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Digestive Diseases and Sciences

, Volume 56, Issue 12, pp 3655–3663 | Cite as

Nonalcoholic Fatty Liver Disease Markers Are Associated with Insulin Resistance in Type 1 Diabetes

  • Tomislav Bulum
  • Branko Kolarić
  • Lea Duvnjak
  • Marko Duvnjak
Original Article

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) has been associated with the insulin resistance.

Aims

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Nonalcoholic fatty liver disease Liver enzymes Type 1 diabetes Insulin resistance Estimated glucose disposal rate 

Notes

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.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Tomislav Bulum
    • 1
  • Branko Kolarić
    • 2
    • 3
  • Lea Duvnjak
    • 1
    • 4
  • Marko Duvnjak
    • 4
    • 5
  1. 1.Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic DiseasesUniversity Hospital MerkurZagrebCroatia
  2. 2.Medical SchoolUniversity of RijekaRijekaCroatia
  3. 3.Zagreb County Institute of Public HealthVelika Gorica, ZagrebCroatia
  4. 4.Medical SchoolUniversity of ZagrebZagrebCroatia
  5. 5.Division of Gastroenterology and HepatologyUniversity Hospital Centre “Sestre milosrdnice”ZagrebCroatia

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