Understand the risk factors associated with non alcoholic fatty liver disease and changes in biochemical parameters in the patients: a prospective study

Background: The true prevalence of both NAFLD and NASH are elusive but estimates based on imaging and autopsy studies suggest that about 20-30% of the adults in United States and western countries have excess fat accumulation in the liver. About 10% of these, strictly speaking about 2-3% of the adult population fulfils the criteria of NASH. True prevalence of NAFLD in Indian patients is not known. So, this study was planned to look for current trend of NAFLD in Indian patients.Methods: This prospective observational study was conducted in the Department of Medicine on 65 patients with ultra-sonography finding of fatty liver disease with no history of alcohol, in one year study duration.Results: It is observed that maximum patients are of middle age from age 31-60 years comprising 76% of patients. Out of total patients, 34% and 66% were males and females respectively. Out of 65 patients, 45(69%) had obesity and maximum number of the patients had waist hip ratio and neck circumference more than the cut off value. Out of 65 patients, 19(29%) had hypercholesterolemia and 42(65%) had hyper-triglyceridemia. Out of 65 patients, 32(49%) had higher alanine transaminase (ALT) level and 17(29%) patients had higher AST level. Out of 65 patients, 29(45%) had the homeostasis model assessment of insulin resistance (HOMA-IR) less than cut off value (less than 2.25) and remaining 36(55%) were having HOMA-IR more than 2.25. The sensitivity for the cut off value for HOMA-IR is 72.7% and specificity is 49.1%.Conclusions: Obesity, neck circumference, and waist hip ratio are higher than its cut off value for both sex, insulin resistance evaluated through HOMA- IR directly relates to the causation of NAFLD but at some extents higher triglyceride levels are also associated but the values of ALT and AST levels did not give any clue in these cases of NAFLD.

The Association between High Sensitivity C-Reactive Protein and Homeostasis Model Assessment of Insulin Resistance in Non-Diabetetic Korean Men

BACKGROUND: Insulin resistance syndrome is recognized as a risk factor for cardiovascular disease (CVD) and type 2 diabetes mellitus (DM). Even though early management and prevention during the pre-DM stage is emphasized, few studies have investigated the risk of insulin resistance and CVD in individuals with normal blood glucose. This study investigates the effectiveness of the high sensitivity C-reactive protein (hs-CRP) test as a preventative measure by examining the relationship between hs-CRP and a homeostasis model assessment of insulin resistance (HOMA-IR) in adult men without DM.METHODS: Our study included 1,924 men who were ≥20 years of age, from the 2015 Korean National Health and Nutrition Examination Survey. Based on fasting glucose levels, subjects were divided into two categories: normal and impaired fasting glucose (IFG).RESULTS: Student's t-test was used to compare the means of the normal and IFG categories, and hs-CRP and HOMA-IR showed significantly lower values for all variations, except height and smoking, at a significance level of 0.001. All subjects were classified into quadrant groups according to hs-CRP values, and ANCOVA was performed to compare the HOMA-IR average of each group. The mean IR did not significantly differ between cohorts, except for in the IFG category of one group.CONCLUSION: In adult men without DM, hs-CRP did not significantly correlate with HOMA-IR, except in the IFG category. This indicates that the risk of CVD increases continuously in the normal blood sugar range. Further studies are needed to improve the usefulness of the high sensitivity hs-CRP test.

Diagnostic value of glycosylated hemoglobin combined with homeostasis model assessment of insulin resistance in obese children with prediabetes / 中华实用儿科临床杂志

Objective To study the diagnostic value of glycosylated hemoglobin(HbA1c)combined with ho-meostasis model assessment of insulin resistance( HOMA-IR)in obese children with prediabetes. Methods Five hundred and ninety-five obese children diagnosed at Outpatient Department of Pediatrics,Tianjin Medical University General Hospital were enrolled in the study from October 2012 to March 2016. Oral glucose tolerance test(OGTT)and HbA1c test were performed after fasting 8 to 10 hours for all the subjects. According to the World Health Organization (WHO)criteria,the obese children were divided into non-prediabetes group(483 cases)and prediabetes group(112 cases). The levels of HOMA-IR and HbA1c were compared between 2 groups. The receiver operating characteristic (ROC)curve was drawn for screening prediabetes,and the diagnosis value of area under curve( AUC)and different cutoff value were calculated. Logistic regression model was used to analyze the combined diagnosis of prediabetic AUC with preserved probability as a single variable and ROC curve. Z test was used to compare the statistical differences of each AUC. Results The levels of HbA1c and HOMA-IR of the prediabetes obese children group[(5. 65 ± 0. 36)%and 11. 60 ± 8. 86]were all higher than those of the non-prediabetes obese children group[(5. 47 ± 0. 32)% and 6. 49 ± 4. 61],and there were significant differences between 2 groups(all P<0. 01). The AUC of HbA1c ROC for prediabetes was 0. 633. When the cutoff was 5. 585%,the sensitivity and specificity were 0. 584 and 0. 601,respective-ly. The AUC of HOMA-IR ROC for prediabetes was 0. 758. When the cutoff was 7. 244,the sensitivity and specificity were 0. 779 and 0. 669,respectively. When combined with HOMA-IR and HbA1c,the AUC was 0. 764. Compared with HbA1c,there were significant differences in AUC of ROC curve between HOMA-IR alone or HOMA-IR com-bined with HbA1c in the diagnosis of prediabetes mellitus(all P<0. 01). There was no significant difference in AUC of ROC curve between HOMA-IR alone and HOMA-IR combined with HbA1c in the diagnosis of prediabetes melli-tus(P>0. 05). Conclusions Only HOMA-IR or HOMA-IR combined with HbA1c may be the optimal indexes for diagnosing obese children with prediabetes.

