Association of hepatic steatosis derived from ultrasound and quantitative MRI with prediabetes in the general population

Muhammad Naeem,Robin Bülow,Henry Völzke,Marcus Dörr,Till Ittermann,Marcello Ricardo Paulista Markus,Jens-Peter Kühn,Nicole Werner,Matthias Nauck,Sabine Schipf,Wolfgang Rathmann,Markus M Lerch

doi:10.1038/s41598-021-92681-3

Abstract

The aim of our study was to investigate the association of hepatic steatosis derived from quantitative ultrasound and magnetic resonance imaging (MRI) with prediabetes in a large population-based study conducted in Northeast Germany. Hepatic steatosis was assessed through transabdominal ultrasound and quantitative MRI. For analysis we included 1622 subjects with MRI who participated in an oral glucose tolerance test and reported no known type 2 diabetes mellitus (T2DM). We classified participants as proposed by the American Diabetes Association: isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT), and undiagnosed T2DM. Regression models were adjusted for age, sex body mass index and alcohol consumption. We observed positive associations of hepatic steatosis with glycated hemoglobin, fasting glucose and insulin, 2-h glucose and insulin, as well as homeostasis model assessment-insulin resistance index. Similarly, individuals having hepatic steatosis as defined by MRI had a higher relative risk ratio (RR) to be in the prediabetes groups i-IFG (RR = 1.6; 95% confidence interval (CI) 1.2; 2.2), i-IGT (RR = 3.3, 95% CI 2.0; 5.6) and IFG + IGT (RR = 2.5, 95% CI 1.6; 3.9) or to have undiagnosed T2DM (RR = 4.8, 95% CI 2.6; 9.0). All associations were attenuated when defining hepatic steatosis by ultrasound. Hepatic steatosis is associated with prediabetes and undiagnosed T2DM in the general population. Quantitative liver MRI revealed stronger associations with prediabetes and undiagnosed T2DM compared to ultrasound, which indicates the higher sensitivity and specificity of MRI to determine hepatic steatosis.

Highlights

Hepatic steatosis is defined as an excessive fat deposition (> 5%) in the liver in the absence of competing liver disease or hepatocellular c arcinoma[1]
Among the study population consisting of 1,746 individuals (913 women) aged 21 to 80 years the prevalence of hepatic steatosis was 37% by using magnetic resonance imaging (MRI) and 36% by using ultrasound
Levels of HbA1c, fasting glucose, 2-h glucose, fasting insulin, 2-h insulin and homeostasis model assessment-insulin resistance index (HOMA-IR) were associated with hepatic steatosis derived from ultrasound or MRI (Table 2)

Summary

Introduction

Hepatic steatosis is defined as an excessive fat deposition (> 5%) in the liver in the absence of competing liver disease or hepatocellular c arcinoma[1]. Population-based studies defining hepatic steatosis by computed tomography showed significant associations with type 2 diabetes mellitus[8,11]. Several previous studies demonstrated associations between sonographically determined hepatic steatosis and type 2 diabetes mellitus[9,12,13,14,15,16,17]. One cross-sectional study found an association between hepatic steatosis defined by fatty liver index and prediabetes categories according to American Diabetes Association (ADA) criteria[24], whereas others did not[16,21]. To the best of our knowledge there is no population-based study, which investigated the association of hepatic steatosis as defined by quantitative magnetic resonance imaging (MRI) with prediabetes and undiagnosed type 2 diabetes mellitus. MRI is able to differentiate between liver fat and iron[26] as well as between focal, regional and general steatosis in a single procedure

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