Background: Type 2 diabetes (T2D) is an emerging disease in the pediatric population. The association between T2D and non-alcoholic fatty liver disease (NAFLD) has been described; this increases the risk of coronary heart disease (CHD). Recent evidence suggests that sizes and composition of HDL may be more important that HDL-C levels in predicting CHD. There is not data regarding the HDL subclasses distribution and composition in T2D youths with hepatic steatosis (HE).
Objective: To evaluate the association between the sizes and composition of HDL with HE in T2D youths.
Material and method: The protocol was approved by the local Ethics and Research Committees. This Cross-sectional study included a total of 70 adolescents, 47 adolescents with T2D and 23 healthy adolescents. The characteristics of the study were explained to all the participants; a complete clinical history, anthropometry and physical examination were performed. The presence of HE was determined by magnetic resonance by spectroscopy (MRS). In a venous blood sample (12 hours fasting); glucose, HbA1c and lipid profile were determined. The size and composition of the HDL subpopulations were analyzed by polyacrylamide gel electrophoresis (PAGE).
Results: 31 adolescents with T2D and HE (PDFF≥5%), 16 with T2D without HE (PDFF<5%) and 23 healthy adolescents formed the study. The values of HDL-C were compared between the 3 groups, characteristically they were higher in the group of healthy adolescents compared with the two groups of patients with T2D (P<0.001). Regarding the distribution of HDL particles; we observed an association between the percentage of liver fat (PDFF) and the HDL2b concentration (P=0.011), HDL2a (P=0.014) and average particle size (P=0.011), and a negative correlation with HDL3c (P=0.021). Likewise, a positive correlation was found with the PDFF and the proportion of TG in the particles (P=0.007), as a negative correlation with the free cholesterol (P<0.001) and cholesterol esters of the particles (P=0.010). To better assess the effect of hepatic steatosis on the HDL subclasses distribution and composition, we performed a multiple linear regression analyses; we found that percentage of liver fat was associated with a lower proportion of HDL2b subclass (P=0.004), TG enriched (P=0.013) and CE depleted (P=0.030) in HDL particles. These associations were independent of age, sex, Tanner stage, BMI, levels of HbA1c and diabetes duration.
Conclusions: In adolescents with T2D, the presence of HE is associated with abnormalities in the distribution of HDL subpopulations, as well as in the lipid composition of the particles.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology