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Associations of Insulin Resistance and Glycemia With Liver Enzymes in Hispanic/Latino Youths

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Background:

Associations of insulin resistance and hyperglycemia with a panel of liver enzymes have not been well studied in a young, heterogenous Hispanic/Latino population. We aimed to assess the associations of insulin resistance and glycemia with nonalcoholic fatty liver disease (NAFLD), as measured by liver enzymes and the pediatric NAFLD fibrosis index (PNFI), and whether these associations are modified by body mass index and mediated by inflammation or endothelial dysfunction.

Materials and Methods:

We conducted a cross-sectional study of 1317 boys and girls aged 8 to 16 years from the Hispanic Community Children’s Health Study/Study of Latino Youth. We used Poisson regression to assess the associations of fasting glucose, hemoglobin A1c, and homeostasis model assessment of insulin resistance (HOMA-IR) with elevated alanine aminotransferase (ALT) (>25 U/L in boys, >22 U/L in girls), aspartate aminotransferase (AST) (≥37 U/L), gamma-glutamyl transpeptidase (GGT) (≥17 U/L), and PNFI (≥9; a function of age, waist circumference, and triglyceride level).

Results:

HOMA-IR was associated with elevated ALT, AST, GGT, and PNFI [prevalence ratios (95% confidence intervals) for each 1-unit increase in the natural log of HOMA-IR: 1.99 (1.40-2.81), 2.15 (1.12-4.12), 1.70 (1.26-2.30), and 1.98 (1.43-2.74), respectively]. Associations were observed in overweight/obese children, but not in normal weight children (P-interaction=0.04 for AST and P-interaction=0.07 for GGT). After further adjustment for adiponectin, high-sensitivity C-reactive protein, e-selectin, and PAI-1, associations of HOMA-IR with liver enzymes and PNFI were attenuated, but remained statistically significant for AST and PNFI.

Conclusion:

Insulin resistance was associated with NAFLD in overweight/obese Hispanic/Latino youth, and this association may be partially mediated by inflammation and endothelial dysfunction.
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Keywords: NAFLD; adolescents; glycemia; hispanic; insulin resistance

Document Type: Research Article

Affiliations: 1: Department of Epidemiology and Population Health 2: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 3: Johns Hopkins School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD 4: Department of Psychology, San Diego State University, San Diego, CA 5: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 6: The Program for Experimental and Theoretical Modeling, Department of Medicine, Division of Hepatology, Loyola University Chicago Medical Center, Maywood, IL 7: Division of Pediatric Endocrinology, University of Miami Leonard M. Miller School of Medicine, Miami 8: Department of Psychology, University of Miami, Coral Gables, FL

Publication date: February 1, 2019

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