title: Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla2Department of Gastroenterology, Rady Children's Hospital, San Diego, California.
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Newton
authors.affiliation: Clinical and Translational Research Institute, University of California San Diego School of Medicine, La Jolla.
authors.forename: Jiayi
authors.initials: J
authors.lastname: Hou
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio5Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Crimmins
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University, New York, New York.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Barlow
authors.affiliation: Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio8Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Stavra A
authors.initials: SA
authors.lastname: Xanthakos
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla2Department of Gastroenterology, Rady Children's Hospital, San Diego, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Africa
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla8Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Behling
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Michele
authors.initials: M
authors.lastname: Donithan
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland10Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla2Department of Gastroenterology, Rady Children's Hospital, San Diego, California11Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Schwimmer
mesh_terms: D000293:Adolescent; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D011236:Prediabetic State / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012720:Severity of Illness Index