Velayutham Vallimayil, Benitez-Aguirre Paul Z, Liew Gerald, Jenkins Alicia J, Craig Maria E, Donaghue Kim C
Paediatrics, University of Sydney, Sydney, New South Wales, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Pediatr Diabetes. 2025 May 15;2025:1910554. doi: 10.1155/pedi/1910554. eCollection 2025.
Data on the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes are lacking. However, MAFLD is well known to contribute to cardiovascular disease (CVD) in people with type 2 diabetes. We aimed to investigate markers of MAFLD in youth with type 1 diabetes and their relationship with chronic complications. A prospective study of 102 adolescents (mean age 14.7 ± 1.9 years) with type 1 diabetes underwent repeated annual diabetes complications assessments, including annual measures of liver enzymes. Early cardiac autonomic nerve dysfunction (CAN) was defined as ≥1 abnormality in seven heart rate variability parameters derived from a 10-min resting electrocardiogram. Multivariate generalized estimating equations explored predictors of CAN and other microvascular complications (retinopathy and early kidney dysfunction). After a median follow-up of 3.5 years (IQR 2.7-4.6), there were significant increases in the mean alanine transaminase level (ALT) and systolic blood pressure (SBP) percentiles. Upper ALT and gamma-glutamyl transferase (GGT) tertiles (T3 vs. T1-2: odds ratio [OR], 95% confidence interval [CI], 2.05 [1.20, 3.48], and 2.99 [1.61, 5.58], respectively) predicted CAN development (23%, = 24) independent of HbA1c and diabetes duration. They were not associated with retinopathy or early kidney dysfunction. Higher ALT and GGT associate with early CAN in adolescents with type 1 diabetes, suggesting hepatic inflammation may compound the impact of the diabetes milieu on systemic endothelial dysfunction.
关于代谢功能障碍相关脂肪性肝病（MAFLD）对1型糖尿病青少年糖尿病并发症影响的数据尚缺。然而，众所周知，MAFLD会导致2型糖尿病患者发生心血管疾病（CVD）。我们旨在研究1型糖尿病青少年中MAFLD的标志物及其与慢性并发症的关系。一项针对102名1型糖尿病青少年（平均年龄14.7±1.9岁）的前瞻性研究，对其进行了年度重复的糖尿病并发症评估，包括每年检测肝酶。早期心脏自主神经功能障碍（CAN）定义为，从10分钟静息心电图得出的7个心率变异性参数中≥1项异常。多变量广义估计方程探讨了CAN和其他微血管并发症（视网膜病变和早期肾功能障碍）的预测因素。中位随访3.5年（四分位间距2.7 - 4.6）后，平均丙氨酸转氨酶水平（ALT）和收缩压（SBP）百分位数显著升高。ALT和γ-谷氨酰转移酶（GGT）的上三分位数（T3与T1 - 2相比：比值比[OR]，95%置信区间[CI]，分别为2.05[1.20，3.48]和2.99[1.61，5.58]）可独立于糖化血红蛋白（HbA1c）和糖尿病病程预测CAN的发生（23%，n = 24）。它们与视网膜病变或早期肾功能障碍无关。较高的ALT和GGT与1型糖尿病青少年的早期CAN相关，提示肝脏炎症可能会加重糖尿病环境对全身内皮功能障碍的影响。
