High fasting insulin concentrations may be a pivotal predictor for the severity of hepatic fibrosis beyond the glycemic status in non-alcoholic fatty liver disease patients before development of diabetes mellitus

Kosei Masuda; Shuhei Noguchi; Masafumi Ono; Tsunehiro Ochi; Kensuke Munekage; Nobuto Okamoto; Narufumi Suganuma; Toshiji Saibara

doi:10.1111/hepr.12832

High fasting insulin concentrations may be a pivotal predictor for the severity of hepatic fibrosis beyond the glycemic status in non-alcoholic fatty liver disease patients before development of diabetes mellitus

Hepatol Res. 2017 Sep;47(10):983-990. doi: 10.1111/hepr.12832. Epub 2016 Dec 5.

Authors

Kosei Masuda¹, Shuhei Noguchi², Masafumi Ono¹, Tsunehiro Ochi¹, Kensuke Munekage¹, Nobuto Okamoto¹, Narufumi Suganuma², Toshiji Saibara¹

Affiliations

¹ Departments of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan.
² Department of Environmental Medicine, Kochi Medical School, Kochi, Japan.

PMID: 27794176
DOI: 10.1111/hepr.12832

Abstract

Background: Insulin resistance and type 2 diabetes mellitus (T2DM) contribute to the progression of non-alcoholic fatty liver disease (NAFLD). However, the relationship between glucose metabolic factors and the histological severity in NAFLD patients before development of T2DM is not well known.

Methods: In 103 biopsy-proven NAFLD patients (68 men and 35 women) with hemoglobin A1c of <6.5% and fasting blood glucose of <126 mg/dL, we investigated whether glucose metabolic factors influenced the severity of hepatic fibrosis without prior known T2DM.

Results: Female gender, age, serum aspartate aminotransferase, the aspartate aminotransferase/alanine aminotransferase ratio, fasting immunoreactive insulin (f-IRI), homeostasis model assessment - insulin resistance, hemoglobin A1c, hyaluronic acid, and type IV collagen 7 s were significantly higher, and 1,5-anhydroglucitol was significantly lower, in the fibrosis stage F3 group than in the F0-2 group. Multiple logistic regression analysis showed that only f-IRI (P = 0.006; odds ratio, 1.15151; 95% confidence interval, 1.04198-1.27254) was significantly indicated as a predictive factor for F3. As determined by both forward and backward stepwise selection analyses to optimize the model, f-IRI (P = 0001; odds ratio, 1.16788) remained an independent predictive factor for F3. To discriminate the F3 group from the F0-2 group, the area under the receiver operating characteristic curves showed that fasting insulin was 0.7219, and the best cut-off value of f-IRI was 13.2 μU/mL in the receiver operating characteristic curve analysis.

Conclusions: High fasting insulin concentrations may be a pivotal glucose metabolic predictor for the severity of hepatic fibrosis beyond the glycemic status in NAFLD patients before development of T2DM.

Keywords: NAFLD; fasting insulin; hepatic fibrosis; type 2 diabetes mellitus.