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Original Investigation |

Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease ONLINE FIRST

Kimberly P. Newton, MD1,2; Jiayi Hou, PhD3; Nancy A. Crimmins, MD, MS4,5; Joel E. Lavine, MD, PhD6; Sarah E. Barlow, MD, MPH7; Stavra A. Xanthakos, MD, MS5,8; Jonathan Africa, MD1,2; Cynthia Behling, MD1,8; Michele Donithan, MHS9; Jeanne M. Clark, MD, MPH9,10; Jeffrey B. Schwimmer, MD1,2,11 ; for the Nonalcoholic Steatohepatitis Clinical Research Network
[+] Author Affiliations
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
2Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
3Clinical and Translational Research Institute, University of California San Diego School of Medicine, La Jolla
4Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
5Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
6Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University, New York, New York
7Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
8Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
9Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
10Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
11Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine
JAMA Pediatr. Published online August 01, 2016. doi:10.1001/jamapediatrics.2016.1971
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Importance  Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown.

Objective  To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH).

Design, Setting, and Participants  This was a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network.

Main Outcomes and Measures  The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values.

Results  There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4% (95% CI, 20.2%-26.6%), and the estimated prevalence of type 2 diabetes was 6.5% (95% CI, 4.6%-8.4%). Girls with NAFLD had 1.6 (95% CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95% CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2%) compared with prediabetes (34.2%) or normal glucose (22%) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95% CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95% CI, 1.5-6.2) compared with those with normal glucose.

Conclusions and Relevance  In this study, nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.

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