Insulin Resistance: The Hidden Threat.
We often hear from patients that their doctors have suggested that they curb their alcohol use because they have a fatty liver; the response from the patient is then, "I don't even drink that much". Well, what if I told you that it was instead those carbs you eat, those "healthy" rice cakes, that "low fat" dressing, those plant based energy bars, fruit yogurt. . . the list goes on and on!
In the ever-evolving world of medical research, the interconnectedness of various health issues often comes to light. One such connection recently highlighted is the relationship between insulin resistance (IR) and Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD). This link is not only a point of intrigue for many healthcare professionals but also opens doors to potential early intervention and preventive strategies.
The Fundamental Role of Insulin Resistance
Insulin resistance is essentially when the body's cells become resistant to the effects of insulin, leading to higher levels of insulin in the blood. Insulin is pivotal in regulating glucose, and an imbalance can pave the way for a host of complications. Giovanni Petralli and his team of researchers dived deep into this aspect, focusing on the part IR plays in the progression of MAFLD.
MAFLD, for those who may not be aware, is a condition where fat accumulates in the liver, which can, in the long run, result in liver fibrosis - a potentially life-threatening situation.
The Study in Detail
Petralli's team conducted a retrospective observational study, which involved a close analysis of 346 non-diabetic, overweight, or obese individuals diagnosed with MAFLD. With an average age of around 50, this group underwent various assessments, from Fibroscan® measurements to biochemical data collections. The aim? To comprehend how different IR scores related to the severity of their MAFLD.
Three IR scores were in focus:
Homoeostasis Model Assessment - Insulin Resistance Index (HOMA-IR)
Triglyceride-Glucose Index
Triglyceride by HDL ratio
Interestingly, all these scores had associations with the Controlled Attenuation Parameter (CAP), which assesses liver steatosis. However, the most profound correlation was found between HOMA-IR and liver stiffness (LS), which is a marker of liver fibrosis. This association remained consistent, regardless of factors like age, sex, BMI, and fibrosis markers.
The Key Findings
One of the standout discoveries was the heightened risk in insulin-resistant individuals. Those with a HOMA-IR score greater than 2.5 (almost half the study group) displayed a four-fold increase in the risk of severe liver disease.
Diving deeper, fasting plasma insulin (FPI) emerged as a significant component of the HOMA-IR score. It was independently related to LS, suggesting that hyperinsulinemia, or excessive levels of insulin in the blood, is a major culprit, irrespective of one's BMI.
So, What Does This Mean?
Simply put, measuring insulin levels could be a game-changer for MAFLD individuals. Not only does it provide a deeper understanding of their condition, but it can be instrumental in identifying those on the brink of liver fibrosis.
Diabetes Metab Res Rev . 2023 Oct 15:e3736. doi: 10.1002/dmrr.3736. Online ahead of print
In a world where preventive strategies are proving more effective than cures, understanding the role of insulin resistance in the prognosis of MAFLD is paramount. This groundbreaking research is a testament to the continuous efforts of the medical community to understand, predict, and, hopefully, prevent some of today's most pressing health challenges. Have you ever even heard your doctor say, your HOMA score is X! We have to act now, and we can fix this; well, we do. . . .Jason & Rita...aka Dr. De Leon and Dr. Gillespie.
