title: Association of nonalcoholic fatty liver disease with insulin resistance.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease is frequently associated with type 2 diabetes mellitus, obesity, and dyslipidemia, but some patients have normal glucose tolerance or normal weight. We tested the hypothesis that there is an association between nonalcoholic fatty liver disease and insulin resistance that is independent of diabetes and obesity.
  
  
  METHODS
  We measured anthropometric and metabolic variables in 46 patients with chronically elevated serum aminotransferase levels, "bright liver" on ultrasound scan, and normal glucose tolerance. Indexes of insulin resistance and secretion were determined using the homeostasis model assessment method. They were compared with 92 normal subjects who were matched for age and sex.
  
  
  RESULTS
  Patients with nonalcoholic fatty liver disease were characterized by fasting and glucose-induced hyperinsulinemia, insulin resistance, postload hypoglycemia, and hypertriglyceridemia. Insulin resistance [odds ratio (OR) = 15 per percent increase, 95% confidence interval (CI): 3.0 to 70], fasting triglyceride level (OR = 3.1 per mmol/liter increase, 95% CI: 1.1 to 8.9), 180-minute blood glucose level (OR = 4.3 per mmol/ liter decrease, 95% CI: 1.6 to 12), and average insulin concentration in response to oral glucose (OR = 3.0 per 100 pmol/liter increase, 95% CI: 1.5 to 6.2) were independently associated with nonalcoholic fatty liver disease. The exclusion of overweight and obese subjects did not change the results.
  
  
  CONCLUSIONS
  Nonalcoholic fatty liver disease is associated with insulin resistance and hyperinsulinemia even in lean subjects with normal glucose tolerance. Genetic factors that reduce insulin sensitivity and increase serum triglyceride levels may be responsible for its development.
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cattedra di Malattie del Metabolismo, Università di Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Marchesini
authors.forename: M
authors.initials: M
authors.lastname: Brizi
authors.forename: A M
authors.initials: AM
authors.lastname: Morselli-Labate
authors.forename: G
authors.initials: G
authors.lastname: Bianchi
authors.forename: E
authors.initials: E
authors.lastname: Bugianesi
authors.forename: A J
authors.initials: AJ
authors.lastname: McCullough
authors.forename: G
authors.initials: G
authors.lastname: Forlani
authors.forename: N
authors.initials: N
authors.lastname: Melchionda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016022:Case-Control Studies; D005234:Fatty Liver / Q000097:blood* / Q000150:complications* / Q000201:enzymology / Q000473:pathology; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio
chemical_list: D001786:Blood Glucose; D007328:Insulin