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Use of HOMA-IR to diagnose non-alcoholic fatty liver disease: a population-based and inter-laboratory study.
- Source :
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Diabetologia [Diabetologia] 2017 Oct; Vol. 60 (10), pp. 1873-1882. Date of Electronic Publication: 2017 Jun 29. - Publication Year :
- 2017
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Abstract
- Aims/hypothesis: Recent European guidelines for non-alcoholic fatty liver disease (NAFLD) call for reference values for HOMA-IR. In this study, we aimed to determine: (1) the upper limit of normal HOMA-IR in two population-based cohorts; (2) the HOMA-IR corresponding to NAFLD; (3) the effect of sex and PNPLA3 genotype at rs738409 on HOMA-IR; and (4) inter-laboratory variations in HOMA-IR.<br />Methods: We identified healthy individuals in two population-based cohorts (FINRISK 2007 [n = 5024] and the Programme for Prevention of Type 2 Diabetes in Finland [FIN-D2D; n = 2849]) to define the upper 95th percentile of HOMA-IR. Non-obese individuals with normal fasting glucose levels, no excessive alcohol use, no known diseases and no use of any drugs were considered healthy. The optimal HOMA-IR cut-off for NAFLD (liver fat ≥5.56%, based on the Dallas Heart Study) was determined in 368 non-diabetic individuals (35% with NAFLD), whose liver fat was measured using proton magnetic resonance spectroscopy ( <superscript>1</superscript> H-MRS). Samples from ten individuals were simultaneously analysed for HOMA-IR in seven European laboratories.<br />Results: The upper 95th percentiles of HOMA-IR were 1.9 and 2.0 in healthy individuals in the FINRISK (n = 1167) and FIN-D2D (n = 459) cohorts. Sex or PNPLA3 genotype did not influence these values. The optimal HOMA-IR cut-off for NAFLD was 1.9 (sensitivity 87%, specificity 79%). A HOMA-IR of 2.0 corresponded to normal liver fat (<5.56% on <superscript>1</superscript> H-MRS) in linear regression analysis. The 2.0 HOMA-IR measured in Helsinki corresponded to 1.3, 1.6, 1.8, 1.8, 2.0 and 2.1 in six other laboratories. The inter-laboratory CV% of HOMA-IR was 25% due to inter-assay variation in insulin (25%) rather than glucose (5%) measurements.<br />Conclusions/interpretation: The upper limit of HOMA-IR in population-based cohorts closely corresponds to that of normal liver fat. Standardisation of insulin assays would be the first step towards definition of normal values for HOMA-IR.
- Subjects :
- Adiposity physiology
Antibodies, Monoclonal, Humanized
Female
Humans
Male
Middle Aged
Non-alcoholic Fatty Liver Disease metabolism
Non-alcoholic Fatty Liver Disease pathology
Reference Values
Young Adult
Blood Glucose metabolism
Insulin blood
Insulin Resistance physiology
Liver pathology
Non-alcoholic Fatty Liver Disease diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1432-0428
- Volume :
- 60
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Diabetologia
- Publication Type :
- Academic Journal
- Accession number :
- 28660493
- Full Text :
- https://doi.org/10.1007/s00125-017-4340-1