Clinical and Diagnostic characteristics of Non-Alcoholic Fatty Liver Disease among Egyptian children and adolescents with type1 diabetes: a cross sectional study.

Abstract Background Type 1 diabetes mellitus patients are at an increased risk for non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the clinical criteria associated with the diagnosis of Non Alcoholic Fatty Liver Disease (NAFLD) among Egyptian children and adolescents with type 1 Diabetes. Methods 74 T1DM patients aged 8–18 y were enrolled in this cross sectional study. Clinical examination and anthropometric assessment were done. Assessments of lipid profile, glycated haemoglobin (HbA1c) and liver enzymes were done. Abdominal Ultrasound evaluation of hepatic steatosis was done and accordingly, patients were divided into two groups (NAFLD & normal liver group) and compared together. Assessment of liver fibrosis using acoustic radiation force impulse elastography (ARFI) was done. Results in this study; 37 male (50%) & 37 females with mean age 14.3 ± 3.0 y. The mean insulin dose was 1.1 ± 0.4 U/kg & mean disease duration was 6.3 ± 3.0 y. NAFLD was detected in 46 cases while 28 cases had normal liver as diagnosed by abdominal ultrasound. Cases with NAFLD had statistically significant higher BMI-Z scores, waist / hip, waist/ height and sum of skin fold thicknesses compared to those with normal liver ((P < 0.05). The mean value of HbA1c % was significantly higher in the NAFLD group (P = 0.003). Additionally, total cholesterol serum levels, triglycerides & LDL were significantly elevated (p = 0.001, 0.019 & 0.001) while the serum level of HDL was significantly lower in the NAFLD cases (p = 0.001). Although, serum levels of the liver enzymes; ALT & AST were significantly higher among cases with NAFLD than in the normal liver group (p = 0.019 & 0.015) respectively, their means were within normal. Using the ARFI elastography; cases with NAFLD exhibited significant fibrosis (F2, 3 &4). BMI, age of patients and female gender were among the risk factors for NAFLD. Conclusions NAFLD represents a serious consequence in type 1 diabetic children and adolescents that deserves attention especially with poor glycemic control. NAFLD has the potential to evolve to fibrosis. BMI, age of patients and female gender were detected as risk factors for NAFLD.