This article is more than 5 years old. Information may no longer be current.

OGIS index may predict fibrosis in NAFLD without diabetes

New research published in Hepatology showed that the oral glucose insulin sensitivity index is closely related to peripheral insulin sensitivity in patients with nonalcoholic fatty liver disease without diabetes, indicating it may be a useful tool for predicting liver fibrosis.

“This proof-of-principle study provides the rationale for the use of [oral glucose insulin sensitivity] as a noninvasive index of liver damage in a low-risk population of NAFLD subjects,” Amalia Gastaldelli, PhD, head of the cardiometabolic risk unit, Institute of Clinical Physiology, Pisa, Italy, and colleagues wrote.

Using data from a validation cohort of 22 patients with NAFLD without diabetes and an independent cohort of 145 patients with NAFLD, the researchers sought to determine the accuracy of insulin resistance and insulin sensitivity indexes and compare them with other techniques, as well as to determine the most accurate tests for predicting liver damage compared with the NAFLD fibrosis score (NFS).

“The NAFLD fibrosis score is currently the best-validated score for the prediction of advanced fibrosis, in both cross-sectional and longitudinal cohorts; but, it is influenced by the degree of body mass index and, especially, by the presence or absence of diabetes/impaired fasting glucose,” the researchers wrote.

In the validation cohort, homeostasis model assessment of insulin resistance score, insulin to glucose ratio and insulin sensitivity index Stumvoll were most accurately associated with hepatic insulin resistance, whereas peripheral insulin sensitivity was most significantly linked to oral glucose insulin sensitivity index (OGIS), insulin sensitivity index Stumvoll and metabolic clearance rate estimation without demographic parameters, according to the research.

In the independent cohort, oral glucose tolerance test-derived indexes were associated with liver damage and OGIS was the best predictor of fibrosis stage greater than 2 (OR = 0.76; 95% CI, 0.61-0.96) and of nonalcoholic steatohepatitis (OR = 0.75; 95% CI, 0.63-0.9).

Further analysis showed OGIS and NFS both identified stages 3 and 4 fibrosis. However, OGIS predicted it “better” compared with NFS (OR = 0.57; 95% CI, 0.45-0.72), according to the research. In addition, OGIS was better able to differentiate stage 2 from stages 3 and 4 fibrosis compared with NFS (P < .003).

The researchers concluded: “In clinical practice, we suggest that OGIS should be part of a panel of noninvasive markers of fibrosis, to be used for an overall evaluation of NAFLD patients within the clinical context and considering all of the other clinical and laboratory findings.” – by Melinda Stevens

Disclosure: Gastaldelli reports advising for Hoffmann-La Roche, Eli Lilly and Sanofi. Please see the study for a full list of all other authors’ relevant financial disclosures.