title: Nonalcoholic Fatty liver disease is associated with increased carotid intima-media thickness only in type 2 diabetic subjects with insulin resistance.
abstract: BACKGROUND
  The association between nonalcoholic fatty liver disease (NAFLD) and subclinical atherosclerosis in type 2 diabetes is controversial.
  
  
  OBJECTIVE
  The objective of the study was to investigate the participation of insulin resistance in the association of NAFLD and the carotid atherosclerotic burden in a large cohort of patients with type 2 diabetes.
  
  
  METHODS
  This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes.
  
  
  METHODS
  Hepatic steatosis and mean carotid intima-media thickness (C-IMT) were measured using ultrasonography. Insulin resistance was assessed using the short insulin tolerance test.
  
  
  RESULTS
  The prevalence of NAFLD was 72.7% in the whole study population. Among subjects with NAFLD, 23.2% were not insulin resistant. There were significant differences in C-IMT and the frequency of carotid atherosclerosis between groups classified by insulin resistance within the same NAFLD strata. C-IMT was highest in subjects with both NAFLD and insulin resistance [0.844 ± 0.004 (mean ± SE) mm vs 0.786 ± 0.008, 0.821 ± 0.007, and 0.807 ± 0.006 mm, P for trend <.001, respectively, in insulin sensitive subjects without NAFLD, insulin resistant subjects without NAFLD, and insulin sensitive subjects with NAFLD]. These differences remained after adjusting for potential confounders. However, C-IMT in subjects having only NAFLD or insulin resistance was not higher than that in those with neither NAFLD nor insulin resistance.
  
  
  CONCLUSIONS
  NAFLD is very common in subjects with type 2 diabetes, but NAFLD not accompanied by insulin resistance is not associated with a carotid atherosclerotic burden. However, having both NAFLD and insulin resistance seemed to be an independent predictor of increased C-IMT.
authors: Department of Internal Medicine (S.-K.K., S.W.P., Y.-W.C.), CHA Bundang Medical Center, CHA University, Seongnam 463-712, Korea; Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute (Y.J.C., B.W.H., K.B.H.), Seoul 121-806, Korea; and Department of Internal Medicine (E.J.L.), Yonsei University College of Medicine, Seoul 120-749, Korea.
authors: Soo-Kyung
authors: SK
authors: Kim
authors: Young Ju
authors: YJ
authors: Choi
authors: Byung Wook
authors: BW
authors: Huh
authors: Seok Won
authors: SW
authors: Park
authors: Eun Jig
authors: EJ
authors: Lee
authors: Yong-Wook
authors: YW
authors: Cho
authors: Kap Bum
authors: KB
authors: Huh
mesh_terms: D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012307:Risk Factors