Abdominal subcutaneous fat thickness and homeostasis model assessment of insulin resistance as simple predictors of nonalcoholic steatohepatitis

Mona A Hegazy, Maysa A Samy, Afaf Tawfik, Mervat M Naguib, Ahmed Ezzat, Mervat E Behiry, Mona A Hegazy, Maysa A Samy, Afaf Tawfik, Mervat M Naguib, Ahmed Ezzat, Mervat E Behiry

Abstract

Background: Obesity, insulin resistance, and diabetes are major risk factors for nonalcoholic fatty liver disease (NAFLD). This study aims to evaluate the association between different grades of NAFLD and abdominal subcutaneous fat thickness with the homeostasis model assessment of insulin resistance (HOMA-IR). Methods: In this pilot study, 59 obese nondiabetic participants with NAFLD were enrolled. Total cholesterol, HbA1c, and HOMA-IR were measured. Abdominal subcutaneous fat thickness in the midline just below the xiphoid process in front of the left lobe of the liver (LSFT) and in the umbilical region (USFT), and the degree of hepatic steatosis, were evaluated by ultrasound scans, and their correlation with the degree of steatosis and the NAFLD Activity Score in liver biopsy was assessed. Results: Of the 59 studied participants, 15 had mild, 17 had moderate, and 27 had severe hepatic steatosis by abdominal ultrasound. The mean ± SD HOMA-IR level in NAFLD patients was 5.41±2.70. The severity of hepatic steatosis positively correlated with body mass index (P<0.001), HOMA-IR (P<0.001), serum triglycerides (P=0.001), LSFT (P<0.001), and USFT (P<0.001). Receiver operating characteristics analysis showed that LSFT at a cut-off of 3.45 cm is the most accurate predictor of severe hepatic steatosis, with 74.1% sensitivity and 84.4% specificity. The best cut-off of USFT for identifying severe hepatic steatosis is 4.55 cm, with 63% sensitivity and 81.3% specificity. Conclusion: Abdominal subcutaneous fat thicknesses in front of the left lobe of the liver and in the umbilical region, together with HOMA-IR, are reliable indicators of the severity of NAFLD in obese nondiabetic individuals.

Keywords: abdominal subcutaneous fat thickness; hepatic steatosis; insulin resistance; obesity.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
ROC curves for detection of severe grade of nonalcoholic fatty liver disease. Abbreviations: ROC, receiver operating characteristics; HOMA, homeostasis model assessment; USFT, paraumbilical abdominal subcutaneous fat thickness; LSFT, midline abdominal subcutaneous fat thickness in front of the liver.
Figure 2
Figure 2
ROC curves for detection of moderate grade of nonalcoholic fatty liver disease. Abbreviations: ROC, receiver operating characteristics; HOMA, homeostasis model assessment; USFT, paraumbilical abdominal subcutaneous fat thickness; LSFT, midline abdominal subcutaneous fat thickness in front of the liver.