Correlation of insulin resistance with male reproductive hormone levels and semen parameters / 中华男科学杂志

<p><b>Objective</b>To investigate the influence of insulin resistance on male reproductive hormones and semen quality.</p><p><b>METHODS</b>Using the electrochemiluminescence method, we measured the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2) and testosterone (T) in the serum of 83 infertile males. We detected the levels of fasting plasma glucose (FPG) and fasting insulin (FINS) and calculated the insulin resistance index presented as homeostasis model assessment of insulin resistance (HOMA-IR). Based on HOMA-IR, we divided the patients into three tertile groups, T1 (HOMA-IR 0.36－0.55, n = 27), T2 (HOMA-IR 0.56－0.80, n = 28) and T3 (HOMA-IR 0.81－1.97, n = 28), obtained their semen parameters by computer-assisted semen analysis (CASA) and analyzed the correlation of HOMA-IR with male reproductive hormone levels and semen parameters.</p><p><b>RESULTS</b>With the elevation of HOMA-IR, the patients of the T1, T2 and T3 groups showed significant decreases in the serum T level (［14,26 ± 4.27］ vs ［14.75 ± 5.00］ vs ［11.62 ± 3.68］ nmol/L, P <0.05) and the percentage of progressively motile sperm (PMS) (［51.04 ± 15.10］% vs ［48.04 ± 16.24］% vs ［37.84 ± 18.23］%, P <0.05). HOMA-IR was correlated negatively with the serum T level (r = －0.333, P = 0.002), semen volume (r = －0.23, P = 0.029) and PMS (r = －0.27, P = 0.015), and so was FINS with the serum T level (r = －0.327, P = 0.003) and PMS (r = －0.315, P = 0.004), while the semen volume was correlated positively with the levels of serum T (r = 0.221, P = 0.048) and FSH (r = 0.222, P = 0.047). Multivariate linear regression analysis showed that HOMA-IR was an independent influencing factor for PMS and the body mass index (BMI) was that for the semen volume and total sperm count.</p><p><b>CONCLUSIONS</b>Insulin resistance may reduce semen quality by changing the levels of male reproductive hormones.</p>

The Effect of Pravastatin on Insulin Resistance in Hyperglycemic Patients / 임상당뇨병

BACKGROUND: The effect of pravastatin on insulin resistance (IR) is controversial and poorly studied in prediabetes. METHODS: This study was performed in hyperglycemic patients at Saint Carollo Hospital from January 1, 2013 to December 31, 2015. Among them, we selected 40 patients (24 prediabetes and 16 new onset diabetes [NOD]) who had been treated with pravastatin 20 mg daily for 2 or 4 months and in whom fasting insulin and fasting glucose had been measured before and after administration of pravastatin. IR was defined as a fasting insulin level ≥ 12.94 µU/mL, homeostasis model for IR (HOMA-IR) ≥ 3.04 or quantitative insulin sensitivity check index (QUICKI) ≤ 0.32. RESULTS: Pravastatin treatment decreased total cholesterol and low-density lipoprotein cholesterol levels by 25.2% and 32.3% respectively (P = 0.000 for all), but did not affect fasting insulin level, HOMA-IR, or QUICKI in total, prediabetes, and NOD groups. Prevalence of IR was significantly different between prediabetes and NOD groups both before and after pravastatin treatment (0% versus 37.5%, P = 0.001), but pravastatin treatment did not affect the prevalence of IR in the prediabetes or NOD group. Fasting glucose level was not significantly different before and after pravastatin treatment in prediabetes (106.8 ± 6.4 mg/dL versus 103.8 ± 8.4 mg/dL, P = 0.223) but was significantly different in the NOD group (171.5 ± 70.1 mg/dL versus 124.4 ± 26.7 mg/dL, P = 0.017). CONCLUSION: Pravastatin treatment did not affect IR or fasting glucose level in hyperglycemic patients. Therefore, we suggest pravastatin can be prescribed to hypercholesterolemic patients with hyperglycemia.