Obesity, but not glycemic control, predicts liver steatosis in children with type 1 diabetes

J Diabetes Complications. 2022 Dec;36(12):108341. doi: 10.1016/j.jdiacomp.2022.108341. Epub 2022 Oct 25.


Objective: Nonalcoholic fatty liver disease (NAFLD), the most common liver disease in children, is strongly associated with obesity and insulin resistance. Although type 1 diabetes (T1D) is characterized by insulin deficiency, increasing obesity rates among children with T1D is a major risk factor for NAFLD in this patient population. Predisposing factors for NAFLD in children with T1D are not known.

Study design: This is a cross-sectional study comparing children with T1D across the range of body mass index (BMI) to the BMI-matched obese group without T1D. Hepatic steatosis was semi-quantitatively measured via the vibration-controlled transient elastogram (VCTE) method. Linear regression analysis was performed to assess the relationship between controlled-attenuated parameter (CAP) scores and clinical parameters. Receiver-operator curve (ROC) analysis was used to evaluate the diagnostic performance of several clinical parameters against NAFLD status determined via CAP.

Results: Two-thirds of subjects with obesity had CAP scores suggestive of NAFLD, while 16 % (n = 6) of T1D patients without obesity had elevated CAP. Obese subjects were different from non-obese subjects in many laboratory and clinical characteristics, regardless of T1D status. CAP score was significantly associated with BMI, HDL-Cholesterol (HDL-c), and HbA1c in all subjects as well as the T1D-only subgroup. Among subjects with obesity only, age, HDL-cand ALT were the most significant predictors. Diagnostic performance of BMI, HDL-c, and BMI/HDL ratio were in the good to the excellent range for predicting NAFLD among all subjects, while performance varied for T1D-only or obesity-only groups.

Conclusion: The clinical and imaging findings of children with T1D and obesity are comparable to non-diabetic children with a similar degree of obesity. Obesity is the major risk factor for NAFLD in pediatric T1D. BMI, HDL-c, and BMI/HDL ratio may be helpful markers to determine further workup for NAFLD in children with T1D, particularly those with obesity.

Keywords: Control-attenuated parameter; Hemoglobin A1c; NAFLD; Receiver-operator curve; Vibration-controlled transient elastogram.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Body Mass Index
  • Child
  • Cholesterol, HDL
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1* / complications
  • Humans
  • Liver
  • Non-alcoholic Fatty Liver Disease* / diagnosis
  • Non-alcoholic Fatty Liver Disease* / diagnostic imaging
  • Obesity / complications
  • Obesity / epidemiology


  • Cholesterol, HDL