The Prevalence of Non-Alcoholic Fatty Liver Disease in Pediatric Type 2 Diabetes: A Systematic Review and Meta-Analysis

Abstract

Introduction: To estimate the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) in pediatric patients with Type 2 Diabetes Mellitus (T2DM). We also aimed to evaluate the association of sex, race/ethnicity, geographic location, NAFLD diagnostic methods, and glycemic control with the prevalence of NAFLD. Method: Literature searches were conducted in MEDLINE, Embase, CINAHL, Cochrane, and Web of Science. Observational studies with ≥ 10 participants reporting the prevalence of NAFLD in pediatric patients with T2DM were included. Four teams of 2 independent reviewers and one team with 3 reviewers screened titles, abstracts, and full-text articles and identified 26 papers fulfilling the eligibility criteria. Data extraction, risk of bias assessment, level of evidence assessment, and meta-analysis were performed. Results: All patients were diagnosed with T2DM ≤18 years of age. Diabetes duration ranged from inclusion at diabetes diagnosis and up to 4.6 years post-diagnosis. NAFLD prevalence was 33.82% and NASH prevalence was 0.28%. The pooled prevalence of NAFLD in Asian subjects was 35.98%, 36.93% in White subjects, 16.76% in Hispanic subjects, and 6.82% in Black subjects. NAFLD prevalence was highest in the Middle East of 55.88% and lowest in Europe of 22.46%. The prevalence was 30.54% in North America, 32.15% in Asia, and 32.70% in Oceania. When assessing diagnostic methods, the prevalence of NAFLD was 24.17% using liver function tests and rose to 48.85% when combined with ultrasound. Studies with Ultrasound-based diagnosis of NAFLD reported a prevalence of 40.61% compared to 54.72% in studies using MRI/MRS. No differences in prevalence were noted based on sex and glycemic control. Heterogeneity was high among studies. Conclusion: A significant proportion of T2DM patients have NAFLD within a few years of their diabetes diagnosis. Further understanding of the natural history and associations between NAFLD and T2DM in children is needed, so that screening and management of NAFLD is optimized.