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NAFLD, insulin resistance linked to worse atherogenic lipoprotein profile

In a cross-sectional study, researchers found that nonalcoholic fatty liver disease and insulin resistance were linked to worsening of atherogenic dyslipidemia, according to data published in The Journal of Clinical Endocrinology & Metabolism.

“Atherogenic dyslipidemia is believed to play a critical role in the development of [cardiovascular disease] in patients with NAFLD. … The aim of the study was to assess the effect of the severity of liver disease by histology on atherogenic dyslipidemia in patients with NAFLD [and nonalcoholic steatohepatitis] well-matched for important clinical characteristics such as obesity and adiposity,” Kenneth Cusi, MD, FACP, FACE, division of endocrinology, diabetes and metabolism, University of Florida, and colleagues wrote.

The researchers recruited 188 patients at high risk for NAFLD or NASH from outpatient clinics in San Antonio, Texas and Gainesville, Florida.

Kenneth Cusi, MD, FACP, FACE 

After measuring hepatic triglyceride content via magnetic resonance spectroscopy, obtaining liver biopsy results and examining metabolic profiles using oral glucose tolerance tests and lipoprotein analyses, the researchers found that patients with NAFLD had more severe insulin resistance compared with patients without NAFLD.

Patients with NAFLD had a higher and worse plasma apolipoprotein B to-A1 ratio (0.66 ± 0.02) compared with patients without NAFLD (0.58 ± 0.02, P = .01) and smaller low density lipoprotein (LDL) particle size (216.2 ± 0.7) compared with patients without NAFLD (219.4 ± 1.1 Å, P = .01).

“Of note, this difference in LDL particle size between patients with and without NAFLD was of similar magnitude when nonobsese and obese patients were analyzed separately, with no interaction between NAFLD and obesity,” the researchers wrote.

The rate of severity of steatohepatitis did not influence the lipoprotein profile. “Worse atherogenic dyslipidemia was best predicted by the degree of liver fat accumulation and adipose tissue and systemic insulin resistance,” the researchers wrote.

“NAFLD was associated with a worse atherogenic lipoprotein profile, regardless of similar BMI and other clinical parameters,” the researchers concluded. “We speculate that this lipoprotein profile is driven mostly by liver fat content and insulin resistance, and appears not to be worsened by obesity or the severity of liver disease.” – by Melinda Stevens

Disclosure: Cusi reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.