Assessing elevated liver enzymes as a potential early screen for type II diabetes mellitus in children

Purpose: As the rise of obesity tracks with the incidence of Type 2 Diabetes Mellitus (T2DM) and nonalcoholic fatty liver diseases (NAFLD), it suggests that metabolic changes in obesity give rise to a clinically significant association between insulin resistance and elevated liver enzymes. This is illustrated in recent adult studies showing a high prevalence of NAFLD in patients with T2DM. Considering the diagnosis of T2DM and NAFLD often occurs late into adulthood, assessing the validity of metabolic-based early screening protocols may identify high-risk individuals in the pediatric population. Our study assesses the prevalence of elevated liver enzymes in children and evaluates the association between elevated liver enzymes and noninvasive risk factors. Methods: Our study enrolled 151 nondiabetic children between the ages 10-14 at the pediatric outpatient clinic at UNTHSC. We recorded noninvasive risk factors and measured liver enzymes. The liver enzymes studied were alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT). Results: Through chi-squared analysis, boys were shown to have a statistically significant relationship between increased BMI and elevated GGT as well a statistically significant relationship between presence of acanthosis nigricans and elevated GGT. It was also shown that young girls and African American children have a higher prevalence of ALP and GGT, respectively. Conclusions: There was significant association between elevated liver enzymes and specific noninvasive risk factors. Furthermore, this study noticed that gender and racial differences may play confounding roles suggesting there is variation within liver enzyme levels inherent in particular subpopulations.