HOMA‐IR: An independent predictor of advanced liver fibrosis in nondiabetic non‐alcoholic fatty liver disease

Abstract

Background and Aim Although non‐alcoholic fatty liver disease (NAFLD) is common in the general population, identifying patients with advanced fibrosis remains a challenge. We investigated whether the homeostasis model assessment parameter of insulin resistance (HOMA‐IR), an index of IR and one of the most important metabolic factors, is an independent predictive factor for advanced fibrosis in nondiabetic patients with NAFLD. Methods This was a retrospective, cross‐sectional multicenter study. We included 361 patients with biopsy‐proven NAFLD who had not been diagnosed with type 2 diabetes mellitus: 175 (48%) were women and 48 (13%) had advanced fibrosis. We used simple random sampling; the sampling ratio of the estimation and validation groups was 7:3. A logistic model was constructed for both the estimation and validation groups. The explanatory variables were age ≥ 49 years, sex (women), body mass index ≥ 26.7 kg/m2, the presence of hypertension, presence of dyslipidemia, fasting plasma glucose level ≥ 98 mg/dL, fasting immune reactive insulin level ≥ 12.0 μU/mL, and HOMA‐IR ≥ 2.90. The median HOMA‐IR of the patients was 2.88 (interquartile range: 2.1–4.8). Results In the estimation group, univariate and multivariate analyses showed that age, dyslipidemia, and HOMA‐IR were independent predictors of advanced fibrosis. In the validation group, only age and HOMA‐IR were found to be independent predictors of advanced fibrosis. Conclusions Homeostasis model assessment parameter of insulin resistance was an independent predictor of advanced liver fibrosis in nondiabetic patients with NAFLD. Given that most patients with NAFLD are nondiabetic, it is important to set goals with respect to improving IR to subsequently reduce liver fibrosis.

Antidiabetic Therapy in the Treatment of Nonalcoholic Steatohepatitis

“…The annual incident rate of overt diabetes (glycated hemoglobin (HbA1c) ≥ 6.5%) is around 2% in NAFLD without T2D when the 75 g oral glucose tolerance test is used to confirm the absence of diabetes at entry [26]. Insulin resistance in NAFLD leads to incident T2D [24,26]. In conclusion, T2D and NAFLD are mutually, closely, and bi-directionally associated [25].…”

“…Older age (odds ratio (OR) = 1.099, p = 0.001), high body mass index (BMI) (OR = 1.088, p = 0.003), low platelet level (OR = 0.996, p = 0.014), and smoking (OR = 1.653, p = 0.013) are independent risk factors of advanced fibrosis (FibroScan > 10.6 kPa) among T2D patients [21]. The existence of T2D is closely associated not only with advanced fibrosis in cross-sectional data [22][23][24] but also with the rapid progression of hepatic fibrosis based on longitudinal data [14,18,[25][26][27][28]. Conversely, NAFLD patients have a higher risk of incidental T2D compared to non-NAFLD patients [27,28].…”

The effects of Anethum graveolens (dill) powder supplementation on clinical and metabolic status in patients with type 2 diabetes

“…Serum insulin was measured by human insulin enzyme-linked immunosorbent (ELISA) kit (monobind). Insulin resistance was estimated according to the Homeostasis Model Assessment (HOMA) calculated as: HOMA-IR = fasting concentrations of glucose (mg/dL) × fasting insulin (μU/mL) / 405 (22). Friedewald formula was used for calculation of LDL 23:…”

Non‐alcoholic fatty liver disease in Asia: How is it different from the West?

“…In recent issues of Journal of Gastroenterology and Hepatology , four publications from Asia—three from Japan and one from Malaysia—investigated the screening and risk factors of liver fibrosis in NAFLD patients. Fujii and colleagues in the Japan Study Group of NAFLD reported that insulin resistance (IR), reflected by the homeostasis model assessment parameter of IR (HOMA‐IR), was an independent predictor of advanced liver fibrosis in Japanese NAFLD patients without diabetes mellitus (DM) . The group proposed that it would be important to improve IR in these non‐diabetic NAFLD patients in order to reduce liver fibrosis .…”

“…Fujii and colleagues in the Japan Study Group of NAFLD reported that insulin resistance (IR), reflected by the homeostasis model assessment parameter of IR (HOMA‐IR), was an independent predictor of advanced liver fibrosis in Japanese NAFLD patients without diabetes mellitus (DM) . The group proposed that it would be important to improve IR in these non‐diabetic NAFLD patients in order to reduce liver fibrosis . IR has been reported previously as an important predictor for NAFLD in European patients .…”