ESPE Abstracts

Background: Type 2 diabetes (T2D) is an emerging disease in the pediatric population. T2D is associated with metabolic-associated fatty liver disease (MAFLD). High-density lipoproteins (HDLs) are lipoproteins that are believed to have atheroprotective properties that reduce the risk of cardiovascular disease (CVD). Current evidence suggests that the physicochemical and functional features of HDLs may play a key role in the pathogenesis of atherosclerosis.

Objective: To assess the impact of MAFLD on cholesterol efflux capacity (CEC) in in T2D youths.

Materials and methods: This Cross-sectional study included a total of 70 adolescents, 47 of which had T2D and 23 were healthy individuals. The protocol was approved by the local Ethics and Research Committees. The presence of MAFLD was determined by MR spectroscopy with proton density fat fraction. We compared the distribution of HDL subtypes (HDL2b, HDL2a, HDL3a, HDL3b, and HDL3c) and the chemical composition of HDLs (total protein, triglycerides, phospholipids, cholesteryl esters, and free cholesterol). HDL functionality was determined by the CEC, measuring the fluorescent cholesterol efflux from J774 macrophage cells.

Results: In Our study, we observed a prevalence of MAFLD in 66% of adolescents with T2D, similar to the reported in other international studies (60-80%). In the T2D and MAFLD population, we didn’t observe a decrease on CEC. Initially, we found an elevation of CEC in adolescents with T2D, however, with the increase in liver fat, a decrease is observed, which could explain a probable metabolic phenomenon, since the physicochemical composition and distribution of the particles is associated with the percentage of liver fat. We observed a correlation between the percentage of liver fat and the HDL2b concentration (P=0.011), HDL2a (P=0.014) and average particle size (P=0.011 and the proportion of triglycerides inside the particles (P=0.007). Likewise, a negative correlation was found with the percentage of liver fat, the cholesterol esters (P=0.010) and the free cholesterol of the particles (P<0.001).

Conclusions: In adolescents with T2D, the presence of MAFLD is associated with abnormalities in the distribution and the lipid composition of HDL particles. Building on the momentum generated by the original MAFLD proposal and adapting the recommendations for pediatric MAFLD would be a step forward that could help to study the impact of MAFLD in the atheroprotective properties of HDL particles.