Korean J Fam Pract.  2023 Dec;13(4):233-239. 10.21215/kjfp.2023.13.4.233.

Homeostatic Model Assessment of Insulin Resistance as a Potential Screening Test for NonAlcoholic Fatty Liver Disease in Korean Adults without Diabetes

• Lee H
• Lee JH

• KMID: 2549646
• DOI: http://doi.org/10.21215/kjfp.2023.13.4.233

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) prevalence rapidly increases worldwide and may lead to end-stage liver disease such as cirrhosis or hepatocellular carcinoma. This study aimed to examine the relationship between NAFLD and insulin resistance, evaluate the accuracy of homeostatic model assessment of insulin resistance (HOMA-IR) for NAFLD in Korean adults without diabetes as a screening tool, and estimate the optimal cut-off value for distinguishing NAFLD from non-NAFLD.
Methods
This cross-sectional study included 12,924 Korean adults aged ≥19 years who participated in the Korean National Health and Nutrition Examination Survey, 2019–2021. Subjects were categorized into two groups based on the hepatic steatosis index (≥30 or <30) as a simple screening tool for NAFLD. We used HOMA-IR as a method to measure insulin resistance. The receiver operating characteristic analysis determined the optimal cut-off value for identifying NAFLD. The association between NAFLD and HOMA-IR was examined using logistic regression analysis.
Results
The area under the curve of HOMA-IR to identify NAFLD was 76.3%. The optimal threshold of HOMA-IR for distinguishing NAFLD from nonNAFLD was 1.665. HOMA-IR cut-off was associated with NAFLD (odds ratio, 1.77; 95% confidence interval, 1.53–2.04; P<0.001), independent from general characteristics, triglyceride levels, and body mass index.
Conclusion
HOMA-IR is independently associated with NAFLD in adults without diabetes and could be used as a screening tool in clinical practice.

Keyword

Insulin Resistance; Korean Adults; Non-Alcoholic Fatty Liver Disease; Diabetes Mellitus