Association between Fatty Liver Disease and Hyperinsulinemia

Abstract

As mentioned before the liver is the primary site of insulin clearance. The majority (80%) of endogenously secreted insulin is cleared by the liver, 15% by the kidney, and 5% by muscle.

In advanced liver disease, insulin clearance is decreased, which is considered to be one of the main causes of hyperinsulinemia in liver cirrhosis.

Fatty Liver Disease is associated with impaired insulin action to suppress hepatic glucose production when measured directly in both nondiabetic subjects and type 2 diabetic patients & Fatty Liver Disease is closely correlated with fasting serum insulin concentrations but the extent to which impaired insulin clearance due to hepatic fat accumulation contributes to hyperinsulinemia has not previously been determined.

Our study aimed at studying the relationship between fatty liver disease and insulin resistance, evaluate factors that affect insulin resistance e.g. waist circumference, body fat according to skin folds and BMI.

The study included 60 patients suffering from nonalcoholic fatty liver divided into two equal groups diabetic and non diabetic. They were recruited from the out patients clinic in Ain shams university hospital; in the period between June 2013 to Dec. 2013.

All patients were subjected to:

• Full history taking. • General examination and calculation of body mass index (BMI), Waist circumference, Skin fold thickness • Abdominal ultrasound. • Laboratory investigations including:

a) Liver function tests b) Complete blood count (CBC). c) Fasting blood glucose (FBS): (Blood sample taken 8 hours after fasting) in mg/dl then convert to mmol/l . d) Two hours post prandial blood glucose. e) Lipid profile including: (Blood sample taken 12 hours after fasting): Triglyceride, total cholesterol & low density lipoprotein (LDL), high density lipoprotein (HDL). f) Serological markers to exclude chronic viral hepatitis (HBs Ag, HCV Ab). g) Laboratory investigations for evaluation of insulin resistance: 1- C peptide 2- Serum Insulin level 3- HbA1c. 4- Insulin resistance equation determined via the homeostasis model assessment (HOMA-IR)

The results of our study were as follow:

All patients with nonalcoholic fatty liver disease in our study (group I and group II) showed insulin resistance.

HOMA IR increased with increasing body weight in both groups while was directly correlated with body fat according to skin fold thickness only in group one.

Also C-peptide increased with increasing body fat according to skin fold thickness in both groups.

On the other hand we found that dyslipidemia was directly proportionate to waist circumference in group one and there was direct correlation between dyslipidemia and insulin resistance in group two.

BMI was directly correlated to body fat according to skin folds, fasting insulin and fasting glucose in both groups.

Waist circumference was directly correlated with body fat according to skin folds in both groups, while inversely correlated with HDL only in group one.

Also sum of skin folds was directly correlated with body weight, fasting glucose, fasting insulin, LDL, and Total cholesterol in both groups.