ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2020) 17 12.10 | DOI: 10.1530/ey.17.12.10

Metabolic Syndrome

12.10. Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease

Nobili V, Mantovani A & Cianfarani S, et al.


To read the full abstract: J Hepatol. 2019;71(4):802–10. doi: 10.1016/j.jhep.2019.06.023

Short summary: Prediabetes is highly prevalent in Caucasian children and adolescents with well-characterized, biopsy-proven non-alcoholic fatty liver disease (NAFLD).

Comment: NAFLD is considered the liver presentation of the metabolic syndrome. NAFLD encompasses a wide spectrum of liver abnormalities, ranging from simple liver steatosis to steatohepatitis, fibrosis, cirrhosis and end-stage liver disease. Multiple factors affect NAFLD development and progression, including obesity, environmental factors and genetic background (e.g. variants in the patatin-like phospholipase domain-containing 3 gene, PNPLA3 ).1 NAFLD has emerged as the most common chronic liver disease in children and adolescents in Western countries.

The study cohort comprised 599 Caucasian children and adolescents with NAFLD (301 girls), aged 5–17 years; compared with 118 children and adolescents with obesity (49 girls) without NAFLD of the same age. The strongest predictor of NASH was increased waist circumference, together with the presence of the risk allele (G) of rs738409 in PNPLA3.

Among children with biopsy-proven NAFLD, the prevalence of prediabetes was 19.8% and of newly diagnosed diabetes, 0.8%. This compared with 11% and 0%, respectively, among children with obesity but without NAFLD. Of note, children/adolescents with prediabetes/diabetes had higher degrees of hepatic steatosis and lobular inflammation than did those with normal glucose tolerance. The presence of prediabetes/diabetes was significantly associated with an almost 2-fold increased risk of having both severe hepatic steatosis and severe lobular inflammation, and was marginally associated with ballooning degeneration (P = 0.069), but not with significant hepatic fibrosis.

These findings suggest that children with NAFLD need close follow-up evaluation of glucose metabolism, in addition to long-term monitoring for progression of liver disease.


1. Bruschi FV, Tardelli M, Claudel T,et al. PNPLA3 expression and its impact on the liver: current perspectives. Hepat Med 2017;9:55–66. doi: 10.2147/HMER.S125718.

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