Relationship between fatty liver and glucose metabolism: a cross-sectional study in 571 obese children

Nutr Metab Cardiovasc Dis. 2012 Feb;22(2):120-6. doi: 10.1016/j.numecd.2010.05.003. Epub 2010 Sep 28.


Background and aims: Early onset type 2 diabetes mellitus (T2DM) is associated with obesity, insulin resistance and impaired beta-cell function. Non-alcoholic fatty liver disease (NAFLD) may be an independent risk factor for T2DM. We investigated the relationship between NAFLD and glucose metabolism in a large sample of obese children.

Methods and results: A total of 571 obese children (57% males and 43% females) aged 8-18 years were consecutively studied at a tertiary care centre specialised in paediatric obesity. Liver ultrasonography was used to diagnose NAFLD after exclusion of hepatitis B and C and alcohol consumption. Oral-glucose tolerance testing (OGTT) was performed; insulin sensitivity was evaluated by using the insulin sensitivity index (ISI) and beta-cell function by using the ratio between the incremental areas under the curve (AUC) of insulin and glucose (incAUCins/incAUCglu). A total of 41% of the obese children had NAFLD. Impaired glucose tolerance or T2DM was present in 25% of the children with NAFLD versus 8% of those without it (p<0.001). Children with NAFLD had higher body mass index (BMI), fasting glucose, 120-min OGTT glucose, incAUCins/incAUCglu and lower ISI as compared with children without NAFLD (p≤0.002). At bootstrapped multivariable median regression analysis controlling for gender, age, pubertal status and BMI, NAFLD was an independent predictor of 120-min OGTT glucose and ISI, but not of incAUCins/incAUCglu. Similar findings were obtained using continuous liver steatosis as the predictor, instead of dichotomous NAFLD.

Conclusion: NAFLD was present in 41% of our obese children and was associated with higher insulin resistance, but not with impaired beta-cell function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Area Under Curve
  • Blood Glucose / metabolism*
  • Body Mass Index
  • Child
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / physiopathology
  • Fatty Liver / complications
  • Fatty Liver / diagnostic imaging
  • Fatty Liver / physiopathology*
  • Female
  • Glucose Intolerance / complications
  • Glucose Intolerance / physiopathology
  • Glucose Tolerance Test
  • Humans
  • Insulin / blood
  • Insulin Resistance
  • Insulin-Secreting Cells / metabolism
  • Liver / diagnostic imaging
  • Liver / metabolism
  • Liver / physiopathology
  • Male
  • Non-alcoholic Fatty Liver Disease
  • Obesity / complications
  • Obesity / physiopathology*
  • Ultrasonography


  • Blood Glucose
  • Insulin