Nonalcoholic fatty liver disease is associated with increased carotid intima-media thickness only in type 2 diabetic subjects with insulin resistance

Soo Kyung Kim, Young Ju Choi, Byung Wook Huh, Seok Won Park, Eunjig Lee, Yong Wook Cho, Kap Bum Huh

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Context: 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. Design, Setting, and Patients: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. Main Outcomes Measures: 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 atherosclerosisbetweengroups classified by insulin resistance within thesame 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, andinsulin 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.

Original languageEnglish
Pages (from-to)1879-1884
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number5
DOIs
Publication statusPublished - 2014 Jan 1

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Carotid Intima-Media Thickness
Liver
Insulin Resistance
Insulin
Medical problems
Type 2 Diabetes Mellitus
Disease Resistance
Non-alcoholic Fatty Liver Disease
Ultrasonography
Observational Studies

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Kim, Soo Kyung ; Choi, Young Ju ; Huh, Byung Wook ; Park, Seok Won ; Lee, Eunjig ; Cho, Yong Wook ; Huh, Kap Bum. / Nonalcoholic fatty liver disease is associated with increased carotid intima-media thickness only in type 2 diabetic subjects with insulin resistance. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 5. pp. 1879-1884.
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abstract = "Context: 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. Design, Setting, and Patients: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. Main Outcomes Measures: 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 atherosclerosisbetweengroups classified by insulin resistance within thesame 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, andinsulin 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.",
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Nonalcoholic fatty liver disease is associated with increased carotid intima-media thickness only in type 2 diabetic subjects with insulin resistance. / Kim, Soo Kyung; Choi, Young Ju; Huh, Byung Wook; Park, Seok Won; Lee, Eunjig; Cho, Yong Wook; Huh, Kap Bum.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 5, 01.01.2014, p. 1879-1884.

Research output: Contribution to journalArticle

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AU - Kim, Soo Kyung

AU - Choi, Young Ju

AU - Huh, Byung Wook

AU - Park, Seok Won

AU - Lee, Eunjig

AU - Cho, Yong Wook

AU - Huh, Kap Bum

PY - 2014/1/1

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N2 - Context: 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. Design, Setting, and Patients: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. Main Outcomes Measures: 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 atherosclerosisbetweengroups classified by insulin resistance within thesame 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, andinsulin 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.

AB - Context: 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. Design, Setting, and Patients: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. Main Outcomes Measures: 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 atherosclerosisbetweengroups classified by insulin resistance within thesame 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, andinsulin 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.

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