Nonalcoholic Fatty Liver Disease in Hispanic Youth With Dysglycemia: Risk for Subclinical Atherosclerosis?

Context: Obese Hispanic adolescents (OHAs) with dysglycemia have increased cardiovascular disease risk burden.
Objective: To investigate if nonalcoholic fatty liver disease (NAFLD) confers added risk for endothelial dysfunction in these youth.
Design: Cross-sectional study.
Setting: Academic institution.
Participants: Thirty-six OHAs (15.3 ± 0.4 years), 20 with prediabetes and 16 with type 2 diabetes, with and without NAFLD.
Intervention: Evaluation of reactive hyperemia index (RHI) and augmentation index (AIx) by peripheral arterial tonometry; muscle, hepatic, and adipose tissue insulin sensitivity (IS; hyperinsulinemic-euglycemic clamp 80 mu/m ² /min, with [6,6 ² H ₂ ]glucose and [ ² H ₅ ] glycerol); body composition; and abdominal and hepatic fat by magnetic resonance imaging/spectroscopy.
Outcome Measures: RHI and AIx.
Hypothesis: OHAs with dysglycemia and NAFLD have worse RHI and AIx vs those without NAFLD.
Results: The NAFLD (n = 23) and non-NAFLD (n = 13) groups were of similar age, sex, glycemic status, body mass index, % body fat and abdominal fat. The NAFLD group had higher hepatic fat ( P < 0.001) lower skeletal muscle IS ( P = 0.01), hepatic IS ( P = 0.01), and adipose tissue IS ( P = 0.04). The NAFLD vs non-NAFLD group had lower RHI (1.4 ± 0.05 vs 1.7 ± 0.09, P = 0.002), greater AIx (-6.0 ± 1.6 vs -12.0 ± 2.1, P = 0.03). Hepatic fat was inversely related to RHI ( r = -0.49, P = 0.002) and positively related to AIx ( r = 0.45, P = 0.006). Hepatic IS ( r = -0.42, P = 0.01) and adipose IS ( r = -.54, P = 0.001) correlated with arterial stiffness (AIx).
Conclusion: In OHAs with dysglycemia, NAFLD is associated with worse endothelial function. RHI and AIx were related to hepatic fat content. Vascular stiffness was related to hepatic and adipose tissue insulin resistance.