Liao Nai-Hui, Wang Chun-Yi, Lai Kuan-Yu, Kao Hsiang-Han, Lin Wen-Yuan, Chen Tsung-Po
Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Medicine (Baltimore). 2025 Aug 22;104(34):e44109. doi: 10.1097/MD.0000000000044109.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent, especially among individuals with type 2 diabetes mellitus. Insulin resistance (IR) is a key shared mechanism. This study aimed to investigate the association between MASLD and IR in individuals with normal glucose levels. We recruited participants from communities and outpatient clinics in central and northern Taiwan, excluding those with impaired fasting glucose or type 2 diabetes mellitus. Data collected included body mass index, blood pressure, body fat percentage, and lifestyle factors. After overnight fasting, blood samples were taken. MASLD was diagnosed via abdominal ultrasonography. IR was calculated using the homeostasis model assessment of insulin resistance formula and categorized into tertiles (T1-T3). Statistical analyses included analysis of variance and multivariate logistic regression. Among 485 participants (mean age 42.0 ± 11.4 years), MASLD prevalence increased with IR levels (T1: 34.1%, T2: 40.1%, T3: 47.8%; P < .001). Fasting glucose remained within normal limits but rose with IR (T1: 81.9 ± 7.4, T2: 85.1 ± 7.6, T3: 87.3 ± 6.5 mg/dL; P < .0001). After adjusting for age, sex, body mass index, exercise, alcohol use, and smoking, MASLD risk was significantly higher in T3 (odds ratio: 3.87, 95% confidence interval: 2.08-7.21) and T2 (odds ratio: 1.83, 95% confidence interval: 1.11-3.00) compared to T1. Even among individuals with normal glucose levels, elevated IR is significantly associated with higher MASLD risk. Early identification and intervention for IR may help prevent MASLD progression.
代谢功能障碍相关脂肪性肝病（MASLD）日益普遍，尤其是在2型糖尿病患者中。胰岛素抵抗（IR）是一个关键的共同机制。本研究旨在调查血糖水平正常个体中MASLD与IR之间的关联。我们从台湾中部和北部的社区及门诊招募参与者，排除空腹血糖受损或2型糖尿病患者。收集的数据包括体重指数、血压、体脂百分比和生活方式因素。过夜禁食后采集血样。通过腹部超声诊断MASLD。使用胰岛素抵抗稳态模型评估公式计算IR，并分为三分位数（T1 - T3）。统计分析包括方差分析和多因素逻辑回归。在485名参与者（平均年龄42.0±11.4岁）中，MASLD患病率随IR水平升高而增加（T1：34.1%，T2：40.1%，T3：47.8%；P <.001）。空腹血糖保持在正常范围内，但随IR升高（T1：81.9±7.4，T2：85.1±7.6，T3：87.3±6.5mg/dL；P <.0001）。在调整年龄、性别、体重指数、运动、饮酒和吸烟因素后，与T1相比，T3（优势比：3.87，95%置信区间：2.08 - 7.21）和T2（优势比：1.83，95%置信区间：1.11 - 3.00）患MASLD的风险显著更高。即使在血糖水平正常的个体中，IR升高也与更高的MASLD风险显著相关。早期识别和干预IR可能有助于预防MASLD进展。
