Nonalcoholic Fatty Liver Disease in Hispanic Youth With Dysglycemia: Risk for Subclinical Atherosclerosis?

CONTEXT

Obese Hispanic adolescents (OHAs) with dysglycemia have increased cardiovascular disease risk burden.

OBJECTIVE

To investigate if nonalcoholic fatty liver disease (NAFLD) confers added risk for endothelial dysfunction in these youth.

DESIGN

Cross-sectional study.

SETTING

Academic institution.

PARTICIPANTS

Thirty-six OHAs (15.3 ± 0.4 years), 20 with prediabetes and 16 with type 2 diabetes, with and without NAFLD.

INTERVENTION

Evaluation of reactive hyperemia index (RHI) and augmentation index (AIx) by peripheral arterial tonometry; muscle, hepatic, and adipose tissue insulin sensitivity (IS; hyperinsulinemic-euglycemic clamp 80 mu/m/min, with [6,6 H]glucose and [H] glycerol); body composition; and abdominal and hepatic fat by magnetic resonance imaging/spectroscopy.

OUTCOME MEASURES

RHI and AIx.

HYPOTHESIS

OHAs with dysglycemia and NAFLD have worse RHI and AIx vs those without NAFLD.

RESULTS

The NAFLD (n = 23) and non-NAFLD (n = 13) groups were of similar age, sex, glycemic status, body mass index, % body fat and abdominal fat. The NAFLD group had higher hepatic fat ( < 0.001) lower skeletal muscle IS ( = 0.01), hepatic IS ( = 0.01), and adipose tissue IS ( = 0.04). The NAFLD vs non-NAFLD group had lower RHI (1.4 ± 0.05 vs 1.7 ± 0.09, = 0.002), greater AIx (-6.0 ± 1.6 vs -12.0 ± 2.1, = 0.03). Hepatic fat was inversely related to RHI ( = -0.49, = 0.002) and positively related to AIx ( = 0.45, = 0.006). Hepatic IS ( = -0.42, = 0.01) and adipose IS ( = -.54, = 0.001) correlated with arterial stiffness (AIx).

CONCLUSION

In OHAs with dysglycemia, NAFLD is associated with worse endothelial function. RHI and AIx were related to hepatic fat content. Vascular stiffness was related to hepatic and adipose tissue insulin resistance.