Abstract
Background
Diabetes and hepatosteatosis are dramatically increasing in childhood. Non-alcoholic fatty liver disease (NAFLD) is defined as a common disorder in adulthood, especially with type-2 diabetes and metabolic syndrome, while very few studies are available on liver health in children with type-1 diabetes.
Patients and methods
One hundred and ten (52 males and 58 females) patients with type-1 diabetes aged between 8 and 18 years were examined. The lipid profile, liver enzymes and hepatobiliary ultrasound findings of patients were investigated in terms of hepatopathies. Patients diagnosed with fatty liver were evaluated by pediatric gastroenterology specialists for the differential diagnosis and exclusion of other etiologies. The relationships between hepatopathy and age, pubertal status, the duration of diabetes and glycemic control were evaluated.
Results
Hepatopathy was found in 17 (15.5%) patients. The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were normal and did not correlate with the ultrasonography (USG) findings. Hyperechogenicity detected by USG, whether it is true fat or glycogen hepatopathy, was found to be associated with “poor glycemic control” independently of age, puberty status and the duration of diabetes.
Conclusions
This study contributes to the literature in terms of the relationship between liver health and glycemic control in pediatric type-1 diabetes. Hepatopathies were releated with poor glycemic control independently of the duration of diabetes. This suggested that liver disorders should be considered as one of the subacute complications of diabetes. It was concluded that routine screening for comorbidities and complications in type-1 diabetes should also include hepatobiliary USG, as liver enzymes alone are inadequate for detecting hepatopathies.
Acknowledgments
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Regnell SE, Lernmark Å. Hepatic steatosis in type 1 diabetes. Rev Diabet Stud 2011;8:454–67.10.1900/RDS.2011.8.454Search in Google Scholar PubMed PubMed Central
2. D’Adamo E, Santoro N, Caprio S. Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed. Endocrinol Metab Clin North Am 2009;38:549–63.10.1016/j.ecl.2009.06.002Search in Google Scholar PubMed
3. Neuschwander-Tetri BA. Non-alcoholic fatty liver disease. BMC Medicine 2017;15:45.10.1186/s12916-017-0806-8Search in Google Scholar PubMed PubMed Central
4. Munns CF, McCrossin RB, Thomsett MJ, Batch J. Hepatic glycogenosis: reversible hepatomegaly in type 1 diabetes. J Paediatr Child Health 2000;36:449–52.10.1046/j.1440-1754.2000.00547.xSearch in Google Scholar PubMed
5. Mauriac P. Stomach, hepatomegaly, growth disorders in diabetic children treated for several years by insulin. Gax Hebd Med Bordeaux 1930;26:402–10.Search in Google Scholar
6. Sweetser S, Kraichely RE. The bright liver of glycogenic hepatopathy. Hepatology 2010;51:711–2.10.1002/hep.23402Search in Google Scholar PubMed
7. Murata F, Horie I, Ando T, Isomoto E, Hayashi H, et al. A case of glycogenic hepatopathy developed in a patient with new-onset fulminant type-1 diabetes: the role of image modalities in diagnosing hepatic glycogen deposition including gradient-dual-echo MRI. Endocr J 2012;59:669–76.10.1507/endocrj.EJ12-0081Search in Google Scholar
8. Ramírez-López G, Morán-Villota S, Mendoza-Carrera F, Portilla-de Buen E, Valles-Sánchez V, et al. Metabolic and genetic markers’ associations with elevated levels of alanine aminotransferase in adolescents. J Pediatr Endocrinol Metab 2018;31:407–14.10.1515/jpem-2017-0217Search in Google Scholar PubMed
9. Félix DR, Costenaro F, Gottschall CB, Coral GP. Non-alcoholic fatty liver disease (Nafld) in obese children-effect of refined carbohydrates in diet. BMC Pediatr 2016;16:187.10.1186/s12887-016-0726-3Search in Google Scholar PubMed PubMed Central
10. Penke M, Kiess W, De Giorgis T. Non-alcoholic fatty liver disease in children and adolescents. J Pediatr Endocrinol Metab 2016;29:1329–30.10.1515/jpem-2016-0415Search in Google Scholar PubMed
11. Scatarige JC, Scott WW, Donovan PJ, Siegelman SS, Sanders RC. Fatty infiltration of the liver: ultrasonographic and computed tomographic correlation. J Ultrasound Med 1984;3:9–14.10.7863/jum.1984.3.1.9Search in Google Scholar PubMed
12. Shannon A, Alkhouri N, Carter-Kent C, Monti L, Devito R, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children with nonalcoholic fatty liver disease (NAFLD). J Pediatr Gastroenterol Nutr 2011;53:190–5.10.1097/MPG.0b013e31821b4b61Search in Google Scholar
13. Tsujimoto T, Takano M, Nishiofuku M, Yoshiji H, Matsumura Y, et al. Rapid onset of glycogen storage hepatomegaly in a type-2 diabetic patient after a massive dose of long-acting insulin and large doses of glucose. Intern Med 2006;45:469–73.10.2169/internalmedicine.45.1548Search in Google Scholar
14. Krishnan B, Babu S, Walker J, Walker AB, Pappachan JM. Gastrointestinal complications of diabetes mellitus. World J Diabetes 2013;4:51–63.10.4239/wjd.v4.i3.51Search in Google Scholar
15. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arc Pediatr Adolesc Med 2003;157:821–7.10.1001/archpedi.157.8.821Search in Google Scholar
16. Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis. Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation 2003;107:1448–53.10.1161/01.CIR.0000060923.07573.F2Search in Google Scholar
17. Marchesini G, Brizi M, Morselli-Labate AM, Bianchi G, Bugianesi E, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999;107:450–55.10.1016/S0002-9343(99)00271-5Search in Google Scholar
18. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116:1413–9.10.1016/S0016-5085(99)70506-8Search in Google Scholar
19. Chitturi S, Abeygunasekera S, Farell GC, Holmes-Walker J, Hui JM, et al. NASH and insulin resistance: insulin hypersecretion and spesific association with insulin resistance syndrome. Hepatology 2002;35:497–9.10.1053/jhep.2002.30692Search in Google Scholar PubMed
20. Al-Hussaini AA, Sulaiman N, Al-Zahrani M, Alenazi A, Khan M. Prevalence of liver disease among type 1 diabetic children. J Pediatr Gastroenterol Nutr 2010;51:57.Search in Google Scholar
21. El-Karaksy HM, Anwar G, Esmat G, Mansour S, Sabry M, et al. Prevalence of hepatic abnormalities in a cohort of Egyptian children with type 1 diabetes mellitus. Pediatr Diabetes 2010;11:462–70.10.1111/j.1399-5448.2009.00627.xSearch in Google Scholar PubMed
22. DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complication in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86.10.1056/NEJM199309303291401Search in Google Scholar PubMed
23. The French Pediatric Diabetes Group. Factors associated with glycemic control: a cross-sectional nationwide study in 2,579 French children with type 1 diabetes. Diabetes Care 1998;7:1146–53.Search in Google Scholar
24. A population-based study (DIABAUD2). Factors influencing glycemic control in young people with type 1 diabetes in Scotland. Diabetes Care 2001;24:239–44.10.2337/diacare.24.2.239Search in Google Scholar PubMed
25. Saunders SA, Wallymahmed M, MacFarlane IA. Glycemic control in a type-1 diabetes clinics for younger adults. Q J Med 2004;97:575–80.10.1093/qjmed/hch098Search in Google Scholar PubMed
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