The prevalence of non-alcoholic fatty liver disease in pediatric type 2 diabetes: a systematic review and meta-analysis
Bibliographic record
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is on the rise in the pediatric population. One of the main associations of T2DM is non-alcoholic fatty liver disease (NAFLD), yet the full burden of NAFLD in T2DM is unclear. This study aimed to estimate the prevalence of NAFLD and non-alcoholic steatohepatitis (NASH) in pediatric patients with T2DM. We also aimed to evaluate the association of sex, race/ethnicity, geographic location, NAFLD diagnostic methods, and glycemic control with NAFLD prevalence in this population. Methods Literature search was conducted in MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Web of Science Core Collection from database inception to 11 May 2023. This systematic review and meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018091127). Observational studies with ≥10 participants reporting the prevalence of NAFLD in pediatric patients with T2DM were included. Four teams of two independent reviewers and one team with three reviewers screened 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 The pooled prevalence of NAFLD was 33.82% (95% CI: 24.23–44.11), and NASH prevalence was 0.28% (95% CI: 0.00–1.04). The Middle East had the highest NAFLD prevalence of 55.88% (95% CI: 45.2–66.29), and Europe had the lowest prevalence of 22.46% (95% CI: 9.33–38.97). The prevalence of NAFLD was 24.17% (95% CI, 17.26–31.81) when only liver function tests were used, but it increased to 48.85% (95% CI, 34.31–63.48) when the latter tests were combined with ultrasound. Studies reporting solely on an ultrasound-based diagnosis of NAFLD reported a prevalence of 40.61% (95% CI, 17.25–66.42) compared to 54.72% (95% CI, 34.76–73.95) in studies using magnetic resonance imaging/magnetic resonance spectroscopy. No differences in prevalence were noted based on glycemic control. Heterogeneity was high among studies. Conclusion NAFLD is a common comorbidity in pediatric T2DM. Further understanding of the optimal screening approaches for NAFLD diagnosis and evaluating its determinants and natural history are warranted to help establish its exact burden and to aid in the development of targeted screening, management, and prevention strategies for NAFLD in pediatric T2DM patients. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018091127 , PROSPERO CRD42018091127.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.047 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.037 |
| Bibliometrics | 0.010 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".