Dimova Rumyana, Chakarova Nevena, Serdarova Mina, Marinova Cvetelina, Popov Dimitar, Del Prato Stefano, Tankova Tsvetalina
Department of Endocrinology, Medical University-Sofia, Sofia, Bulgaria
Department of Endocrinology, Medical University-Sofia, Sofia, Bulgaria.
BMJ Open Diabetes Res Care. 2024 Dec 20;12(6):e004542. doi: 10.1136/bmjdrc-2024-004542.
Previous studies have suggested an association between beta-cell and autonomic function and metabolic-associated fatty liver disease (MAFLD). We explored the association between controlled attenuated parameter (CAP) and insulin secretion and action, as well as sympathetic and parasympathetic activity in normal (NGT) and impaired (IGT) glucose tolerance.
Twenty-five NGT (age 44.8±9.6 years; body mass index (BMI) 32.3±6.9 kg/m) and 27 IGT (47.6±11.8 years; 31.0±6.5 kg/m) subjects underwent a 75 g oral glucose tolerance test (OGTT) and a mixed meal tolerance test (MMTT) for assessment of glucose and insulin secretion. Parameters of beta-cell function and insulin sensitivity were calculated. Body composition was assessed by bioimpedance analysis (Inbody720). Autonomic function was assessed by ANX V.3.0 monitoring system. CAP was determined by Fibroscan (Echosense) and presence of MAFLD was defined as CAP >233 dB/m.
A CAP >233 dB/m was found in 72% of subjects with NGT and 67% of subjects with IGT. Subjects with MAFLD, irrespective of glucose tolerance, had higher BMI and waist circumference, lower insulin secretion and action, and lower parasympathetic activity. On a matrix analysis, after adjustment for age and BMI, CAP was positively related to systolic blood pressure (SBP); insulin action was negatively related to parasympathetic activity. Regression analysis showed that AUC-insulin MMTT remained independently related to MAFLD: OR 24.4 (95% CI 2.17 to 274.77; p=0.010). A "cut-off" value of 15,620 uIU/mL*180 min provided a 75% sensitivity and 75% specificity for CAP >233 dB/m.
Our results do not support a role for parasympathetic activity in MAFLD. Rather, they show that stimulated hyperinsulinemia may be associated with greater risk of MAFLD irrespective of glucose tolerance in a high-risk population without diabetes.
先前的研究表明β细胞和自主神经功能与代谢相关脂肪性肝病（MAFLD）之间存在关联。我们探讨了正常糖耐量（NGT）和糖耐量受损（IGT）人群中受控衰减参数（CAP）与胰岛素分泌及作用，以及交感神经和副交感神经活动之间的关联。
25名NGT受试者（年龄44.8±9.6岁；体重指数（BMI）32.3±6.9kg/m²）和27名IGT受试者（47.6±11.8岁；31.0±6.5kg/m²）接受了75g口服葡萄糖耐量试验（OGTT）和混合餐耐量试验（MMTT），以评估葡萄糖和胰岛素分泌。计算β细胞功能和胰岛素敏感性参数。通过生物电阻抗分析（Inbody720）评估身体成分。通过ANX V.3.0监测系统评估自主神经功能。通过Fibroscan（Echosense）测定CAP，MAFLD的存在定义为CAP>233dB/m。
在72%的NGT受试者和67%的IGT受试者中发现CAP>233dB/m。患有MAFLD的受试者，无论糖耐量如何，其BMI和腰围更高，胰岛素分泌及作用更低，副交感神经活动更低。在矩阵分析中，调整年龄和BMI后，CAP与收缩压（SBP）呈正相关；胰岛素作用与副交感神经活动呈负相关。回归分析显示，MMTT的胰岛素曲线下面积（AUC-insulin）与MAFLD仍独立相关：比值比（OR）为24.4（95%置信区间2.17至274.77；p=0.010）。15,620uIU/mL*180分钟的“临界”值对CAP>233dB/m的敏感性为75%，特异性为75%。
我们的结果不支持副交感神经活动在MAFLD中起作用。相反，它们表明在无糖尿病的高危人群中，无论糖耐量如何，刺激后的高胰岛素血症可能与MAFLD的更高风险相关。
