Hepatic steatosis and insulin resistance: does etiology make a difference?
OBJECTIVE
To ascertain whether the etiology of hepatic steatosis modulates insulin resistance (IR) and to determine the predictors of IR.


METHODS
We studied IR through HOMA IR in 146 subjects, 99 of whom had ultrasonographic and/or histologic steatosis. Twenty-two had familial heterozygous hypobetalipoproteinemia (FHBL), 48 had non-alcoholic fatty liver disease (NAFLD), 34 HCV infection (17 with HCV1b, 17 with HCV3a) and 42 were healthy controls without steatosis.


RESULTS
Steatosis was present in 77.3% of FHBL and, by enrolment criteria, in all NAFLD and HCV cases. Overall HOMA-IR correlated with BMI and GGT (P<0.01). FHBL and healthy groups had similar HOMA-IR and GGT values, whereas higher levels were observed in HCV and NAFLD. HCV3a and FHBL patients were hypolipidemic. HOMA-IR was similar in FHBL patients and controls and lower than in HCV and NAFLD. FHBL patients had a high extent of steatosis, similar to that observed in HCV3a, but lower grading and staging than NAFLD and HCV. At multivariate analysis, steatosis and GGT predicted HOMA-IR.


CONCLUSIONS
Data suggest that not all hepatic fat associates with IR. FHBL patients, for some aspects, resemble HCV3a infection, possibly suggesting a shared steatogenic mechanism. Among steatotic patients serum GGT levels is the independent predictor of IR.
Lonardo
Amedeo
A
Unità Operativa di Medicina Interna e Gastroenterologia, Nuovo Ospedale Civile-Estense, Via Giardini, Baggiovara, Modena 41100, Italy. a.lonardo@libero.it
Lombardini
Silvia
S
Scaglioni
Federica
F
Carulli
Lucia
L
Ricchi
Matteo
M
Ganazzi
Dorval
D
Adinolfi
Luigi Elio
LE
Ruggiero
Giuseppe
G
Carulli
Nicola
N
Loria
Paola
P
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001786:Blood Glucose / Q000378:metabolism; D018450:Disease Progression; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000378:metabolism; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications / Q000378:metabolism; D007333:Insulin Resistance; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D005723:gamma-Glutamyltransferase