NAFLD linked to metabolic impairments in obesity, type 2 diabetes
In middle-aged patients with obesity and type 2 diabetes, the presence of nonalcoholic fatty liver disease is associated with more severe hyperinsulinemia, dyslipidemia and adipose tissue/hepatic insulin resistance compared with patients without nonalcoholic fatty liver disease, according to study findings.
Kenneth Cusi, MD, FACP, FACE, an Endocrine Today Editorial Board member and chief of the division of endocrinology, diabetes and metabolism at the University of Florida in Gainesville, and colleagues evaluated 154 patients with obesity stratified into four groups: a control group without type 2 diabetes or nonalcoholic fatty liver disease (NAFLD; controls; n = 18); no NAFLD but type 2 diabetes (n = 50); diabetes and isolated steatosis (n = 21); or diabetes and nonalcoholic steatohepatitis (NASH; n = 65). Ten healthy controls without obesity also were evaluated as a reference for metabolic measurements.
Researchers sought to determine the metabolic effect of isolated steatosis or NASH in patients with type 2 diabetes and obesity.
Researchers found that the isolated steatosis and NASH groups had higher hepatic triglyceride levels compared with those in the other two groups. Only the NASH group had increased levels of plasma aspartate aminotransferase and alanine aminotransferase. No difference was found in intrahepatic triglyceride levels between controls and the group with diabetes but without NAFLD.
Similar elevations in fasting plasma glucose levels and HbA1c were seen in patients with type 2 diabetes (with or without NAFLD) compared with controls (P .05 for all). No association was seen between the presence of isolated steatosis or NASH with poorer blood pressure control, increased use of hypertensive medication or higher total or LDL cholesterol. However, the NASH group was found to have higher plasma triglycerides and a trend toward lower HDL compared with patients with type 2 diabetes only or controls.
The isolated steatosis and NASH groups had an approximate 1.5-fold to 2.5-fold increase in fasting plasma insulin compared with those without the conditions.
“In middle-aged obese patients with [type 2 diabetes], the presence of NAFLD is associated with hyperinsulinemia and more severe adipose tissue and hepatic insulin resistance, as well as worse atherogenic dyslipidemia,” the researchers wrote. “The clinical implication is that the presence of NAFLD in patients with [type 2 diabetes] should alert the health care provider to institute a more aggressive lifestyle intervention and consider strategies to minimize high cardiovascular risk.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.