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Insulin Resistance, the Metabolic Syndrome, and Nonalcoholic Fatty Liver Disease

IV Division of Internal Medicine, Department of Experimental Medicine and Pathology (F.A., M.D.B., S.Fr., K.F., S.Fi., C.A., F.V.) and Department of Clinics and Applied Medical Therapy (R.C., M.G.C.), University La Sapienza, 00161 Rome, Italy; and Department of Medical and Surgical Sciences (B.Z., F.L.), University of Padua, 35100 Padua, Italy

Address all correspondence and requests for reprints to: Prof. Francesco Angelico, IV Division of Internal Medicine, Policlinico Umberto 1, Via Antonio Nibby 8, 00161 Rome, Italy. E-mail: Francesco.angelico{at}uniroma1.it.

Background/Aims: An association of nonalcoholic fatty liver disease with the insulin-resistant metabolic syndrome has been suggested. The aim of the study was to assess the association of fatty liver to different degrees of insulin resistance and secretion.

Methods and Results: The study was performed in 308 alcohol- and virus-negative consecutive patients attending a metabolic clinic, who underwent a complete clinical and biochemical work-up including oral glucose tolerance test and routine liver ultrasonography. Steatosis was graded as absent/mild, moderate, and severe.

In nondiabetic subjects, a progressive (P < 0.05) increase in mean homeostasis model of insulin resistance was recorded from the group without steatosis to the groups with mild/moderate and severe steatosis. Severe steatosis was associated with the clustering of the five clinical and biochemical features proposed for the clinical diagnosis of the metabolic syndrome.

Subjects with the metabolic syndrome with a more pronounced insulin resistance had a higher prevalence of severe steatosis (P < 0.01) compared with those with homeostasis model of insulin resistance below the median.

Conclusions: The findings stress the heterogeneous presentation of patients with the metabolic syndrome when the diagnosis is based on the broad Adult Treatment Panel III clinical criteria and demonstrate that those who are more insulin resistant have a higher prevalence of severe steatosis.

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