Non-alcoholic fatty liver disease (NAFLD) spectrum in children with type 1 diabetes mellitus evaluated with non-invasive fibrosis score and instrument: A cross-sectional study

Aim of the study
The aim of the study was to evaluate NAFLD spectrum in children with type 1 of diabetes mellitus (T1DM) by simple fibrosis scores and advanced biochemical markers in association with abdominal ultrasonography (US), Acoustic radiation force impulse elastography (ARFI) and comparing their results.

Material and methods
A case-control study was conducted on 142children and adolescents with T1DM and79 subjects as controls. Through medical history, clinical examination, and laboratory assessment including glycosylated hemoglobin (HbA1c) levels and liver enzymes including AST and ALT were carried out. Calculation of simple fibrosis scores (AST/ALT ratio, AST to platelet ratio index (APRI), fibrosis (FIB)-4 index, paediatric NAFLD fibrosis index (PNFI) were done. Assessment of advanced biochemical markers including hyaluronic acid (HA) , amino terminal pro peptide of type III collagen (PIIINP) and tissue inhibitor of metalloproteinase 1 (TIMP-1) levels. Also, ELF test were calculated.

Results
Data of non-invasive fibrosis score, there were statistically significant difference between cases and controls in fibrosis 4 score, Discriminant score also ratio of AST to ALT value (p = 0.009, 0.000 and 0.019) respectively. Also, regarding advanced biochemical markers and ELF score, there were a high statistically significant difference in TMP, Hyaluronic acid and ELF(p = 0.00, 0.044 and 0.00) respectively.

Conclusions
Our results support that there are available non-invasive biomarkers for hepatic affection in children with T1DM. Obtained results support that there is a going on process in diabetic children could be assessed by AST/ALT ratio, FIB-4 index and ELF Score with performing abdominal sonography while ARFI needed in more advanced stage.