Prevalence of prediabetes and type 2 diabetes in children with obesity and increased transaminases in European German‐speaking countries. Analysis of the APV initiative

Abstract

Summary Background Non‐alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. Objectives The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. Methods Data from the observational multicentre (n = 51), cross‐sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. Results The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0–12.8) and 1.4% (95% CI: 1.1–1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI‐SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1–15.4) in the mild, 21.9% (95% CI: 18.8–25.1) in the advanced group, 10.7% (95% CI: 9.4–11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17–1.72, 2.26‐fold; (1.78–2.86), respectively], the advanced group also for T2DM [2.39 (1.36–4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). Conclusions Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM.

High prevalence of undiagnosed comorbidities among adolescents with obesity

“…≥ 5.6 mmol/L as recommended by the ADA 53 and ISPAD 54 , rather than the WHO value ≥ 6.1 mmol/L 55 ), as using the higher WHO cut-off, our pre-diabetes rate would have dropped from 52 to 38%. Nonetheless, when compared to previous studies in US and Europe that used the same cut-off values as ours, the prevalence of pre-diabetes in our study was still 4 times greater 52,56 . Moreover, due to the high risk of diabetes in our vulnerable study population and our aim to prevent worsening of their metabolic health through early identification and intervention, we contend that the lower threshold for abnormal fasting glycaemia was justified.…”

“…www.nature.com/scientificreports/ Reduction in insulin sensitivity as well as impaired glucose metabolism were common complications among our study population. Insulin resistance as assessed from the HOMA-IR values among our adolescents was more than 1.5 times higher when compared with adolescents with obesity in the US 51 and Europe 52 . In addition, more www.nature.com/scientificreports/ than half of our participants had pre-diabetes (i.e.…”

Liver Enzymes Correlate With Metabolic Syndrome, Inflammation, and Endothelial Dysfunction in Prepubertal Children With Obesity

“…Its elevation is also associated with the incidence of MetS, diabetes mellitus, and cardiovascular disease ( 14 ). Children with increased liver transaminases as surrogates of NAFLD show higher prevalences for prediabetes and type 2 diabetes mellitus as compared to those with normal transaminases ( 31 )…”

The Intricate Relationship between Type 2 Diabetes Mellitus (T2DM), Insulin Resistance (IR), and Nonalcoholic Fatty Liver Disease (NAFLD)

“…By now, TD2M is reported to affect 1 in 11 adults and up to 463 million people worldwide [23]. Since the 90s, there is an increased incidence and prevalence of prediabetes and T2DM among the paediatric population which is linked to a high-fat diet, sedentarism, obesity, and liver-related diseases [24,25]. As T2DM is defined by high serum glucose levels, IR, and damaged islet cell function, it is possible that patients with NAFLD have a higher risk of developing diabetes as they usually express abnormal glucose metabolism [26].…”