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Hepatic indices predict NAFLD in patients with type 1 diabetes

The fatty liver index and the hepatic steatosis index are effective markers for predicting liver fat content and metabolic syndrome in patients with diabetes, according to results of a recently published study.

“Non-alcoholic fatty liver disease has been recognized as a risk factor and co-morbidity of disorders associated with obesity and insulin resistance,” the researchers wrote. “However, NAFLD can develop also in non-obese subjects without insulin resistance, but with a possible genetic predisposition to liver fat accumulation, due to dietary factors ... and other conditions. Patients with NAFLD have increased risk for hepatic malignancy and cardiovascular events, moreover, NAFLD is strongly associated with metabolic syndrome. Due to the traditional view that patients with type 1 diabetes are mainly of normal weight, NAFLD has not been intensively studied in these patients.”

The study comprised 40 patients with type 1 diabetes. Twelve of the patients had confirmed hepatic steatosis. The fatty liver index and hepatic steatosis index scores were significantly higher in the patients with steatosis compared with patients without steatosis.

The fatty liver index had sensitivity of 90%, specificity of 74%, positive likelihood ratio of 3.46, negative likelihood ratio of –0.14, positive predictive value of –0.64 and negative predictive value of –0.93. The hepatic steatosis index had sensitivity of 86%, specificity of 66%, positive likelihood ratio of 1.95, negative likelihood ratio of –0.21, positive predictive value of –0.5 and negative predictive value of –0.(95% CI, 0.58-0.91).

The fatty liver index correlated with intrahepatic fat content, particularly among 17 men, 23 women, 14 patients with a score of 60 or greater, 12 patients who had liver steatosis, 29 patients with BMI over 25 kg/m² and 21 patients with metabolic syndrome. Other correlated factors include C-reactive protein, serum total cholesterol, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase systolic blood pressure.

The hepatic steatosis index did not meet significant correlation with intrahepatic fat content. However, it did correlate with waist circumference and C-reactive protein.

Independent determinants of intrahepatic fat content included C-reactive protein (P = .038) and waist circumference (P = .001). Factors influencing hepatic steatosis included C-reactive protein (P = .027) and gamma-glutamyl transferase (P = .037)

Liver steatosis was associated with metabolic syndrome (P = .016). Metabolic syndrome also associated with the fatty liver index scores of 60 or great (P = .003) and the hepatic steatosis index scores of 36 or greater (P = .002).

“In conclusion, the tested indices can serve as surrogate markers for liver fat content and metabolic syndrome in patients with diabetes mellitus type 1, however broader studies are needed,” the researchers . “Usage of [fatty liver index] and [hepatic steatosis] for screening purposes might be an effective tool for selection of patients for research in the field of NAFLD in diabetes mellitus type 1.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.