Relationship Between Insulin Resistance and Hepatic Steatosis in Non-Obese Adults With Type 2 Diabetes
DOI:
https://doi.org/10.61336/jdme.0402.04Keywords:
Type 2 diabetes mellitus, insulin resistance, hepatic steatosisAbstract
Hepatic steatosis is increasingly recognized in individuals with type 2 diabetes mellitus (T2DM) even in the absence of generalized obesity, but the relationship between hepatic fat accumulation and insulin resistance in non-obese adults remains incompletely characterized. This study evaluated the association between insulin resistance and hepatic steatosis in non-obese adults with T2DM. A cross-sectional metabolic imaging study was conducted among 172 adults with T2DM and body mass index below 30 kg/m². Hepatic steatosis was quantified using controlled attenuation parameter assessment combined with transient elastography, while insulin resistance was estimated using fasting insulin, fasting glucose, and HOMA-IR. Anthropometric measurements, HbA1c, lipid profile, liver enzymes, uric acid, high-sensitivity C-reactive protein, and serum adiponectin were also assessed. Participants with hepatic steatosis had significantly higher fasting insulin, HOMA-IR, triglycerides, alanine aminotransferase, and hs-CRP concentrations and lower adiponectin concentrations than participants without hepatic steatosis. Hepatic fat accumulation demonstrated a positive correlation with HOMA-IR, waist circumference, triglyceride-to-HDL cholesterol ratio, and ALT. After adjustment for age, sex, BMI, diabetes duration, physical activity, and lipid parameters, HOMA-IR remained independently associated with hepatic steatosis severity. Participants in the highest HOMA-IR tertile had approximately 3.4-fold greater odds of hepatic steatosis compared with those in the lowest tertile. The association remained significant after additional adjustment for waist circumference and HbA1c. These findings indicate that insulin resistance may be an important metabolic determinant of hepatic steatosis even among adults with T2DM who do not meet conventional criteria for obesity.
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