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

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Abstract

The liver is intensely involved in glucose metabolism and is thereby closely related to diabetes pathophysiology. Adult patients with type 1 diabetes mellitus (DM) are at an increased risk for non-alcoholic fatty liver disease (NAFLD). Here, we studied the prevalence of NAFLD in a cohort of children and adolescents with type 1 DM in a tertiary care paediatric diabetes centre in Germany. We screened 93 children and adolescents with type 1 DM using ultrasound, laboratory investigations, and liver stiffness measurements (Fibroscan® [FS] and acoustic radiation force imaging [ARFI]). Of these, 82 (88.1%) had completely normal results in all examined aspects. Only one patient (1.1%) fulfilled the criteria as potential NAFLD with ALT > twice the upper limit of normal. Ten of the 93 patients (10.8%) showed any mild abnormality in at least one examined category including ALT, conventional ultrasounds and liver stiffness measurements. However, none of these ten fulfilled the NAFLD case definition criteria. Therefore, these slightly abnormal results were judged to be unspecific or at least of unknown significance in terms of NAFLD indication.

Conclusion: Compared to data from the general population, our results do not indicate a significantly increased prevalence of NAFLD in this cohort, and advocate against the systematic screening for NAFLD in paediatric type 1 DM.

What is Known:

• Non-alcoholic fatty liver disease (NAFLD) is common in adults with type 1 DM, and paediatric patients with type 1 DM in Egypt and Saudi Arabia.

What is New:

• Our results do not indicate a significantly increased prevalence of NAFLD in a cohort of children and adolescents with type 1 DM from Germany compared to prevalence data from the general population.

• This finding advocates against the systematic screening for NAFLD in paediatric type 1 DM in western countries.

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Abbreviations

AAL:

anterior axillary line

ALT:

alanine aminotransferase

ARFI:

acoustic radiation force imaging

BMI:

body mass index

DM:

diabetes mellitus

FS:

fibroscan

HbA1c:

glycated haemoglobin A

ISPAD:

International Society for Pediatric and Adolescent Diabetes

IQR:

interquartile range

MCL:

medioclavicular line

NAFLD:

non-alcoholic fatty liver disease

SDS:

standard deviation score

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Acknowledgements

We gratefully thank Yasemin Fidan for her extensive efforts to coordinate appointments and manage the collected data. Further thanks to Dr. Carsten Döing, Gisela Mayr, Martina Creon, Denise Reiner and Dr. Christina Reinauer for their help with recruiting participants for this study. We thank the “Vereinigung Rheinisch-Westfälischer Kinder- und Jugendärzte und Kinderchirurgen” for their financial support. Our special thanks go to all of the participants and their families.

Authors’ contributions

S.K. designed the study, analysed the data, wrote and finalised the manuscript, participated in recruiting the patients. D.K. performed ultrasound examinations, and revised the manuscript draft. G.K. performed the elastography measurements and revised the manuscript draft. M.F. contributed to study design, data analysis, and revised manuscript draft. J.S. performed ultrasound examinations and revised the manuscript draft. D.H. supervised the study and revised the manuscript draft. E.M. supervised the study and revised the manuscript draft. T.M. contributed to study design, patient recruitment, data analysis and manuscript preparation/revision. All authors approved the final submitted manuscript.

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Authors and Affiliations

  1. Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children’s Hospital, Moorenstr. 5, 40225, Duesseldorf, Germany

    Sebastian Kummer, Michael Friedt, Ertan Mayatepek & Thomas Meissner

  2. Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital, Moorenstr. 5, 40225, Dusseldorf, Germany

    Dirk Klee & Joerg Schaper

  3. Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Moorenstr. 5, 40225, Duesseldorf, Germany

    Gerald Kircheis & Dieter Häussinger

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  1. Sebastian Kummer
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Correspondence to Sebastian Kummer.

Ethics declarations

The authors declare that they have no conflict of interest. This study was funded by a research grant of the “Vereinigung Rheinisch-Westfälischer Kinder- und Jugendärzte und Kinderchirurgen” (no specific grant number). The funder was not involved in study design, data collection, data analysis, manuscript preparation and/or publication decisions. No author has any financial relationship with the organization that sponsored the research. All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The study protocol was approved by the Ethics Committee of the Medical Faculty of the Heinrich-Heine-University Duesseldorf (Study number 3755, February 2012). Written and informed consent was obtained from all participants’ parents or respective guardians before inclusion in the study, and additionally from the participants themselves if they were ≥8 years of age.

Additional information

Communicated by Peter de Winter

Revisions received: 03 February 2017; 05 February 2017

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Kummer, S., Klee, D., Kircheis, G. et al. Screening for non-alcoholic fatty liver disease in children and adolescents with type 1 diabetes mellitus: a cross-sectional analysis. Eur J Pediatr 176, 529–536 (2017). https://doi.org/10.1007/s00431-017-2876-1

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