Impact of Nonalcoholic Fatty Liver Disease on Insulin Resistance in Relation to HbA1c Levels in Nondiabetic Subjects

Abstract

A cross-sectional analysis was conducted in healthy, nondiabetic Korean adults to assess the prevalence of nonalcoholic fatty liver disease (NAFLD), to compare the prevalence of NAFLD across different glycemic ranges as assessed by glycosylated hemoglobin (HbA1c), and to examine the impact of NAFLD on insulin resistance in relation to HbA1c levels. METHODS:After rigorous exclusion criteria, the fi nal number of subjects who participated in a comprehensive health status checkup program was 99,969. All subjects were classifi ed into four categories with respect to HbA1c level ( ≤ 4.9, 5.0 -5.4, 5.5 -5.9, and 6.0 -6.4 % ). We estimated the odds ratio (OR) for prevalence of NAFLD according to the categorized level of HbA1C and evaluated the association of NAFLD with the homeostatic model assessment of insulin resistance (HOMA-IR) in relation to the HbA1c level. RESULTS:Twenty-eight percent ( n = 28,130, 40.2 % of the men, 10.3 % of the women) of the study subjects had NAFLD. Men had a 5.83-fold (95 % confi dence interval 5.63 -6.05) increased risk for having NAFLD than did women. The risk for NAFLD increased with increasing level of HbA1c (OR 1.44, 2.62, and 7.18) when compared with the lowest quartile (HbA1C ≤ 4.9 % ). HOMA-IR increased in the NAFLD subjects as the level of HbA1c increased. The magnitude of association of HOMA-IR with HbA1c level was greater in NAFLD subjects than in non-NAFLD subjects ( P < 0.001 for interaction). These associations were consistent even after adjustment for body mass index and other metabolic components.CONCLUSIONS: NAFLD had an association with HbA1c level and insulin resistance in nondiabetic individuals, and these associations were independent of obesity and other metabolic components.

Improvement of Nonalcoholic Fatty Liver Disease With Carnitine-Orotate Complex in Type 2 Diabetes (CORONA): A Randomized Controlled Trial

“…These results indicate that improvement of hepatic steatosis is associated with improvement of glycemic control in relation to insulin resistance. Hepatic steatosis is well known to be closely associated with insulin resistance, which plays an integral role in the pathogenesis of type 2 diabetes (2,3,35). Despite this close association of hepatic steatosis with insulin resistance, a causal relationship between NAFLD and glucose metabolism has not been clearly established.…”

“…resistance (2,3). Recent study results have shown that NAFLD independently increases one's risk of diabetes and cardiovascular diseases (4)(5)(6)(7)(8), which suggests that treatment of fatty liver might ameliorate the risk of type 2 diabetes and cardiovascular diseases.…”

Independent Association Between Improvement of Nonalcoholic Fatty Liver Disease and Reduced Incidence of Type 2 Diabetes

“…On the multivariate analysis, age, sex, BMI, IFG, family history of diabetes, DL, HT, and physical exercise were adjusted as potential confounders between NAFLD and T2DM. Stratified analysis by sex was conducted because NAFLD is more prevalent in men than in women (22)(23)(24)(25)(26), and its pathogenesis has a sex-related difference (22,26).…”

Association between hemoglobin glycation index and hepatic steatosis in non-diabetic individuals

“…A growing body of evidence suggests that NAFLD is strongly associated not only with impaired glucose metabolism and obesity [5][6][7] but also with an increased risk to develop diabetes mellitus [8][9][10], and an independent association between NAFLD and glycated hemoglobin (HbA1c) levels has been reported in several studies [11][12][13][14]. HbA1c is the gold standard for evaluating glucose control in patients affected by diabetes mellitus and for monitoring the efficacy of therapies [15,16].…”