HOMA-IR: An independent predictor of advanced liver fibrosis in nondiabetic non-alcoholic fatty liver disease.
BACKGROUND AND AIM
Although non-alcoholic fatty liver disease (NAFLD) is common in the general population, identifying patients with advanced fibrosis remains a challenge. We investigated whether the homeostasis model assessment parameter of insulin resistance (HOMA-IR), an index of IR and one of the most important metabolic factors, is an independent predictive factor for advanced fibrosis in nondiabetic patients with NAFLD.


METHODS
This was a retrospective, cross-sectional multicenter study. We included 361 patients with biopsy-proven NAFLD who had not been diagnosed with type 2 diabetes mellitus: 175 (48%) were women and 48 (13%) had advanced fibrosis. We used simple random sampling; the sampling ratio of the estimation and validation groups was 7:3. A logistic model was constructed for both the estimation and validation groups. The explanatory variables were age ≥ 49 years, sex (women), body mass index ≥ 26.7 kg/m2 , the presence of hypertension, presence of dyslipidemia, fasting plasma glucose level ≥ 98 mg/dL, fasting immune reactive insulin level ≥ 12.0 μU/mL, and HOMA-IR ≥ 2.90. The median HOMA-IR of the patients was 2.88 (interquartile range: 2.1-4.8).


RESULTS
In the estimation group, univariate and multivariate analyses showed that age, dyslipidemia, and HOMA-IR were independent predictors of advanced fibrosis. In the validation group, only age and HOMA-IR were found to be independent predictors of advanced fibrosis.


CONCLUSIONS
Homeostasis model assessment parameter of insulin resistance was an independent predictor of advanced liver fibrosis in nondiabetic patients with NAFLD. Given that most patients with NAFLD are nondiabetic, it is important to set goals with respect to improving IR to subsequently reduce liver fibrosis.
['Fujii|Hideki|H|https://orcid.org/0000-0003-1267-9623', 'Imajo|Kento|K|', 'Yoneda|Masato|M|', 'Nakahara|Takashi|T|', 'Hyogo|Hideyuki|H|', 'Takahashi|Hirokazu|H|', 'Hara|Tasuku|T|', 'Tanaka|Saiyu|S|', 'Sumida|Yoshio|Y|', 'Eguchi|Yuichiro|Y|', 'Chayama|Kazuaki|K|', 'Nakajima|Atsushi|A|', 'Nishimoto|Naoki|N|', 'Kawada|Norifumi|N|', '|||']
D000328:Adult D000367:Age Factors D015415:Biomarkers D001786:Blood Glucose D003430:Cross-Sectional Studies D018450:Disease Progression D050171:Dyslipidemias D005260:Female D006801:Humans D007328:Insulin D007333:Insulin Resistance D007564:Japan D008055:Lipids D008103:Liver Cirrhosis D008297:Male D008875:Middle Aged D065626:Non-alcoholic Fatty Liver Disease D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
NAFLD insulin resistance type 2 diabetes mellitus hepatic fibrosis