Increased visceral adiposity predicts NAFLD in normal-weight adults with type 2 diabetes
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Adults with type 2 diabetes who are not obese but have elevated visceral adiposity are at increased risk for nonalcoholic fatty liver disease, or NAFLD, compared with those without elevated visceral adiposity, according to research in Journal of Diabetes Investigation.
In a cross-sectional study of Japanese adults, researchers found that, although BMI levels in normal-weight patients with increased visceral adiposity (mean BMI, 23.4 kg/m²) were comparable to those in patients with overweight and no increased visceral adiposity (mean BMI, 25.7 kg/m²), the normal-weight patients exhibited a more severe cardiometabolic risk profile, including higher blood pressure, LDL cholesterol and uric acid levels.
“Importantly, they were at increased risk for the prevalent NAFLD even after adjusting for covariates, including age, gender and transaminase,” Ryotaro Bouchi, MD, PhD, of the Graduate School of Medical and Dental Sciences at Tokyo Medical and Dental University, Tokyo, and colleagues wrote.
Bouchi and colleagues analyzed data from 140 Japanese adults with type 2 diabetes and no liver diseases (mean age, 65 years; 44.6% women) visiting the hospital for care between April 2014 and March 2015.
Researchers measured visceral fat area (VFA) and liver attenuation index (LAI) via CT scan. Patients were classified into four groups based on BMI and VFA: BMI less than 25 kg/m² and a VFA of less than 100 cm2; BMI of at least 25 kg/m² and VFA less than 100 cm2; BMI less than 25 kg/m² and a VFA of at least 100 cm2; and BMI of at least 25 kg/m² and VFA of at least 100 cm2. Researchers used multivariate linear regression and logistic regression analysis to determine the effect of increasing VFA on LAI in adults without obesity.
Within the cohort, 25% of participants (n = 35) were classified as normal weight but with elevated VFA. Participants in this group had a lower LAI vs. those without obesity and a VFA less than 100 (1.09 vs. 1.23; P = .019). Multivariate linear regression analysis showed increasing VFA in adults with and without overweight or obesity, as well as adults with obesity and no VFA, was significantly associated with LAI after adjusting for age, smoking status and alanine aminotransferase level.
Multivariate regression analysis showed that increasing VFA in normal-weight adults was a significant predictor of LAI, with an OR of 5.88 (95% CI, 1.03-33.52).
The researchers noted that prescription rates for angiotensin-receptor blockers, diuretics and statins in patients without obesity but with increased VFA were lower than those with both overweight or obesity and increased VFA, indicating that the patients without obesity may have “insufficient opportunities” for cardiometabolic risk management due to their normal BMI.
“We, therefore, propose that visceral adiposity should be directly evaluated for the management of NAFLD among nonobese patients with type 2 diabetes as well as obese patients,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.