Multifocal fatty liver disease, insulin resistance and carotid atherosclerosis: exploring the interrelated relationship

Abstract

Introduction: Multifocal fatty liver infiltrations are not uncommon ultrasonographic finding; they are explained by the presence of aberrant vascular supply independent of the portal circulation or insulin resistance. Aim: To study the significance of this ultrasonographic finding. Methods: A study group ( n = 96) with multifocal fatty liver and two control groups: healthy subjects ( n = 100) and patients with diffuse fatty liver disease ( n = 100) were enrolled. They were tested for fasting blood glucose, lipid profile, transaminases, serum insulin, glycated hemoglobin, Homeostatic Model Assessment of Insulin Resistance, high-sensitivity C-reactive protein and liver stiffness in Fibroscan. Results: Patients with multifocal fatty liver showed a statistically significant higher values of serum transaminases, markers of insulin resistance, high-sensitivity C-reactive protein, and neutrophil lymphocyte ratio ( p <0.05). Lipid profile parameters were significantly higher ( p <0.05). Mean liver stiffness (9.8 ± 1.2 kPa) and carotid intima media thickness (1.16 ± 0.2 mm) were significantly higher when compared to healthy subjects and patients with diffuse fatty liver disease. Independent predictors of insulin resistance and premature carotid atherosclerosis in patients with multifocal fatty liver disease were: serum gamma-glutamyl transferase (odds ratio 1.69), high-sensitivity C-reactive protein (odds ratio 1.62), uric acid (odds ratio 1.55), very low-density lipoprotein (odds ratio 1.74), total cholesterol/high-density lipoprotein (odds ratio 1.58) and severity of liver stiffness measured by Fibroscan (odds ratio 1.9). Conclusions: Multifocal fatty liver is an aggressive form of nonalcoholic fatty liver disease and should be considered a radiological sign of insulin resistance that needs special attention and management.

Systematic review and meta‐analysis: Association between liver fibrosis and subclinical atherosclerosis in nonalcoholic fatty liver disease

“…Specifically, three studies utilised liver biopsy to determine fibrosis stage, 19–21 while two used MRE 22,23 . The remaining seven studies used TE to assess the fibrosis stage 24–30 …”

“…Three studies utilised CAC scores to assess atherosclerosis, 22,23,28 while two studies used PWV 20,29 . One study employed an AI for this purpose, 21 while the other six studies used IMT measurements 19,24–27,30 …”

“…Among the selected studies, a total of nine studies reported adjusted ORs, which were obtained after controlling for relevant confounding factors through appropriate statistical adjustments 19–23,25,28–30 . Additionally, three studies provided unadjusted ORs, indicating the association between the variables without accounting for potential confounders 24,26,27 …”

“…[19][20][21][22][23]25,[28][29][30] Additionally, three studies provided unadjusted ORs, indicating the association between the variables without accounting for potential confounders. 24,26,27…”

“…20,29 One study employed an AI for this purpose, 21 while the other six studies used IMT measurements. 19,[24][25][26][27]30…”