Clinical relevance of dual-energy X-ray absorptiometry (DXA) as a simultaneous evaluation of fatty liver disease and atherosclerosis in patients with type 2 diabetes

Abstract

BackgroundWhole body dual-energy X-ray absorptiometry (DXA) can simultaneously measure both regional fat and non-fat mass. Android-to-gynoid (A/G) ratio measured by DXA has been reported to be associated with cardiovascular risks and visceral adiposity; however, little is known regarding its relationship with fatty liver disease and atherosclerosis among patients with diabetes. This study was designed to investigate the association of android and gynoid fat mass measured by DXA with fatty liver disease and atherosclerosis in patients with type 2 diabetes.MethodsThis is a cross-sectional study of 259 patients with type 2 diabetes (mean age 64 ± 13 years; 40.2 % female). Android and gynoid fat mass (kg) were measured by DXA. Skeletal muscle index (SMI) was calculated as appendicular non-fat mass (kg) divided by height (m2). Visceral fat area (VFA, cm2), subcutaneous fat area (SFA, cm2), and liver attenuation index (LAI) were assessed by abdominal computed tomography. Intima media thickness (IMT, mm) in common carotid arteries was determined by carotid ultrasonography.ResultsA/G ratio was significantly correlated with VFA (r = 0.72, p < 0.001), SFA (r = 0.32, p < 0.001) and LAI (r = −0.26, p < 0.001). A/G ratio (standardized β −0.223, p = 0.002) as well as VFA (standardized β −0.226, p = 0.001) were significantly associated with LAI in the univariate model. A/G ratio remained to be significantly associated with LAI (standardized β −0.224, p = 0.005) after adjusting for covariates including body mass index and transaminases. Among patients with low SMI (SMI < 7.0 in male and < 5.4 in female), A/G ratio was significantly associated with carotid IMT in the multivariate model (standardized β 0.408, p = 0.014).ConclusionsDXA can be used to simultaneously estimate the risks for both fatty liver disease and atherosclerosis in patients with type 2 diabetes.

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“…The measurement was taken with each hand in a standing position, and the average of grip strength was used for muscle strength in this study. Regional fat and fat‐free mass were measured by the whole body DXA (Lunar iDXA, GE Healthcare, Madison, WI) as described previously . The appendicular skeletal muscle index (SMI) was calculated as the appendicular lean mass divided by the square of the height (kg/m 2 ).…”

Reduction of visceral fat by liraglutide is associated with ameliorations of hepatic steatosis, albuminuria, and micro-inflammation in type 2 diabetic patients with insulin treatment: a randomized control trial

“…Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured at the level of umbilicus by abdominal CT examination (Aquilion PRIME, Toshiba Medical Systems, Tochigi, Japan) as described previously [15]. Hepatic fat accumulation was also determined by liver attenuation index (LAI) in the CT examination as described previously [16].…”

“…Madison, WI) as described previously [15]. Skeletal muscle index (SMI) was calculated as the following: SMI = (appendicular non-fat mass, kg) divided by height (m) 2 .…”