:
- A cross-sectional study comparing BMI-matched obese children with and without T1D.
- Hepatic steatosis assessed using vibration-controlled transient elastography (VCTE) to measure controlled-attenuated parameter (CAP) scores.
- Linear regression and ROC analyses to evaluate associations between CAP scores and clinical parameters, and diagnostic performance of predictors.
Main Results:
- Two-thirds of obese subjects exhibited CAP scores indicative of NAFLD; 16% of non-obese T1D patients also had elevated CAP.
- CAP scores correlated significantly with BMI, HDL-Cholesterol (HDL-c), and HbA1c across all subjects and in the T1D subgroup.
- BMI, HDL-c, and the BMI/HDL ratio demonstrated good to excellent performance in predicting NAFLD in the overall cohort.
Conclusions:
- Clinical and imaging findings in obese children with T1D mirror those in non-diabetic obese children.
- Obesity emerges as the principal risk factor for NAFLD in pediatric T1D.
- BMI, HDL-c, and BMI/HDL ratio are valuable markers for NAFLD screening in T1D children, especially those who are obese.
Objective:
Nonalcoholic fatty liver disease (NAFLD), the most common liver disease in children, is strongly associated with obesity and insulin resistance. Although type 1 diabetes (T1D) is characterized by insulin deficiency, increasing obesity rates among children with T1D is a major risk factor for NAFLD in this patient population. Predisposing factors for NAFLD in children with T1D are not known.
Study Design:
This is a cross-sectional study comparing children with T1D across the range of body mass index (BMI) to the BMI-matched obese group without T1D. Hepatic steatosis was semi-quantitatively measured via the vibration-controlled transient elastogram (VCTE) method. Linear regression analysis was performed to assess the relationship between controlled-attenuated parameter (CAP) scores and clinical parameters. Receiver-operator curve (ROC) analysis was used to evaluate the diagnostic performance of several clinical parameters against NAFLD status determined via CAP.
Results:
Two-thirds of subjects with obesity had CAP scores suggestive of NAFLD, while 16 % (n = 6) of T1D patients without obesity had elevated CAP. Obese subjects were different from non-obese subjects in many laboratory and clinical characteristics, regardless of T1D status. CAP score was significantly associated with BMI, HDL-Cholesterol (HDL-c), and HbA1c in all subjects as well as the T1D-only subgroup. Among subjects with obesity only, age, HDL-cand ALT were the most significant predictors. Diagnostic performance of BMI, HDL-c, and BMI/HDL ratio were in the good to the excellent range for predicting NAFLD among all subjects, while performance varied for T1D-only or obesity-only groups.
Conclusion:
The clinical and imaging findings of children with T1D and obesity are comparable to non-diabetic children with a similar degree of obesity. Obesity is the major risk factor for NAFLD in pediatric T1D. BMI, HDL-c, and BMI/HDL ratio may be helpful markers to determine further workup for NAFLD in children with T1D, particularly those with obesity.
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