Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.
J Clin Endocrinol Metab. 2011 Apr;96(4):1093-7. doi: 10.1210/jc.2010-2190. Epub 2011 Jan 20.
Although fatty liver and insulin resistance are known to be associated, the relationship between the two in the development of type 2 diabetes mellitus (T2DM) is unclear.
We investigated the 5-yr risk of developing T2DM in individuals diagnosed with fatty liver using ultrasound and stratified by insulin sensitivity using quartiles of fasting insulin concentration.
We examined the clinical and laboratory data of 11,091 Koreans who had a medical evaluation including fasting insulin concentration and abdominal ultrasound at baseline and had a follow-up after 5 yr.
At baseline, 27% of the population had fatty liver. Almost half (47%) of the individuals with fatty liver had baseline insulin concentration in the highest quartile compared with 17% in those without fatty liver (P < 0.001). Regardless of baseline insulin concentration, individuals with fatty liver had significantly (P < 0.001) more baseline clinical and metabolic abnormalities, including higher glucose and triglyceride concentration and lower high-density lipoprotein cholesterol concentration. In addition, regardless of baseline insulin concentration, individuals with fatty liver had a significantly increased risk for incident T2DM compared with those without fatty liver [crude odds ratio, 5.05 (95% confidence interval, 2.08-12.29) in the lowest insulin quartile and 6.34 (3.58-11.21) in the highest quartile]. In individuals in the highest insulin quartile, the odds ratio for developing T2DM remained significant even after multivariate adjustment including baseline glucose concentration [2.42 (1.23-4.75)].
Although associated with insulin resistance, fatty liver diagnosed by ultrasound appears to independently increase the risk of T2DM.
虽然已知脂肪肝和胰岛素抵抗之间存在关联，但在 2 型糖尿病（T2DM）的发展过程中，两者之间的关系尚不清楚。
我们使用超声检查评估了诊断为脂肪肝的个体发生 T2DM 的 5 年风险，并按空腹胰岛素浓度四分位将其分为胰岛素敏感性不同的亚组。
我们检查了 11091 名韩国人的临床和实验室数据，这些人在基线时接受了包括空腹胰岛素浓度和腹部超声检查在内的医学评估，并在 5 年后进行了随访。
在基线时，人群中有 27%患有脂肪肝。与无脂肪肝的个体相比，几乎一半（47%）的脂肪肝患者空腹胰岛素浓度处于最高四分位（P<0.001）。无论基线胰岛素浓度如何，患有脂肪肝的个体基线时的临床和代谢异常明显更多，包括血糖和甘油三酯浓度升高以及高密度脂蛋白胆固醇浓度降低。此外，无论基线胰岛素浓度如何，患有脂肪肝的个体发生 T2DM 的风险显著高于无脂肪肝的个体[粗比值比，最低胰岛素四分位数为 5.05（95%置信区间，2.08-12.29），最高四分位数为 6.34（3.58-11.21）]。在胰岛素最高四分位数的个体中，即使在包括基线血糖浓度在内的多变量调整后，发生 T2DM 的比值比仍然显著[2.42（1.23-4.75）]。
尽管与胰岛素抵抗有关，但通过超声诊断的脂肪肝似乎独立增加了 T2DM 的发病风险。
