Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children and is linked to type 2 diabetes mellitus (T2DM). A study published in Diabetes Care evaluated whether changes in liver chemistries over time can serve as biomarkers of diabetes risk in children with MASLD.

This multicenter longitudinal cohort study included 1,035 children with biopsy-confirmed MASLD and no T2DM at baseline. Participants were followed for a mean of 3.9 years. Liver enzymes, including γ-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), were measured annually. T2DM was diagnosed using fasting glucose, glycated hemoglobin (HbA1c), and clinical criteria. Extended Cox models with inverse probability weighting were used to assess associations between liver enzyme trajectories and diabetes risk.

The cumulative incidence of T2DM during follow-up was 12.3%. In independent models, increases in GGT (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.34-1.80), AST (HR 1.31; 95% CI 1.20-1.43), and ALT (HR 1.13; 95% CI 1.07-1.20) were associated with a higher risk of developing T2DM.

In a model including all three liver enzymes, only GGT and AST remained significant. A 30-unit increase in GGT over time was associated with a higher risk of developing T2DM in children with MASLD. These findings indicate that longitudinal changes in liver chemistries, particularly GGT and AST, may help identify children at increased risk of T2DM.