pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity.
High FIB-6 score is associated with a threefold higher risk of youth-onset type 2 diabetes.
pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity.
Youth-onset type 2 diabetes is an aggressive phenotype of metabolic disease, yet tools to identify children with obesity at highest short-term risk are limited.
We included 4856 children with obesity (aged 12.0 years at baseline) and 23,758 general population comparators.
a high liver risk score means a threefold higher risk of youth type 2 diabetes
The incidence rate (95% CI) per 10,000 person-years was 1.02 (0.61, 1.72) in the general population comparators, 45.5 (37.8, 54.7) in individuals with obesity and a FIB-6 <4, and 161.7 (122.2, 213.9) when the FIB-6 was ≥4.
In contrast, neither score, measured at paediatric age, predicted type 2 diabetes risk at 20-25 years of age.
Among individual score components, elevated alanine aminotransferase (ALT) and HOMA-IR were most strongly associated with type 2 diabetes risk.
In an independent cohort, higher FIB-6 scores were associated with greater adipose tissue insulin resistance.
A liver-derived composite risk score identifies a subgroup of adolescents with obesity at markedly increased short-term risk of type 2 diabetes.
These findings suggest that integrating hepatic and metabolic variables may improve early risk stratification in paediatric obesity and help identify individuals who may benefit from intensified monitoring during adolescence.