January 1, 2021International Journal of Medical Sciences53 citationsOpen Access

Association of Hepatic Steatosis Index and Fatty Liver Index with Carotid Atherosclerosis in Type 2 Diabetes

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 Diabetes Mellitus (n=768). Intervention: Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI) vs. Lower index values. Primary outcome: Carotid atherosclerosis (OR 1.174, 95% CI 1.123-1.228, p=<0.001).

CWChenxi Wang ZCZhensheng Cai XDXia Deng

Key Result

Higher Hepatic Steatosis Index and Fatty Liver Index were independently associated with an increased risk of carotid atherosclerosis in patients with type 2 diabetes (HSI OR 1.174; FLI OR 1.011).

Study Design

Type

Cross-Sectional (n=768)

Multicenter

Structured PICO

Population

768 hospitalized adults with type 2 diabetes mellitus in China, evaluated cross-sectionally for the association between hepatic steatosis indices and carotid atherosclerosis.

Outcome

Carotid atherosclerosis assessed by carotid intima-media thickness (CIMT) measured by Color Doppler ultrasound (thickening defined as CIMT ≥ 1.0mm) and presence of carotid plaquesurrogate

Non-invasive indices of hepatic steatosis (HSI and FLI) are independently associated with carotid atherosclerosis in patients with type 2 diabetes, suggesting their potential utility as simple markers for assessing diabetic macrovascular complications.

Main Result

Odds Ratio: 1.174 (95% CI 1.123–1.228)

p-value: p=<0.001

Limitations

Cross-sectional study design precludes drawing causal conclusions.
Lack of histological examination and imaging techniques for direct measurement of NAFLD.
Conducted in a single center in China with primarily Han Chinese people, limiting generalizability to other ethnic groups.
The cohort consisted of patients with high HbA1c but relatively low BMI, which may not reflect the characteristics of diabetic patients with high insulin resistance.

Abstract

Background/aim: Previous studies have suggested that the hepatic steatosis index (HSI) and fatty liver index (FLI) can be used as a predictor of non-alcoholic fatty liver disease (NAFLD). The aim of our study was to determine whether non-invasive indices of hepatic steatosis (HSI and FLI) are associated with carotid atherosclerosis in type 2 diabetes mellitus (T2DM). Methods: This was a cross-sectional study conducted in the T2DM patients (n=768). Carotid intima-media thickness (CIMT) was measured by the Color Doppler ultrasound. The HSI was calculated based on gender, body mass index (BMI), and transaminases level. The FLI was based on BMI, waist circumference (WC), triacylglycerols (TG) and g-glutamyl transferase (GGT). Results: Raised HSI and FLI levels was associated with increased CIMT levels in T2DM patients. Patients with greater CIMT had higher HSI (39.10 5.70 vs 36.10 4.18, P < 0.001) and FLI (46.35 (29.96, 65.54) vs 36.93 (18.7, 57.93), P < 0.001) than those with lower CIMT. Subjects with existing carotid plaque had higher HSI (38.28 5.63 vs 35.69 3.45 P < 0.001) and FLI (47.41 (27.77, 66.62) vs 37.19 (17.71, 51.78), P < 0.001) accordingly. HSI (r = 0.343, P < 0.001) and FLI (r = 0.184, P < 0.001) were positively related with the CIMT. In the linear regression, after full adjustment metabolic risk factors, smoking, and measures of insulin resistance, HSI and FLI were independently associated with CIMT (HSI: = 0.011, FLI: = 0.001, all P < 0.01). Further, logistic regression analyses showed that higher HSI and FLI had an impact on the risk for carotid atherosclerosis HSI: OR (95%CI): 1.174 (1.123-1.228), FLI: OR (95%CI): 1.011(1.004-1.019), all P < 0.01. Overall, increasing values of HSI and FLI were associated with CIMT (P < 0.05) significantly across different categories of age and hypertension. Conclusion: Current data suggest HSI and FLI are independently correlated with carotid atherosclerosis in T2DM. They may be a simple and useful marker for assessing the progression of diabetic macrovascular complications.

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