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Low serum IGF-I may signal liver fibrosis in type 2 diabetes

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February 18, 2019

Low levels of serum insulin-like growth factor I may increase the risk for liver fibrosis in adults with type 2 diabetes who consume very little alcohol on a daily basis, according to findings published in the Journal of Diabetes Investigation.

“Liver fibrosis is one of the most important factors of liver disease progression, and advanced liver fibrosis is associated with hepatocellular carcinoma and liver failure,” Teruki Miyake, MD, PhD, a senior assistant professor in the department of gastroenterology and metabology at Ehime University Graduate School of Medicine in Japan, and colleagues wrote. “Additionally, the presence of diabetes in [nonalcoholic fatty liver disease] patients is a significant predictor of moderate to severe fibrosis, and paired biopsies showed that the prevalence of diabetes in [nonalcoholic fatty liver disease] patients with fibrosis progression was higher than in those with nonprogressed [nonalcoholic fatty liver disease].”

Miyake and colleagues conducted a cross-sectional study of 415 adults with type 2 diabetes who were treated for diabetes between May 2013 and December 2016 at Uwajima City Hospital in Japan (mean age, 61.9 years; 40.2% women). Men in the cohort consumed less than 30 g of alcohol per day and women consumed less than 20 g per day.

The researchers measured serum levels of growth hormone, IGF-I, IFG-I assay as well as IGF-I standard deviation scores on the morning after a participant was admitted to the hospital. In addition, a subset of 176 participants were also measured for levels of 7S domain of type IV collagen (IV-7S). Liver fibrosis was calculated via the fibrosis-4 index. A score of more than 3.25 confirmed liver fibrosis.

In the study population, the mean fibrosis-4 index score was 1.6, the mean IV-7S measurement was 4 ng/mL, the mean IGF-I measure was 118.6 ng/mL and the mean IGF-I standard deviation score was –0.54.

The researchers found that there was an inverse correlation between fibrosis-4 index and both IGF-I (r = –0.38; P < .0001) and IGF-I standard deviation scores (r = –0.26; P < .0001). This compared with a positive correlation between IV-7S and fibrosis-4 index (r = 0.48; P < .0001) and an inverse correlation with IGF-I (r = –0.43; P < .0001) and IGF-I standard deviation scores (r = –0.43, P < .0001).

After adjusting for age, BMI, fasting plasma glucose, HbA1c, visceral fat area, triglycerides, HDL cholesterol, gamma-glutamyl transpeptidase and GH, the researchers confirmed the inverse relationship between fibrosis-4 index score and IGF-I (P < .0001) and IGF-I standard deviation scores (P < .0001), as well as the inverse correlation between IV-7S and IGF-I (P = .0004) and IGF-I standard deviation scores (P < .0001).

“Our findings showed that low serum IGF-I levels are a possible risk factor for liver fibrosis in type 2 diabetes mellitus patients,” the researchers wrote. “This result might help clinicians to identify type 2 diabetes mellitus patients with advanced [nonalcoholic steatohepatitis] by measuring serum IGF-I levels. Therefore, we might need to pay attention to IGF-I in type 2 diabetes mellitus patients.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures

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