RESEARCH ARTICLEOpen Access
Ethnicity and elevated liver transaminases among
newly diagnosed children with type 2 diabetes
Omar D Hudson1, Martha Nunez3and Gabriel Q Shaibi1,2,3*
Background: To examine the influence of ethnicity on liver transaminases among adolescents with type 2 diabetes
Methods: A retrospective medical chart review of 57 (30 males and 27 females) newly diagnosed patients with
T2DM. Ethnicity was determined by self-report and height, weight, body mass index (BMI) and glycosylated
hemoglobin (HbA1c) were obtained using standard clinical procedures. Fasting levels of alanine aminotransaminase
(ALT) and aspartate aminotransferase (AST) were collected prior to the initiation of any therapy.
Results: Age, gender, height, weight, BMI, and HbA1c did not differ between ethnic groups. Compared to African-
Americans, Hispanics had significantly higher ALT (23.9 ± 3.4 vs. 107.8 ± 20.3, p=0.002) and AST (17.7 ± 2.5 vs. 71.1 ±
15.7, p<0.001) and were significantly more likely to have ALT values above the upper limit of normal (20% vs. 71%,
p=0.005) and twice the upper limit of normal (0% vs. 39%, p=0.05) as well as AST values above the upper limit of
normal (0% vs. 53%, p=0.002). No differences in ALT or AST were found between Hispanics and non-Hispanic whites or
between African-Americans and non-Hispanic whites.
Conclusions: These preliminary findings suggest that Hispanic children with T2DM may be at higher risk for
developing non-alcoholic fatty liver disease and indicate that a comprehensive hepatic evaluation is warranted in this
population. Future studies that incorporate more precise and proximal measures of liver health are warranted in this
Keywords: Type 2 diabetes mellitus, Fatty liver, Alanine aminotransferase, Aspartate aminotransferase
Childhood obesity is increasing worldwide and nearly
35% of children and adolescents in the United States are
overweight or obese . Coinciding with this epidemic is
an increase in obesity-related metabolic comorbidities
such as type 2 diabetes mellitus (T2DM) and non-
alcoholic fatty liver disease (NAFLD) [2,3]. These
chronic conditions present challenges to pediatric practi-
tioners as no consensus on their management exists and
there is limited evidence regarding long-term prognosis.
Both conditions appear to be related to the underlying
pathophysiologic process of insulin resistance [4,5] and
may act synergistically to place youth at increased risk
for premature morbidity and mortality. Only 1 study to
date has examined NAFLD risk in youth with T2DM
and found that as many as 48% of those diagnosed with
T2DM also exhibit elevated liver transaminases . The
authors concluded that the high prevalence of elevated
serum aminotransferases among children with T2DM
may be an indication of concomitant NAFLD in this
Although pediatric obesity has increased worldwide,
certain ethnic subgroups of youth are disproportionately
impacted by both NAFLD and T2DM. In particular,
Hispanic and African-American adolescents are more
likely to present with T2DM compared to non-Hispanic
whites but Hispanic adolescents are thought to be at
highest risk for NAFLD while African-Americans are at
lowest risk . To date, no studies have examined the
degree to which liver transaminases are differentially ele-
vated across ethnic groups among youth diagnosed with
* Correspondence: email@example.com
1Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s
Hospital, Phoenix, AZ, USA
2Center for Metabolic and Vascular Biology, Arizona State University,
Full list of author information is available at the end of the article
© 2012 Hudson et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Hudson et al. BMC Pediatrics 2012, 12:174
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Cite this article as: Hudson et al.: Ethnicity and elevated liver
transaminases among newly diagnosed children with type 2 diabetes.
BMC Pediatrics 2012 12:174.
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Hudson et al. BMC Pediatrics 2012, 12:174
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