Background: Type 2 diabetes (T2D) is an emerging disease in the pediatric population. The mechanisms responsible for the development of nonalcoholic fatty liver disease (NAFLD) and progression to nonalcoholic steatohepatitis (NASH) in these patients are incompletely understood. Low serum insulin-like growth factor-1 (IGF-1) levels are associated with increased histologic severity of NAFLD. Growing evidence suggests that growth hormone (GH) and IGF-1 may have roles in the development and progression of NAFLD.
Objective: To evaluate the association between serum IGF-1 levels with the percentage of liver fat in T2D youths.
Material and Method: This Cross-sectional study included a total of 70 adolescents, 47 adolescents with T2D and 23 healthy adolescents. The protocol was approved by the local Ethics and Research Committees. The characteristics of the study were explained to all the participants; a complete clinical history, anthropometry and physical examination were performed. To evaluate the average of liver fat, the imaging estimated proton density fat fraction (PDFF) was determined by magnetic resonance (MR). The serum IGF-1 levels were analyzed by chemiluminescent immunometric assay.
Results: Mean age was 14.9 ± 2.2 years, and body mass index (BMI) was 23.6 ± 4.6 kg/m2. Considering the average PDFF threshold of 6.5% or higher, we had 31 adolescents with T2D and NAFLD, 16 with T2D without NAFLD and 23 healthy adolescents. Mean serum IGF-1 was lower in subjects with NAFLD, (207.2 ± 93.1 ng/ml vs. 241.9 ± 78.6 ng/ml, P= <0.05). We observed an association between the percentage of liver fat and IGF-1 levels (P=0.012). After a multivariable analysis, the association was non-significant when we adjusted for BMI, severity of NAFLD, or Tanner score. With the exception of the association between IGF-1 levels and NAFLD which remained significant after adjustment for levels of HbA1c.
Conclusions: In adolescents with T2D, low serum IGF-1 levels are associated with increased of the percentage of liver fat (PDFF). Further investigation is warranted to determine the differential effects of GH and IGF-1 on the development and progression of NAFLD in adolescents with T2D, which could further elucidate pathophysiology and identify therapeutic targets.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology