ArticleDiabetologia2026
pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity.
Article in Diabetologia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aims/hypothesisYouth-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 evaluated whether the paediatric liver fibrosis risk scores (pFIB) pFIB-c and pFIB-6, originally developed for metabolic dysfunction-associated steatotic liver disease (MASLD) fibrosis risk stratification, identify individuals at increased risk of incident type 2 diabetes.
methodsA cohort study was conducted using the Swedish Childhood Obesity Treatment Register (BORIS, 2005-2020) linked with national registers, from which type 2 diabetes was ascertained. We included 4856 children with obesity (aged 12.0 years at baseline) and 23,758 general population comparators. The pFIB-c and pFIB-6 scores were calculated as published. Time-to-event analysis yielding HR was performed using Cox regression and flexible parametric survival models.
resultsAmong children with obesity, 12.4% had a pFIB-6 ≥4. A high pFIB-6 score increased the risk for type 2 diabetes at 9-19 years of age (adjusted HR 3.05 [95% CI 2.17, 4.28]). 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 pFIB-6 <4, and 161.7 (122.2, 213.9) when the pFIB-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 pFIB-6 scores were associated with greater adipose tissue insulin resistance. CONCLUSIONS/
interpretationA 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.
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