Metabolic dysfunction-associated steatotic liver disease and its association with glycemic control metrics in children and adolescents with type 1 diabetes: an exploratory study

Claudio Maffeis; Claudia Piona; Anita Morandi; Marco Marigliano; Elisa Morotti; Valentina Mancioppi; Chiara Zusi; Federica Emiliani; Alessandro Mantovani; Antonio Colecchia; Giovanni Targher

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ESPE Abstracts (2024) 98 RFC1.6

ESPE2024 Rapid Free Communications Diabetes and Insulin (6 abstracts)

Metabolic dysfunction-associated steatotic liver disease and its association with glycemic control metrics in children and adolescents with type 1 diabetes: an exploratory study

Claudio Maffeis ¹ , Claudia Piona ¹ , Anita Morandi ¹ , Marco Marigliano ¹ , Elisa Morotti ¹ , Valentina Mancioppi ¹ , Chiara Zusi ¹ , Federica Emiliani ¹ , Alessandro Mantovani ² , Antonio Colecchia ³ & Giovanni Targher ⁴

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¹Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics and Gynecology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. ²Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. ³Gastroenterology Unit, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Modena, Italy. ⁴Department of Medicine, University of Verona, Verona, Italy

Context: Metabolic dysfunction-associated fatty liver disease (MASLD) is the most common chronic liver disease. Recent data showed that MASLD is a common condition also in adults with type 1 diabetes (T1D) and it is independently associated with an increased risk of diabetic complications.

Aims: To examine the prevalence of MASLD and its association with glycemic control metrics in children and adolescents with T1D.

Methods: We enrolled 244 children and adolescents with T1D (115 girls, mean age 16.2±3.2 years). The diagnosis of MASLD was defined by the presence of hepatic steatosis on ultrasonography in combination with at least one of five common cardiometabolic risk factors. CGM metrics of four weeks preceding the visit, BMI, blood pressure (BP) and circulating lipids at recruitment, mean HbA1c from T1D onset and three genetic variants strongly related to MASLD susceptibility [rs738409 (PNPLA3), rs58542926 (TM6SF2), rs1260326 (GCKR)] were also assessed.

Results: The prevalence of MASLD was 27.5% in children and adolescents with T1D. Blood pressure, total cholesterol, LDL cholesterol, non-HDL cholesterol, HbA1c, and time above range (TAR) were significantly higher (all P <0.05) in subjects with MASLD than in those without MASLD. Mean HbA1c from diabetes onset [adjusted odds ratio (OR) 1.703 (95%CI 1.040 – 2.787), P = 0.034], TAR [adjusted OR 1.028 (95%CI 1.009 – 1.047), P = 0.006] and LDL cholesterol [adjusted OR 1.045 (95%CI 1.013 – 1.078), P = 0.004] were significantly associated with the presence of MASLD.

Conclusion: MASLD is a common condition in children and adolescents with T1D. The mean HbA1c from diabetes onset, TAR, and LDL cholesterol levels were independent predictors of MASLD. These findings underline the importance of achieving and maintaining good glycemic control and the need to prevent MASLD from childhood.