‘Often overlooked’: Insulin resistance tops risk predictors for MASLD in lean patients
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Key takeaways:
- Risk factors for MASLD in lean patients include insulin resistance, HbA1c and waist circumference.
- Insulin resistance could be a biomarker for lean patients at risk for MASLD.
VANCOUVER, British Columbia — Insulin resistance, HbA1c and waist circumference represent independent risk factors for metabolic dysfunction-associated steatotic liver disease among lean patients, according to data presented here.
Researchers noted that MASLD among lean patients, specifically those with BMI < 25 kg/m2, often goes undetected due to normal liver enzyme levels and the absence of diabetes. However, early detection of lean MASLD is crucial for prompt therapy that could otherwise prevent cardiovascular and liver-related complications.
“The rising concern of MASLD in lean individuals with limited visible symptoms prompted this research,” Manasik Abdu, MD, PGY-3 chief resident in the department of internal medicine at the University of Buffalo, told Healio. “Identifying a disease that is often overlooked due to its lack of association with obesity and the absence of clinical signs is a significant clinical challenge.”
To assess the clinical utility of insulin resistance as “a noninvasive, cost-effective and easily applicable” biomarker for detecting MASLD in lean patients, Abdu and colleagues examined data from the National Health and Nutrition Examination Surveys from 2017 to 2020. The researchers included lean adults with valid transient elastography measurements (n = 860; median age, 53 years; 48% women), excluding those with reported high alcohol consumption, viral hepatitis or HIV.
Abdu and colleagues defined insulin resistance using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), calculated as insulin (U/mL) multiplied by fasting glucose (mmol/L) divided by 22.5. The researchers applied multivariable logistic regression analyses to assess the link between HOMA-IR and other metabolic factors with MASLD; they also used receiver operating characteristic (ROC) curve analysis to measure the area under the ROC curve (AUC) for HOMA-IR to detect MASLD.
According to study results presented at the ACG Annual Meeting, the researchers identified three independent risk factors for lean patients with MASLD: HOMA-IR > 2 (adjusted OR = 1.4; 95% CI, 1.17-1.68), HbA1c (OR = 1.29; 95% CI, 1.05-1.57) and waist circumference (OR = 1.07; 95% CI, 1.02-1.12).
“These factors provide valuable insights into the risk profile of lean individuals for MASLD,” Abdu told Healio. “HOMA-IR exhibits an AUC of 0.81, indicating its potential for predicting MASLD. This high AUC suggests that HOMA-IR is a strong indicator of the disease.”
The researchers reported that an optimal sensitivity of 92.2% was achieved at HOMA-IR > 1.4 cutoff and a specificity of 91.6% at HOMA-IR > 3 cutoff, with a negative predictive value of 97.8% and 93.4%, respectively. However, the positive predictive value remained low (< 30%), regardless of the HOMA-IR cutoff.
Abdu and colleagues acknowledged that due to this limited positive predictive value, HOMA-IR “may not be a stand-alone diagnostic tool” since diagnostic confirmation with imaging studies or liver biopsies may be required.
“Health care professionals should consider using HOMA-IR as a screening tool for lean individuals at risk of MASLD,” Abdu said. “This can help in identifying lean patients who might be at risk for liver complications, even when they don’t exhibit traditional risk factors like obesity or diabetes.”
She added: “Incorporating HOMA-IR into the screening process can streamline patient care and optimize resource allocation while improving overall health outcomes. [Yet] further research is needed to refine the role of HOMA-IR and its clinical implications in the context of lean MASLD and screening protocols.”
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Abdu M, et al. Homeostasis model assessment of insulin resistance as a clinical marker of nonalcoholic fatty liver disease in lean individuals. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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