Soo-Kyung Kim1, Young Ju Choi, Byung Wook Huh, Seok Won Park, Eun Jig Lee, Yong-Wook Cho, Kap Bum Huh. 1. Department of Internal Medicine (S.-K.K., S.W.P., Y.-W.C.), CHA Bundang Medical Center, CHA University, Seongnam 463-712, Korea; Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute (Y.J.C., B.W.H., K.B.H.), Seoul 121-806, Korea; and Department of Internal Medicine (E.J.L.), Yonsei University College of Medicine, Seoul 120-749, Korea.
Abstract
CONTEXT: The association between nonalcoholic fatty liver disease (NAFLD) and subclinical atherosclerosis in type 2 diabetes is controversial. OBJECTIVE: The objective of the study was to investigate the participation of insulin resistance in the association of NAFLD and the carotid atherosclerotic burden in a large cohort of patients with type 2 diabetes. DESIGN, SETTING, AND PATIENTS: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. MAIN OUTCOMES MEASURES: Hepatic steatosis and mean carotid intima-media thickness (C-IMT) were measured using ultrasonography. Insulin resistance was assessed using the short insulin tolerance test. RESULTS: The prevalence of NAFLD was 72.7% in the whole study population. Among subjects with NAFLD, 23.2% were not insulin resistant. There were significant differences in C-IMT and the frequency of carotid atherosclerosis between groups classified by insulin resistance within the same NAFLD strata. C-IMT was highest in subjects with both NAFLD and insulin resistance [0.844 ± 0.004 (mean ± SE) mm vs 0.786 ± 0.008, 0.821 ± 0.007, and 0.807 ± 0.006 mm, P for trend <.001, respectively, in insulin sensitive subjects without NAFLD, insulin resistant subjects without NAFLD, and insulin sensitive subjects with NAFLD]. These differences remained after adjusting for potential confounders. However, C-IMT in subjects having only NAFLD or insulin resistance was not higher than that in those with neither NAFLD nor insulin resistance. CONCLUSIONS: NAFLD is very common in subjects with type 2 diabetes, but NAFLD not accompanied by insulin resistance is not associated with a carotid atherosclerotic burden. However, having both NAFLD and insulin resistance seemed to be an independent predictor of increased C-IMT.
CONTEXT: The association between nonalcoholic fatty liver disease (NAFLD) and subclinical atherosclerosis in type 2 diabetes is controversial. OBJECTIVE: The objective of the study was to investigate the participation of insulin resistance in the association of NAFLD and the carotid atherosclerotic burden in a large cohort of patients with type 2 diabetes. DESIGN, SETTING, AND PATIENTS: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. MAIN OUTCOMES MEASURES: Hepatic steatosis and mean carotid intima-media thickness (C-IMT) were measured using ultrasonography. Insulin resistance was assessed using the short insulin tolerance test. RESULTS: The prevalence of NAFLD was 72.7% in the whole study population. Among subjects with NAFLD, 23.2% were not insulin resistant. There were significant differences in C-IMT and the frequency of carotid atherosclerosis between groups classified by insulin resistance within the same NAFLD strata. C-IMT was highest in subjects with both NAFLD and insulin resistance [0.844 ± 0.004 (mean ± SE) mm vs 0.786 ± 0.008, 0.821 ± 0.007, and 0.807 ± 0.006 mm, P for trend <.001, respectively, in insulin sensitive subjects without NAFLD, insulin resistant subjects without NAFLD, and insulin sensitive subjects with NAFLD]. These differences remained after adjusting for potential confounders. However, C-IMT in subjects having only NAFLD or insulin resistance was not higher than that in those with neither NAFLD nor insulin resistance. CONCLUSIONS: NAFLD is very common in subjects with type 2 diabetes, but NAFLD not accompanied by insulin resistance is not associated with a carotid atherosclerotic burden. However, having both NAFLD and insulin resistance seemed to be an independent predictor of increased C-IMT.
Authors: Ansel Shao Pin Tang; Kai En Chan; Jingxuan Quek; Jieling Xiao; Phoebe Tay; Margaret Teng; Keng Siang Lee; Snow Yunni Lin; May Zin Myint; Benjamin Tan; Vijay K Sharma; Darren Jun Hao Tan; Wen Hui Lim; Apichat Kaewdech; Daniel Huang; Nicholas Ws Chew; Mohammad Shadab Siddiqui; Arun J Sanyal; Mark Muthiah; Cheng Han Ng Journal: Clin Mol Hepatol Date: 2022-03-02
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