Eunice X. Tan1,2, Michelle H. Lee2, Nurhalisa B. Jumat2, Mark D. Muthiah1,2, Sue-Anne Toh2,3, Yock-Young Dan1,2
1Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore, 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
3Department of Medicine, National University Hospital, Singapore
Background/Aims: Prevalence of diabetes mellitus (DM) and non-alcoholic fatty liver disease (NAFLD) are on the rise mirroring the obesity epidemic. NAFLD has been reported to predict incident DM. This study aims to report the prevalence of NAFLD in healthy patients, and its relationship with markers of insulin resistance.
Methods: 387 healthy patients with no history of diabetes were included in the study. All patients underwent Fibroscan (Echosens) and euglycemic hyperinsulinemic clamp (EHC) to phenotype degree of insulin resistance. Patients who had no steatosis were then compared to those with steatosis or steatofibrosis. Data analysis was performed using R version 3.5.2
Results: Median age was 46(39-54) years and 154(39.8%) were males. Median BMI was 24.8(22-28) kg/m2. 198(51%) had no NAFLD, 165(42.6%) had hepatic steatosis and 34(6.2%) had steatofibrosis. More males, Malays and Indians had steatosis or steatofibrosis. There was stepwise increase in BMI, waist circumference, ALT, AST, GGT, uric acid (UA), hs-CRP and triglyceride (TG) from no steatosis, steatosis to steatofibrosis. Glucose disposal measured during EHC (M-value) decreased and acute insulin response (AIR) increased with increasing NAFLD severity (Table 1). On multivariate analysis, homeostatic model assessment for insulin resistance (HOMA-IR), HDL, TG and UA were independently associated with NAFLD (OR 1.55 95%CI 1.13-2.14, p=0.007; OR 0.29 95%CI 0.09-0.91, p=0.04; OR 2.03 95%CI 1.13-3.84, p=0.02; OR1.01 95%CI 1.00-1.01, p<0.001 respectively).
Conclusion: Almost half of our multi-ethnic cohort of healthy subjects has NAFLD and a higher proportion of Malays and Indians compared to Chinese had NAFLD. There was a stepwise increase in peripheral insulin resistance with increasing severity of NAFLD. HOMA-IR, HDL, TG and UA were independently associated with NAFLD.
Keywords: Fatty liver, Epidemiology, Multi-ethnic