Characteristics and related factors of type 2 diabetes mellitus with non-alcoholic fatty liver disease in children

Objectives To investigate the clinical characteristics and metabolic risk factors of with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD) in children. Methods A total of 473 children with T2DM admitted to Beijing Children's Hospital from February 2008 to December 2015 consisting of 90 patients with NAFLD and 383 patients without NAFLD. Clinical data were collected and analyzed including gender, age, duration of diabetes, height, weight, waist and hip circumference, body mass index, blood pressure, hemoglobin, serum lipid and uric acid, glycated hemoglobin (HbA1c), fasting plasma glucose, 2-hour postprandial glucose level, fasting insulin and C-peptide, insulin resistance index (HOMA-IR) in steady-state model. The t test and rank sum test were used in the comparison group, and Logistic regression was used for multivariate analysis. Results (1) In the 473 children with T2DM, 90 cases (19.03%) were complicated with NAFLD. (2) In T2DM with NAFLD group, the levels of age, height, weight, body mass index, systolic and diastolic blood pressure, liver function, serum lipid and uric acid were significantly higher than those in non-NAFLD group (P<0.05). The levels of hemoglobin, HOMA-IR, fasting insulin and C-peptide in NAFLD group were significantly higher than those in non-NAFLD group [(142±11) vs (134±14) g/L, 2.7(1.7, 4.4) vs 1.4(0.5, 3.1), 10.2(6.0, 15.1) vs 4.8(1.7, 10.3) μU/ml, 2.5(2.3, 3.0) vs 0.7(0.3, 22.0) μg/L, t=-5.037, Z=7 900, 8 858, 4 062, all P<0.01]. The 2-hour postprandial glucose level was lower than that in non-NAFLD group [(12.2±4.0) vs (13.6±4.2) mmol/L, t=2.473, P<0.05]. (3)Unconditional multivariable logistic regression analysis showed that hemoglobin concentration and uric acid were independent risk factors for T2DM with NAFLD with odds ratio 3.981 and 3.645 respectively (both P<0.05). Conclusions T2DM with NAFLD usually occurs in the older and obese children with more severe blood pressure, serum lipids, uric acid, hemoglobin, liver function. Hemoglobin level and increased uric acid may help predict the development of NAFLD in children with T2DM. Key words: Diabetes mellitus, type 2; Children; Non-alcoholic fatty liver disease; Related factors