Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease.
OBJECTIVE
To analyze the associations of pancreatic fat with other fat depots and β-cell function in pediatric nonalcoholic fatty liver disease (NAFLD).


METHODS
We examined 158 overweight/obese children and adolescents, 80 with NAFLD [hepatic fat fraction (HFF) ≥ 5%] and 78 without fatty liver. Visceral adipose tissue (VAT), pancreatic fat fraction (PFF) and HFF were determined by magnetic resonance imaging. Estimates of insulin sensitivity were calculated using the homeostasis model assessment of insulin resistance (HOMA-IR), defined by fasting insulin and fasting glucose and whole-body insulin sensitivity index (WBISI), based on mean values of insulin and glucose obtained from oral glucose tolerance test and the corresponding fasting values. Patients were considered to have prediabetes if they had either: (1) impaired fasting glucose, defined as a fasting glucose level ≥ 100 mg/dL to < 126 mg/dL; (2) impaired glucose tolerance, defined as a 2 h glucose concentration between ≥ 140 mg/dL and < 200 mg/dL; or (3) hemoglobin A1c value of ≥ 5.7% to < 6.5%.


RESULTS
PFF was significantly higher in NAFLD patients compared with subjects without liver involvement. PFF was significantly associated with HFF and VAT, as well as fasting insulin, C peptide, HOMA-IR, and WBISI. The association between PFF and HFF was no longer significant after adjusting for age, gender, Tanner stage, body mass index (BMI)-SD score, and VAT. In multiple regression analysis with WBISI or HOMA-IR as the dependent variables, against the covariates age, gender, Tanner stage, BMI-SD score, VAT, PFF, and HFF, the only variable significantly associated with WBISI (standardized coefficient B, -0.398; P = 0.001) as well as HOMA-IR (0.353; P = 0.003) was HFF. Children with prediabetes had higher PFF and HFF than those without. PFF and HFF were significantly associated with prediabetes after adjustment for clinical variables. When all fat depots where included in the same model, only HFF remained significantly associated with prediabetes (OR = 3.38; 95%CI: 1.10-10.4; P = 0.034).


CONCLUSIONS
In overweight/obese children with NAFLD, pancreatic fat is increased compared with those without liver involvement. However, only liver fat is independently related to prediabetes.
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Lucia
L
Pacifico
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Michele
M
Di Martino
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Caterina
C
Anania
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Gian Marco
GM
Andreoli
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Mario
M
Bezzi
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Carlo
C
Catalano
Lucia Pacifico, Caterina Anania, Gian Marco Andreoli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
Claudio
C
Chiesa
D050154:Adiposity; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002648:Child; D003430:Cross-Sectional Studies; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D050152:Intra-Abdominal Fat / Q000473:pathology; D016014:Linear Models; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016017:Odds Ratio; D010179:Pancreas / Q000378:metabolism* / Q000473:pathology*; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin
Beta-cell function; Children; Nonalcoholic fatty liver disease; Pancreatic fat; Visceral fat