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

Gutierrez-Buey G (1), Núñez-Córdoba JM (2), Llavero-Valero M (1), Gargallo J (1), Salvador J (3), Escalada J (3).
(1) Clínica Universidad de Navarra, Department of Endocrinology and Nutrition, Avenida Pío XII, 31008 Pamplona, Spain.
(2) Clínica Universidad de Navarra, Research Support Service, Central Clinical Trials Unit, Avenida Pío XII, 31008 Pamplona, Spain. Electronic address: jnunezco@unav.es.
(3) 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. 

Revisão:European Journal of Internal Medicine

Data: 7/Mar/2017

Endocrinologia e Nutrição [ES]

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.

CITA DEL ARTÍCULO  Eur J Intern Med. 2017 Mar 7. pii: S0953-6205(17)30090-0. doi: 10.1016/j.ejim.2017.03.006

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