(04-02-11) Interrelationship between Fatty Liver and Insulin Resistance in the Development of Type 2 Diabetes.

Sung KC, Kim SH.

Division of Cardiology (K.-C.S.), Department of Medicine, Kangbuk Samsung
Hospital, Sungkyunkwan University, Seoul, South Korea 110-746; and Division of
Endocrinology (S.H.K.), Department of Medicine, Stanford University School of
Medicine, Stanford, California 94305.
Abstract
Context: Although fatty liver and insulin resistance are known to be
associated, the relationship between the two in the development of type 2
diabetes mellitus (T2DM) is unclear. Objective: We investigated the 5-yr risk
of developing T2DM in individuals diagnosed with fatty liver using ultrasound
and stratified by insulin sensitivity using quartiles of fasting insulin
concentration. Design and Methods: We examined the clinical and laboratory data
of 11,091 Koreans who had a medical evaluation including fasting insulin
concentration and abdominal ultrasound at baseline and had a follow-up after 5
yr. Results: At baseline, 27% of the population had fatty liver. Almost half
(47%) of the individuals with fatty liver had baseline insulin concentration in
the highest quartile compared with 17% in those without fatty liver (P <
0.001). Regardless of baseline insulin concentration, individuals with fatty
liver had significantly (P < 0.001) more baseline clinical and metabolic
abnormalities, including higher glucose and triglyceride concentration and
lower high-density lipoprotein cholesterol concentration. In addition,
regardless of baseline insulin concentration, individuals with fatty liver had
a significantly increased risk for incident T2DM compared with those without
fatty liver [crude odds ratio, 5.05 (95% confidence interval, 2.08-12.29) in
the lowest insulin quartile and 6.34 (3.58-11.21) in the highest quartile]. In
individuals in the highest insulin quartile, the odds ratio for developing T2DM
remained significant even after multivariate adjustment including baseline
glucose concentration [2.42 (1.23-4.75)]. Conclusion: Although associated with
insulin resistance, fatty liver diagnosed by ultrasound appears to
independently increase the risk of T2DM.

Source: J Clin Endocrinol Metab. 2011 Jan 20. [Epub ahead of print]

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