Nobili V, et al. - Through a cross-sectional study of 599 Caucasian children/adolescents with and without non-alcoholic fatty liver disease (NAFLD), researchers evaluated the prevalence of prediabetes vs diabetes, and explored if liver disease severity could be predicted by abnormal glucose tolerance. A significantly greater prevalence of abnormal glucose tolerance (prediabetes or diabetes) was observed in children/adolescents with NAFLD vs patients without NAFLD. There were 124 children/adolescents with NAFLD who had abnormal glucose tolerance; 119 fulfilled the diagnostic criteria for prediabetes and 5 fulfilled the criteria for diabetes. A two-fold increased risk of non-alcoholic steatohepatitis (NASH) correlated with the combined presence of prediabetes and diabetes, but this correlation was reduced (though still significant) following adjustment for age, sex, waist circumference, and the patatin-like phospholipase domain-containing protein-3 rs738409 polymorphism. The latter two variables were actively affiliated with NASH. Among children/adolescents with biopsy-proven NAFLD, abnormal glucose tolerance (especially prediabetes) was concluded to be extremely prevalent. These children also had a greater risk of NASH, however, central adiposity was the factor that was most powerfully correlated with NASH.