Centro Studi Fegato, Basovizza e Dipartimento ACADEM, Università di Trieste, Trieste, Italy.
Nutr Metab Cardiovasc Dis. 2012 Feb;22(2):120-6. doi: 10.1016/j.numecd.2010.05.003. Epub 2010 Sep 28.
Early onset type 2 diabetes mellitus (T2DM) is associated with obesity, insulin resistance and impaired beta-cell function. Non-alcoholic fatty liver disease (NAFLD) may be an independent risk factor for T2DM. We investigated the relationship between NAFLD and glucose metabolism in a large sample of obese children.
A total of 571 obese children (57% males and 43% females) aged 8-18 years were consecutively studied at a tertiary care centre specialised in paediatric obesity. Liver ultrasonography was used to diagnose NAFLD after exclusion of hepatitis B and C and alcohol consumption. Oral-glucose tolerance testing (OGTT) was performed; insulin sensitivity was evaluated by using the insulin sensitivity index (ISI) and beta-cell function by using the ratio between the incremental areas under the curve (AUC) of insulin and glucose (incAUCins/incAUCglu). A total of 41% of the obese children had NAFLD. Impaired glucose tolerance or T2DM was present in 25% of the children with NAFLD versus 8% of those without it (p<0.001). Children with NAFLD had higher body mass index (BMI), fasting glucose, 120-min OGTT glucose, incAUCins/incAUCglu and lower ISI as compared with children without NAFLD (p≤0.002). At bootstrapped multivariable median regression analysis controlling for gender, age, pubertal status and BMI, NAFLD was an independent predictor of 120-min OGTT glucose and ISI, but not of incAUCins/incAUCglu. Similar findings were obtained using continuous liver steatosis as the predictor, instead of dichotomous NAFLD.
NAFLD was present in 41% of our obese children and was associated with higher insulin resistance, but not with impaired beta-cell function.
早发性 2 型糖尿病（T2DM）与肥胖、胰岛素抵抗和β细胞功能受损有关。非酒精性脂肪性肝病（NAFLD）可能是 T2DM 的一个独立危险因素。我们在一个大型肥胖儿童样本中研究了 NAFLD 与糖代谢之间的关系。
在一家专门从事儿科肥胖症的三级保健中心，连续研究了 571 名年龄在 8-18 岁的肥胖儿童（57%为男性，43%为女性）。排除乙型肝炎和丙型肝炎以及饮酒后，采用肝脏超声诊断 NAFLD。进行口服葡萄糖耐量试验（OGTT）；使用胰岛素敏感指数（ISI）评估胰岛素敏感性，使用胰岛素和葡萄糖增量面积比（incAUCins/incAUCglu）评估β细胞功能。41%的肥胖儿童患有 NAFLD。患有 NAFLD 的儿童中，糖耐量受损或 T2DM 的发生率为 25%，而无 NAFLD 的儿童为 8%（p<0.001）。与无 NAFLD 的儿童相比，患有 NAFLD 的儿童的体重指数（BMI）、空腹血糖、120 分钟 OGTT 血糖、incAUCins/incAUCglu 更高，ISI 更低（p≤0.002）。在性别、年龄、青春期状态和 BMI 进行 bootstrap 多变量中位数回归分析后，NAFLD 是 120 分钟 OGTT 血糖和 ISI 的独立预测因素，但不是 incAUCins/incAUCglu 的独立预测因素。使用连续的肝脂肪变性作为预测因子，而不是使用二分法的 NAFLD，得到了类似的发现。
我们肥胖儿童中 41%存在 NAFLD，与更高的胰岛素抵抗有关，而与β细胞功能受损无关。
