title: Liver steatosis is associated with insulin resistance in skeletal muscle rather than in the liver in Japanese patients with non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  To examine the association between liver histological features and organ-specific insulin resistance indices calculated from 75-g oral glucose tolerance test data in patients with non-alcoholic fatty liver disease.
  
  
  METHODS
  Liver biopsy specimens were obtained from 72 patients with non-alcoholic fatty liver disease, and were scored for steatosis, grade and stage. Hepatic and skeletal muscle insulin resistance indices (hepatic insulin resistance index and Matsuda index, respectively) were calculated from 75-g oral glucose tolerance test data, and metabolic clearance rate was measured using the euglycemic hyperinsulinemic clamp method.
  
  
  RESULTS
  The degree of hepatic steatosis, and grade and stage of non-alcoholic steatohepatitis were significantly correlated with Matsuda index (steatosis r = -0.45, P < 0.001; grade r = -0.54, P < 0.001; stage r = -0.37, P < 0.01), but not with hepatic insulin resistance index. Multiple regression analyses adjusted for age, sex, body mass index and each histological score showed that the degree of hepatic steatosis (coefficient = -0.22, P < 0.05) and grade (coefficient = -0.40, P < 0.01) were associated with Matsuda index, whereas the association between stage and Matsuda index (coefficient = -0.07, P = 0.593) was no longer significant. A similar trend was observed for the association between steatosis and metabolic clearance rate (coefficient = -0.62, P = 0.059).
  
  
  CONCLUSIONS
  Liver steatosis is associated with insulin resistance in skeletal muscle rather than in the liver in patients with non-alcoholic fatty liver disease, suggesting a central role of fatty liver in the development of peripheral insulin resistance and the existence of a network between the liver and skeletal muscle.
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Ken-Ichiro
authors: K
authors: Kato
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Yumie
authors: Y
authors: Takeshita
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan ; Department of Comprehensive Metabology, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Hirofumi
authors: H
authors: Misu
authors: Department of Diagnostic Pathology, Kobe University Graduate School of Medicine Kobe, Japan.
authors: Yoh
authors: Y
authors: Zen
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Shuichi
authors: S
authors: Kaneko
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan ; Department of Comprehensive Metabology, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Toshinari
authors: T
authors: Takamura
keywords: Hepatic and muscle insulin resistance; Liver steatosis; Non-alcoholic fatty liver disease