References

    1. The GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27. doi:10.1056/NEJMoa1614362
    1. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer — viewpoint of the IARC working group. N Engl J Med. 2016;375:794–798. doi:10.1056/NEJMsr1606602
    1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–1231. doi:10.1056/NEJMra011775
    1. Jessica B, Michele D, Brent AN, et al. Clinical model for NASH and advanced fibrosis in adult patients with diabetes and NAFLD: guidelines for referral in NAFLD. Diabetes Care. 2015;38:1347–1355. doi:10.2337/dc14-1239
    1. Petäjä EM, Yki-Järvinen H. Definitions of normal liver fat and the association of insulin sensitivity with acquired and genetic NAFLD-a systematic review. Int J Mol Sci. 2016;17:E633. doi:10.3390/ijms17050633
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. doi:10.1002/hep.28431
    1. Kahal H, Abouda G, Rigby AS, Coady AM, Kilpatrick ES, Atkin SL. Glucagon-like peptide-1 analogue, liraglutide, improves liver fibrosis markers in obese women with polycystic ovary syndrome and nonalcoholic fatty liver disease. Clin Endocrinol (Oxf). 2014;81:523–528. doi:10.1111/cen.12369
    1. Bayard M, Holt J, Boroughs E. Nonalcoholic fatty liver disease. Am Fam Physician. 2006;73:1961–1968.
    1. Bohte AE, van Werven JR, Bipat S, Stoker J. The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol. 2011;21:87–97. doi:10.1007/s00330-010-1905-5
    1. Ducluzeau PH, Manchec-Poilblanc PM, Roullier V, et al. Distribution of abdominal adipose tissue as a predictor of hepatic steatosis assessed by MRI. Clin Radiol. 2010;65:695–700. doi:10.1016/j.crad.2010.03.013
    1. Alkassabany YM, Farghaly AG, El-Ghitany E. Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria, Egypt. Arab J Gastroenterol. 2014;15(2). doi:10.1016/j.ajg.2014.05.002
    1. Zaki M, Ezzat W, Elhosary Y, Saleh O. Predictors of non-alcoholic fatty liver disease in Egyptian obese adolescents. Int Scholarly Sci Res Innovation. 2014;8(9):657–660.
    1. World Medical Association. World Medical Association Declaration of Helsinki ethical principles for medical research involving human subjects. Jama. 2013;310:2191–2194. doi:10.1001/jama.2013.281053
    1. Mottin CC, Moretto M, Padoin AV, et al. The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg. 2004;14:635–637. doi:10.1381/096089204323093408
    1. Rumack CM. Diagnostic ultrasound In: Rumack CM, editor. General Adult Ultrasound St Louis: Mosby; 1998;110–112.
    1. Hegazy M, Mostafa A. Liver ultrasound scanning in the detection of hepatic steatosis and fibrosis in NASH patients. Egypt J Intern Med. 2012;24:27–31.
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. doi:10.1002/hep.28431
    1. Hegazy M, Abdel Samie R, Ezzat A, Ramadan N, Rashed L, ElSayed A. PNPLA3 and TNF-α G238A genetic polymorphisms in Egyptian patients with different grades of severity of NAFLD. OJGas. 2016;6:53–64. doi:10.4236/ojgas.2016.63008
    1. Holterman AX, Guzman G, Fantuzzi G, et al. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity (Silver Spring). 2013;21:591–597. doi:10.1002/oby.20174
    1. Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutr Today. 2015;50:117–128. doi:10.1097/NT.0000000000000092
    1. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738. doi:10.1210/edrv.21.6.0415
    1. Yano K, Hosokawa K, Nakai K, Kubo T, Matsuo Y. Regional differences in ultrasonic assessment of subcutaneous fat thickness in the abdomen: effects on the TRAM flap. Ann Plast Surg. 2003;51:130–135. doi:10.1097/01.SAP.0000058503.46432.96
    1. Gaba RC, Knuttinen MG, Brodsky TR, et al. Hepatic steatosis: correlations of body mass index, CT fat measurements, and liver density with biopsy results. Diagn Interv Radiol. 2012;18:282–287. doi:10.4261/1305-3825.DIR.4958-11.2
    1. Lee SH, Kim D, Baek MY, et al. Abdominal subcutaneous fat thickness measured by ultrasonography correlates with hyperlipidemia and steatohepatitis in obese children. Pediatr Gastroenterol Hepatol Nutr. 2015;18:108–114. doi:10.5223/pghn.2015.18.2.108
    1. Parente DB, Oliveira N, Brasil P, et al. Preperitoneal fat as a non-invasive marker of increased risk of severe non-alcoholic fatty liver disease in patients with type 2 diabetes. J Gastroenterol Hepatol. 2018;33(2):511–517. doi:10.1111/jgh.13903
    1. van der Poorten D, Milner KL, Hui J, et al. Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology. 2008;48:449–457. doi:10.1002/hep.v48:2
    1. Fukuda K, Seki Y, Ichihi M, et al. Usefulness of ultrasonographic estimation of preperitoneal and subcutaneous fat thickness in the diagnosis of nonalcoholic fatty liver disease in diabetic patients. J Med Ultrason. 2015;42:357–363. doi:10.1007/s10396-015-0615-7
    1. Rader DJ. Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus. Am J Med. 2007;120:S12–S18. doi:10.1016/j.amjmed.2007.01.003
    1. Geloneze B, Repetto EM, Geloneze SR, Tambascia MA, Ermetice MN. The threshold value for insulin resistance (HOMA-IR) in an admixture population. IR in the Brazilian metabolic syndrome study. Diabetes Res Clin Pract. 2006;13:219–220. doi:10.1016/j.diabres.2005.10.017
    1. Summer AE, Cowie CC. Ethnic differences in the ability of triglyceride levels to identify insulin resistance. Atherosclerosis. 2008;13:696–703. doi:10.1016/j.atherosclerosis.2006.12.018
    1. Hegazy M, Abdel-Rahman M, El-Gayar Dina AH. Liver ultrasound is more sensitive in assessing the severity of nonalcoholic fatty liver disease with homeostasis model assessment-insulin resistance. Eglj. 2012;12:41–46.
    1. Isaksen VT, Larsen MA, Goll R, Florholmen JR, Paulssen EJ. Hepatic steatosis, detected by hepatorenal index in ultrasonography, as a predictor of insulin resistance in obese subjects. BMC Obes. 2016;20(3):39. doi:10.1186/s40608-016-0118-0
    1. De Barros F, Setúbal S, Martinho JM, Ferraz L, Gaudêncio A. Correlation of non-alcoholic fatty liver disease and features of metabolic syndrome in morbidly obese patients in the preoperative assessment for bariatric surgery. Arq Bras Cir Dig. 2016;29:260–263. doi:10.1590/0102-6720201600040011
    1. Souza MR, Diniz Mde F, Medeiros-Filho JE, Araújo MS. Metabolic syndrome and risk factors for non-alcoholic fatty liver disease. Arq Gastroenterol. 2012;49:89–96. doi:10.1590/S0004-28032012000100015
    1. Gupte P, Amarapurkar D, Agal S, et al. Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19:854–858. doi:10.1111/jgh.2004.19.issue-8
    1. Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15:310–315. doi:10.1381/0960892053576820

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