Endocrinol Metab.  2022 Jun;37(3):455-465. 10.3803/EnM.2022.1434.

The Impact of Insulin Resistance on Hepatic Fibrosis among United States Adults with Non-Alcoholic Fatty Liver Disease: NHANES 2017 to 2018

• Bae JC
• Beste LA
• Utzschneider KM

• KMID: 2531389
• DOI: http://doi.org/10.3803/EnM.2022.1434

Abstract

Background
We aimed to investigate the association of hepatic steatosis with liver fibrosis and to assess the interactive effects of hepatic steatosis and insulin resistance on liver fibrosis in a nationally representative sample of United States adults.
Methods
We conducted a cross-sectional analysis using data from National Health and Nutrition Examination Survey 2017 to 2018, which for the first time included transient elastography to assess liver stiffness and hepatic steatosis. We evaluated the association between hepatic steatosis (using controlled attenuation parameter [CAP]) and clinically significant liver fibrosis (defined as liver stiffness ≥7.5 kPa) using logistic regression with an interaction term for hepatic steatosis and insulin resistance (defined as homeostatic model assessment of insulin resistance ≥3.0).
Results
Among adults undergoing transient elastography (n=2,023), 45.9% had moderate or greater hepatic steatosis and 11.3% had clinically significant liver fibrosis. After adjustment for demographic and metabolic factors, the odds of significant liver fibrosis increased as CAP score rose (odds ratio, 1.35 per standard deviation increment; 95% confidence interval, 1.11 to 1.64). We detected a significant interaction effect between CAP score and insulin resistance on the probability of significant liver fibrosis (P=0.016 for interaction). The probability of significant liver fibrosis increased in the presence of insulin resistance with increasing CAP score, while those without insulin resistance had low probability of significant liver fibrosis, even with high CAP scores.
Conclusion
Individuals with hepatic steatosis had higher odds of fibrosis when insulin resistance was present. Our findings emphasize the importance of the metabolic aspects of the disease on fibrosis risk and suggest a need to better identify patients with metabolic associated fatty liver disease.

Keyword

Non-alcoholic fatty liver disease; Insulin resistance; Fibrosis; Elasticity imaging techniques

Figure

• 

  Fig. 1. Flow diagram of participants for the study (National Health and Nutrition Examination Survey [NHANES] 2017 to 2018).

• 

  Fig. 2. Relationship of controlled attenuation parameter (CAP) score and homeostatic model assessment of insulin resistance (HOMA-IR) with liver stiffness measurement (LSM) and liver fibrosis. Simple correlation of LSM with (A) CAP score and (B) HOMA-IR. (C) Restricted cubic spline model of association between CAP score and odds ratio (OR) of clinically significant liver fibrosis (LSM ≥7.5 kPa). (D) Restricted cubic spline model of HOMA-IR with OR of clinically significant liver fibrosis (LSM ≥7.5 kPa). CI, confidence interval.

• 

  Fig. 3. The interaction effects between controlled attenuation parameter (CAP) score and insulin resistance on liver stiffness (A, B) and the probability of having clinically significant liver fibrosis (liver stiffness measurement [LSM] ≥7.5 kPa) (C, D). All participants (n>=2,023) for (A) and (C). Without diabetes (n>=1,642) for (B) and (D). Adjusted for age, sex, race/ethnicity, and lipid-lowering medication. HOMAIR, homeostatic model assessment of insulin resistance; CI, confidence interval.

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