Abstract
BackgroundThe metabolic syndrome is a worldwide health issue, with non-alcoholic fatty liver disease (liver steatosis) being one of its features, particularly closely related to insulin resistance. This study aims to investigate whether quantification of hepatic steatosis by abdominal ultrasonography, using hepatorenal index, is a feasible tool for the prediction of insulin resistance, and thus the metabolic syndrome.MethodsPatients were recruited from the Centre of Obesity at the University Hospital of North Norway, and among participants from the Sixth Tromsø Study. Homeostasis Model Assessment of Insulin Resistance (HOMA1-IR) was measured, body mass index (BMI, kg/m2) calculated, and hepatorenal index (HRI), i.e. the ratio of liver to kidney optical densities, was measured by transabdominal ultrasonography. Receiver operating characteristic (ROC) analyses were performed, detecting insulin resistance at HOMA1-IR cut-off values >2.3 and >2.5.ResultsNinety participants were included in the study, of which 46 (51 %) had BMI ≥30 and 27 (30 %) had BMI ≥35. Overall, HRI at level 1.17 had sensitivity 0.90 and specificity 0.70 for predicting insulin resistance (HOMA1-IR >2.3) in all participants. For participants with BMI ≥30, HRI at level 1.17 had sensitivity 0.94 and specificity 0.70, and for BMI ≥35, HRI at level 1.17 had sensitivity 0.93 and specificity 0.75 for predicting HOMA1-IR >2.3. Setting the HRI limit at 1.42 gave low sensitivities and high specificities in all BMI groups. In the analysis predicting HOMA1-IR >2.5, sensitivity values were almost the same as in the analysis predicting HOMA1-IR >2.3, but specificity values were lower in this analysis.ConclusionDetection and quantification of hepatic steatosis by ultrasound and the hepatorenal index is a feasible screening tool for identifying patients with low risk of having insulin resistance (IR, HRI <1.17), patients at risk of having IR (HRI 1.17-1.41) and patients with likely IR (HRI ≥1.42), especially in obese individuals.
Highlights
The metabolic syndrome is a worldwide health issue, with non-alcoholic fatty liver disease being one of its features, closely related to insulin resistance
Components of the metabolic syndrome are strongly associated to Non-alcoholic fatty liver disease (NAFLD) in normal-weight subjects without diabetes, and in obese subjects diagnosed with NAFLD the prevalence have been found to be 67–71 % [8, 9]
For the participants included from the Centre of Obesity, we calculated both HOMA1-insulin resistance (IR) and Whole Body Insulin Sensitivity Index (WBISI), in order to verify the reliability of HOMA1-IR in our data set
Summary
The metabolic syndrome is a worldwide health issue, with non-alcoholic fatty liver disease (liver steatosis) being one of its features, closely related to insulin resistance. Obesity is a major worldwide health issue due to its association with the metabolic syndrome (MetS). Components of MetS are increased waist circumference, hypertension, insulin resistance (IR), type 2 diabetes and dyslipidemia, i.e. hypertriglyceridemia and low levels of high density lipoproteins (HDL) [2, 3]. Components of the metabolic syndrome are strongly associated to NAFLD in normal-weight subjects without diabetes, and in obese subjects diagnosed with NAFLD the prevalence have been found to be 67–71 % [8, 9]. In subjects with diabetes mellitus type 2 or impaired glucose tolerance, the prevalence of NAFLD is found to be 30–70 % [10,11,12]
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