HIGHER FATTY LIVER INDEX VALUES AT SIMILAR BLOOD PRESSURE CLASSIFICATION INDICATE HIGH INSULIN RESISTANCE AND POTENTIAL INFLAMMATION

Abstract

Objective: The relationship between fatty liver, which is visceral fat accumulation, and insulin resistance and inflammation as seen in hypertension classification is not clear. The Fatty Liver Index (FLI) is an established score for metabolic dysfunction-associated fatty liver disease (MASLD), which is associated with a risk of diabetes and cardiovascular disease. FLI is derived from a formula based on body mass index, waist circumference, and triglyceride and gamma-glutamyltransferase values. Design and method: A cross-sectional study enrolling consecutive individuals was conducted at a health checkup center in Japan from January 2022 to November 2022. A total of 3553 men (mean Age 50.6), excluding those with diabetes mellitus and those undergoing treatment for inflammatory diseases, were included in the study, and divided according to the Classification of hypertension in the ESH guideline. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein (CRP) levels were divided into two groups by FLI (<26 (group L) and > or = 26 (group H)) and compared by Mann-Whitney U test. The cutoff value for fatty liver by FLI was determined by prior abdominal ultrasonography, and was set at 26(sensitivity 0.82, specificity 0.72). Results: Results of single regression analysis with FLI showed significant correlations in systolic blood pressure(r=0.31, p < 0.0001), diastolic blood pressure(r=0.36, p < 0.0001), HOMA-IR(r=0.36, p < 0.0001), and CRP(r=0.08, p < 0.0001). Optimal blood pressure(n=1783, mean FLI; 23.1, mean HOMA-IR; 1.28, mean CRP; 0.098mg/dL), Normal blood pressure(n=807, 33.9, 1.61, 0.14), High-normal blood pressure(n=535, 37.8, 1.90, 0.12), Grade 1 hypertension(n=124, 44.8, 2.0, 0.14), Grade 2 hypertension(n=53, 49.0, 1.71, 0.09), Grade 3 hypertension(n=18, 54.6, 2.89, 0.22), Isolated systolic hypertension(n=118, 36.2, 1.59, 0.09), Isolated diastolic hypertension(n=115, 44.1, 1.94, 0.12). HOMA-IR and CRP of H group were significantly higher than L group (all p < 0.001). Conclusions: Higher FLI values at similar blood pressure levels may indicate high insulin resistance and potential inflammation, suggesting the need for strict management.