Fatty Liver Disease and Its Impaction on Insulin Resistance

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) involves excess liver fat accumulation without specific causes like alcohol or viral  infections, categorized into simple steatosis and nonalcoholic steatohepatitis (NASH). While simple steatosis is generally stable, NASH is  linked to progressive liver disease. Diagnosis excludes secondary causes, and NAFLD, marked by hepatocyte changes, inflammation, and  fibrosis, may lead to severe complications. Strongly correlated with adipose and hepatic tissue insulin resistance (IR). NAFLD disrupts  glucose-insulin interplay, compromising insulin's regulatory functions and contributing to metabolic disorders and disease progression.  

Objective: This study aimed to investigate fatty liver disease and evaluate its impact on IR.

Patients and Methods: This cross-sectional  study, conducted at Ain Shams University, included 98 adult patients with NAFLD patients who had liver disease and impaired glucose  tolerance to assess IR. We recorded demographic and anthropometric data, metabolic syndrome assessment, ultrasound grading of  steatosis, and laboratory tests for liver function, FIB-4 index, and IR using HOMA-IR.

Results: In this study, IR was prevalent in 63.3%. The  cases, predominantly females (52%), had mean age of 43 years, 50% were hypertensive, and 48% were diabetic. IR was directly related to  age, and its prevalence was significantly higher in patients with diabetes and hypertension. IR correlated positively with body weight,  BMI, ALT, AST, FIB-4, TG, and cholesterol. Fatty liver grading showed a significant association with IR, particularly in grade 2 cases. The  optimal HOMA-IR cutoff for distinguishing between grade I and II fatty liver was >2.56, with high sensitivity (100%) and specificity  (88.73%). These findings emphasize the intricate relationship between NAFLD, IR, and associated metabolic factors.

Conclusion: The  study established a robust link between IR and NAFLD, noting a 63.3% prevalence of IR in the subjects. Employing HOMA-IR, a cutoff point  >2.56 effectively differentiated between NAFLD grades I and II, demonstrating 100% sensitivity, 88.73% specificity, and a  remarkable AUC of 98. This underscored HOMA-IR's valuable role in identifying and stratifying NAFLD, especially in individuals with  diabetes.