Ultrasonographically detected non-alcoholic fatty liver disease is an independent predictor for identifying patients with insulin resistance in non-obese, non-diabetic middle-aged Asian adults

Dong Hyun Sinn, Geum-Youn Gwak, Ha Na Park, Jee Eun Kim, Yang Won Min, Kwang Min Kim, Yu Jin Kim, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Byung Chul Yoo
American Journal of Gastroenterology 2012, 107 (4): 561-7

OBJECTIVES: We assessed the association among ultrasonographically detected non-alcoholic fatty liver disease (US-NAFLD), metabolic syndrome (MetS), and insulin resistance (IR) in non-obese, non-diabetic middle-aged adults, to find out whether US-NAFLD is independently associated with IR in this population.

METHODS: A total of 5,878 non-obese (body mass index, ≥ 18.5 and < 25), non-diabetic individuals were analyzed. IR was estimated with the homeostasis model assessment index (HOMA2-IR) and defined when HOMA2-IR ≥ 1.5. MetS was defined by the Adult Treatment Panel III (ATP III) criteria.

RESULTS: MetS was present in 381 (6.5%) participants, IR was present in 801 (13.6%) participants, and US-NAFLD was present in 1,611 (27.4%) participants. The increase in the prevalence of US-NAFLD closely followed the increase in the number of metabolic components diagnosed according to the ATP III criteria (15.2%, 28.5%, 48.0%, 65.7%, 71.4%, and 100% for 0, 1, 2, 3, 4, and 5 metabolic components, respectively, P < 0.001). US-NAFLD showed a significantly higher odds ratio (OR) for IR, regardless of the number of metabolic components (OR (95% confidence interval) of 3.48 (2.45-4.94), 3.63 (2.74-4.82), 3.19 (2.29-4.44), and 2.43 (1.43-3.81) for 0, 1, 2, and ≥ 3 metabolic components, respectively, P < 0.001 for all values). MetS showed a low sensitivity (0.22) for the identification of individuals with IR, and either US-NAFLD alone (0.60) or US-NAFLD with MetS (0.66) improved sensitivity with acceptable trade-off in specificity.

CONCLUSIONS: US-NAFLD was an independent predictor for IR, irrespective of the number of metabolic components of MetS in the non-obese, non-diabetic middle-aged Asian adults. US-NAFLD could identify individuals with IR that cannot be identified by MetS in this population.

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