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TOPLINE:

Children with obesity and metabolic dysfunction–associated steatotic liver disease (MASLD) have a higher risk for youth-onset type 2 diabetes (T2D), and the risk increases dramatically in the presence of intermediate hyperglycemia.

METHODOLOGY:

• A bidirectional association between MASLD and T2D has been shown in adults, but its extent in the pediatric population remains unclear.
• Researchers conducted a nationwide cohort study to assess the association between MASLD in pediatric obesity and the risk for youth-onset T2D using data from the Swedish Childhood Obesity Treatment Register (1999-2020).
• The study included 10,346 children with overweight or obesity but without T2D at baseline (median age, 12.5 years; 43.1% girls; 1102 with MASLD) and 59,336 matched control individuals from the general population.
• MASLD was defined by transaminase levels or diagnosis codes, and T2D was ascertained from national registers.
• The impact of obesity treatment on the risk for T2D was assessed in a subgroup of children with obesity undergoing ≥ 6 months of treatment.

TAKEAWAY:

• The effect of MASLD on the risk for T2D was evaluated over a median follow-up period of 8.1 years.
• MASLD in pediatric obesity was associated with a 2.7-fold increased risk for youth-onset T2D, with the association being prominent during adolescence (adjusted hazard ratio [aHR], 3.99).
• Girls, older individuals, and those with more severe obesity, intermediate hyperglycemia, and parental history of T2D also had an increased risk for T2D.
• Concomitant MASLD and intermediate hyperglycemia increased the risk for T2D by ninefold, with 67% of the T2D cases in this group attributed to this synergistic effect.
• An optimal response in obesity treatment reduced the risk for T2D by at least 43% (aHR, 0.23).

IN PRACTICE:

“Liver and glucose screening should both be a regular part of obesity management,” the authors wrote. “A decrease in the degree of obesity in pediatric years is essential to prevent youth-onset type 2 diabetes.”

SOURCE:

This study, led by Resthie R. Putri, Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden, was published online in Diabetes Care.

LIMITATIONS: 

Although two methods were used to identify MASLD, exposure misclassification may still occur. The lack of histopathology and imaging data limited the assessment of the MASLD spectrum and its association with T2D. The method used to ascertain T2D may not identify patients in primary care who are managed without antidiabetic medications.

DISCLOSURES: 

The study was supported by the Freemasons Foundation for Children’s Welfare in Stockholm, the Center for Innovative Medicine, the Sällskapet Barnavård Foundation, and the Anna-Lisa & Arne Gustafsson foundation. Three of the authors reported being a member of a steering committee; chairing a working group; receiving consulting fees, honoraria for lectures, and payments for expert testimony; serving in leadership roles; and conducting commissioned research. The remaining authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.