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Is HOMA-IR a potential screening test for non-alcoholic fatty liver disease in adults with type 2 diabetes?

  • Gala Gutierrez-Buey
    Affiliations
    Clínica Universidad de Navarra, Department of Endocrinology and Nutrition, Avenida Pío XII, 31008 Pamplona, Spain
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  • Jorge M. Núñez-Córdoba
    Correspondence
    Corresponding author.
    Affiliations
    Clínica Universidad de Navarra, Research Support Service, Central Clinical Trials Unit, Avenida Pío XII, 31008 Pamplona, Spain
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  • María Llavero-Valero
    Affiliations
    Clínica Universidad de Navarra, Department of Endocrinology and Nutrition, Avenida Pío XII, 31008 Pamplona, Spain
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  • Javier Gargallo
    Affiliations
    Clínica Universidad de Navarra, Department of Endocrinology and Nutrition, Avenida Pío XII, 31008 Pamplona, Spain
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  • Javier Salvador
    Affiliations
    Clínica Universidad de Navarra, Department of Endocrinology and Nutrition, Avenida Pío XII, 31008 Pamplona, Spain

    CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Diabetes & Metabolic Diseases Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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  • Javier Escalada
    Affiliations
    Clínica Universidad de Navarra, Department of Endocrinology and Nutrition, Avenida Pío XII, 31008 Pamplona, Spain

    CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Diabetes & Metabolic Diseases Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Published:March 07, 2017DOI:https://doi.org/10.1016/j.ejim.2017.03.006

      Highlights

      • NAFLD prevalence in T2DM adults was 73.2% (95% confidence interval: 59.7%–84.2%).
      • HOMA-IR was independently associated with NAFLD in adults with T2DM.
      • HOMA-IR showed a good capacity in discriminating NAFLD in adults with T2DM.

      Abstract

      Background

      Non-alcoholic fatty liver disease (NAFLD) is the commonest hepatic disease in many parts of the World, with particularly high prevalence in patients with type 2 diabetes (T2DM). However, a good screening test for NAFLD in T2DM has not been established. Insulin resistance (IR) has been associated with NAFLD, and homeostatic model assessment of insulin resistance (HOMA-IR), a good proxy for IR, may represent an affordable predictive test which could be easily applied in routine clinical practice. We aimed to evaluate the diagnostic accuracy of HOMA-IR for NAFLD in T2DM and sought to estimate an optimal cut-off value for discriminating NAFLD from non-NAFLD cases.

      Methods

      We conducted a retrospective analysis of 56 well-controlled patients with T2DM (HbAc1 < 7%, on oral anti-diabetic and/or glucagon-like peptide-1 agonist treatment), who had at least one glucose and insulin level determined, and at least one hepatic imaging test (ultrasonography or computed tomography scanning).

      Results

      The prevalence of NAFLD was 73.2% (95% CI: 59.7–84.2) in our population. An association between HOMA-IR and NAFLD was found (OR 1.5; 95% CI: 1.03–2.1; p = 0.033), independently of transaminases, fat percentage, BMI and triglyceride levels. The AUROC curve of HOMA-IR for identifying NAFLD was 80.7% (95% CI: 68.9–92.5). A value of HOMA-IR of 4.5 was estimated to be an optimal threshold for discriminating NAFLD from non-NAFLD cases.

      Conclusion

      HOMA-IR is independently associated with the presence of NAFLD in adults with T2DM, and might potentially be applied in clinical practice as a screen for this condition.

      Keywords

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