Friday, June 24, 2011
A significant number of obese teens with type 2 diabetes also have fatty liver disease, but few are being screened for it, according to a new Cincinnati Children’s Hospital Medical Center study.
The finding is significant because non-alcoholic fatty liver disease (NAFLD) can progress to serious liver disease without weight loss, says Erica Reynolds, MD, a fellow in the division of Endocrinology at Cincinnati Children’s and the study’s lead author.
Dr. Reynolds will present her study at 11:30 a.m. Pacific time Saturday, June 25, at the annual meeting of the American Diabetes Association in San Diego.
“Published guidelines suggest that all obese children, regardless of age, be screened for NAFLD,” says Dr. Reynolds. “Pediatric diabetes providers need to be aware of these guidelines to ensure that obese patients with type 2 diabetes are screened and evaluated properly.”
Dr. Reynolds and colleagues at Cincinnati Children’s studied 59 obese patients between the ages of 10 and 18 seen for type 2 diabetes at Cincinnati Children’s between 2007 and 2009. Half of the patients were white, and three of every four were female. The researchers also examined two years of clinical and laboratory data from before the patients’ visits.
Liver enzymes had been measured in only 63 percent of these patients. Only 30 percent had a normal ALT – a test that measures enzymes within liver cells. If the liver is injured or damaged, liver cells spill these enzymes into the blood, raising enzyme levels in the blood and indicating liver disease. Six patients had “clearly abnormal” ALTs, and all of these patients had “persistently elevated” ALT on follow-up testing.
“Screening rates were suboptimal in these young people with type 2 diabetes, despite a significant prevalence of elevated ALT,” says Dr. Reynolds. “And physician intention to screen based on patient obesity was probably even lower, as enzyme levels were probably obtained for other reasons. All obese children should be screened if we are to improve outcomes for these patients.”
Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News and World Report's 2011 Best Children's Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties - a distinction shared by only two other pediatric hospitals in the United States. Cincinnati Children's is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org.