Nonalcoholic Fatty Liver Disease Markers Are Associated with Insulin Resistance in Type 1 Diabetes
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Nonalcoholic fatty liver disease (NAFLD) has been associated with the insulin resistance.
To explore the relationship between markers of NAFLD, namely concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK), γ-glutamyltransferase (GGT), ferritin and bilirubin and insulin resistance in type 1 diabetes.
Our study included 353 patients with type 1 diabetes. Insulin sensitivity was measured with estimated glucose disposal rate calculated using the equation: eGDR = 24.31 − (12.22 × WHR) − (3.29 × HT) − (0.57 × HbA1c); WHR = waist to hip ratio, HT = hypertension. Correlations and multiple logistic regressions analysis were performed to identify the relationships between NAFLD associated markers and eGDR, individual components of insulin resistance and risk of insulin resistance.
AST, ALT, AST-to-ALT ratio, ALK and ferritin significantly correlated with insulin resistance measured by eGDR (r = −0.13, −0.14, 0.13, −0.18, and −0.24, respectively; all P < 0.05), and with individual components of insulin resistance, most notably WHR. In a multiple logistic regression model adjusted according to age, sex, duration of diabetes and BMI, increased levels of AST, ALT and ALK resulted in an increased risk for the development of insulin resistance in our subjects (OR = 1.03, 1.02, and 1.01, respectively; all P < 0.05).
These findings indicate that higher levels of ALT, AST and ALK are additional markers of insulin resistance in type 1 diabetes and suggest that those subjects must be considered as potentially affected not only by a hepatic but also by a multisystemic disease through altered insulin sensitivity.
KeywordsNonalcoholic fatty liver disease Liver enzymes Type 1 diabetes Insulin resistance Estimated glucose disposal rate
Conflict of interest
The authors disclose that they did not receive any financial support for the study. No proprietary interest is involved in the study.
- 2.Martin FIR, Hopper JL. The relationship of acute insulin sensitivity to the progression of vascular disease in long-term type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1987;24:1–9.Google Scholar
- 13.Dichl AM, Goodman Z, Ishak KG. Alcohollike liver disease in nonalcoholics: a clinical and histologic comparison with alcohol-induced liver disease. Gastroenterology. 1988;95:1056–1062.Google Scholar
- 24.Angelico F, Del Ben M, Conti R, et al. Insulin resistance, the metabolic syndrome, and nonalcoholic fatty liver disease. J Clin Endocrinol Metab. 2005; 1578–1582.Google Scholar
- 35.Nakanishi N, Nishina K, Li W, Sato M, Suzuki K, Tatara K. Serum gamma-glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men. J Intern Med. 2003; 95–287.Google Scholar
- 44.Kelly DE, McKolanis TM, Hegazi RAF, Kuller LH, Kalhan SC. Fatty liver in type 2 diabetes: relation to regional adiposity, fatty acids, and insulin resistance. Am J Physiol Endocrinol Metab. 2003;285:E906–E916.Google Scholar