Schult Andreas, Mehlig Kirsten, Svärdsudd Kurt, Wallerstedt Sven, Björkelund Cecilia, Hansson Per-Olof, Zetterberg Henrik, Kaczynski Jerzy
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 41390, Västra Götaland, Sweden.
Transplant Institute, Sahlgrenska University Hospital, Gothenburg 41345, Västra Götaland, Sweden.
World J Hepatol. 2025 Jun 27;17(6):107160. doi: 10.4254/wjh.v17.i6.107160.
Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels. It is associated with fatty liver disease and elevated liver function tests (LFT) in cross-sectional studies, but data from cohort studies are scarce.
To investigate the association between insulin and pathological LFT, liver disease, and cirrhosis in a population-based retrospective cohort study.
Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used. LFT were obtained at two time points 8 years to 24 years after baseline. Liver disease diagnoses were obtained from nationwide registries. The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.
Total follow-up was 54054 person-years for women and 27556 person-years for men. Insulin levels were positively correlated with elevated LFT during follow-up, whereas physical activity and coffee consumption were negatively correlated. Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease, adjusted hazard ratio (aHR) of 4.3 (95%CI: 1.6-14.6) and cirrhosis (aHR = 4.8, 95%CI: 1.6-14.6).
This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease. The results support the concept of metabolic dysfunction associated liver disease.
胰岛素抵抗是一种以胰岛素水平升高为特征的心脏代谢风险因素。在横断面研究中，它与脂肪性肝病和肝功能检查（LFT）升高有关，但队列研究的数据较少。
在一项基于人群的回顾性队列研究中，调查胰岛素与病理性LFT、肝病和肝硬化之间的关联。
使用了来自前瞻性队列研究的857名男性和1228名女性的人体测量和心脏代谢因素。在基线后8年至24年的两个时间点获取LFT数据。肝病诊断来自全国性登记处。分析了胰岛素水平与LFT升高或肝病及肝硬化发展之间的关联。
女性的总随访时间为54054人年，男性为27556人年。随访期间，胰岛素水平与LFT升高呈正相关，而体力活动和咖啡摄入量呈负相关。胰岛素水平处于上三分位数且饮酒量高于代谢相关脂肪性肝病（MASLD）阈值的个体，患肝病的风险增加，调整后风险比（aHR）为4.3（95%CI：1.6-14.6），患肝硬化的风险也增加（aHR = 4.8，95%CI：1.6-14.6）。
这项基于人群的研究提供了证据，表明高胰岛素水平是肝酶升高和临床显性肝病发展的风险因素。结果支持代谢功能障碍相关肝病的概念。
