Department of Epidemiology and Population Health.
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
J Clin Gastroenterol. 2019 Feb;53(2):e46-e53. doi: 10.1097/MCG.0000000000000946.
Associations of insulin resistance and hyperglycemia with a panel of liver enzymes have not been well studied in a young, heterogenous Hispanic/Latino population. We aimed to assess the associations of insulin resistance and glycemia with nonalcoholic fatty liver disease (NAFLD), as measured by liver enzymes and the pediatric NAFLD fibrosis index (PNFI), and whether these associations are modified by body mass index and mediated by inflammation or endothelial dysfunction.
We conducted a cross-sectional study of 1317 boys and girls aged 8 to 16 years from the Hispanic Community Children's Health Study/Study of Latino Youth. We used Poisson regression to assess the associations of fasting glucose, hemoglobin A1c, and homeostasis model assessment of insulin resistance (HOMA-IR) with elevated alanine aminotransferase (ALT) (>25 U/L in boys, >22 U/L in girls), aspartate aminotransferase (AST) (≥37 U/L), gamma-glutamyl transpeptidase (GGT) (≥17 U/L), and PNFI (≥9; a function of age, waist circumference, and triglyceride level).
HOMA-IR was associated with elevated ALT, AST, GGT, and PNFI [prevalence ratios (95% confidence intervals) for each 1-unit increase in the natural log of HOMA-IR: 1.99 (1.40-2.81), 2.15 (1.12-4.12), 1.70 (1.26-2.30), and 1.98 (1.43-2.74), respectively]. Associations were observed in overweight/obese children, but not in normal weight children (P-interaction=0.04 for AST and P-interaction=0.07 for GGT). After further adjustment for adiponectin, high-sensitivity C-reactive protein, e-selectin, and PAI-1, associations of HOMA-IR with liver enzymes and PNFI were attenuated, but remained statistically significant for AST and PNFI.
Insulin resistance was associated with NAFLD in overweight/obese Hispanic/Latino youth, and this association may be partially mediated by inflammation and endothelial dysfunction.
在年轻且异质的西班牙裔/拉丁裔人群中，胰岛素抵抗和高血糖与一系列肝酶之间的关系尚未得到充分研究。我们旨在评估胰岛素抵抗和血糖与非酒精性脂肪性肝病（NAFLD）的关系，这些关系通过肝酶和小儿非酒精性脂肪性肝病纤维化指数（PNFI）来衡量，以及这些关系是否会因体重指数而改变，并通过炎症或内皮功能障碍来介导。
我们对来自西班牙裔儿童健康研究/拉丁裔青年研究的 1317 名 8 至 16 岁的男孩和女孩进行了横断面研究。我们使用泊松回归来评估空腹血糖、糖化血红蛋白和稳态模型评估的胰岛素抵抗（HOMA-IR）与丙氨酸氨基转移酶（ALT）升高（男孩>25U/L，女孩>22U/L）、天门冬氨酸氨基转移酶（AST）（≥37U/L）、γ-谷氨酰转肽酶（GGT）（≥17U/L）和 PNFI（≥9；这是年龄、腰围和甘油三酯水平的函数）之间的关系。
HOMA-IR 与 ALT、AST、GGT 和 PNFI 升高有关[每增加 1 个自然对数单位 HOMA-IR 的比值比（95%置信区间）：1.99（1.40-2.81）、2.15（1.12-4.12）、1.70（1.26-2.30）和 1.98（1.43-2.74）]。在超重/肥胖儿童中观察到了这些关联，但在正常体重儿童中没有观察到（AST 的 P 交互作用=0.04，GGT 的 P 交互作用=0.07）。在进一步调整了脂联素、高敏 C 反应蛋白、E-选择素和 PAI-1 后，HOMA-IR 与肝酶和 PNFI 的关联减弱，但 AST 和 PNFI 的关联仍具有统计学意义。
超重/肥胖的西班牙裔/拉丁裔青少年中存在胰岛素抵抗与 NAFLD 相关，这种关联可能部分通过炎症和内皮功能障碍来介导。
