TY  - JOUR
T1  - Association of Insulin Resistance and Ectopic Fat Accumulation with HOMA Indices: A Single-Centre Observational Study
TT  - İnsülin Direnci ve Ektopik Yağ Birikiminin HOMA İndeksleri ile İlişkisi: Tek Merkezli Bir Gözlem Çalışması
AU  - Emir, Sevde Nur
AU  - Emir, Servet
PY  - 2024
DA  - August
Y2  - 2024
DO  - 10.25048/tudod.1461623
JF  - Turkish Journal of Diabetes and Obesity
JO  - Turk J Diab Obes
PB  - Zonguldak Bulent Ecevit University
WT  - DergiPark
SN  - 2587-0335
SP  - 97
EP  - 106
VL  - 8
IS  - 2
LA  - en
AB  - Purpose: The aim of this study was to investigate the relationship between non-alcoholic fatty liver disease (NAFLD), non-alcoholic fatty pancreas (or pancreatic) disease (NAFPD) and HOMA indices in obese patients without a diagnosis of diabetes mellitus, using ultrasound (US) as a common non-invasive diagnostic tool during routine examinations.Methods: In this single-centre, retrospective study, the records of patients who applied to the obesity outpatient clinic in 2023 were reviewed. Digital records were scanned and patients with abdominal ultrasound reports indicating age, gender, body mass index(BMI), fasting plasma glucose, fasting plasma glucose, C-peptide level and degree of pancreatic and hepatic steatosis were included in the study. Patients with known chronic disease or diabetes mellitus and patients with specific drug use were excluded from the study. Homa indices were calculated using fasting plasma glucose and C-peptide levels.Results: A total of 62 patients were included. Body mass index was 39.1, 91% had NAFLD and 82% had NAFPD. There was a significant positive correlation between BMI and NAFLD and NAFPD. HOMA scores revealed a statistically significant impact of NAFLD on insulin resistance (HOMA-IR) and insulin sensitivity (HOMA-S) but not on beta-cell function (HOMA-B). No significant effect of NAFPD on HOMA scores was observed.Conclusion: The findings underline the association between NAFLD and insulin resistance and highlight the metabolic burden of ectopic fat deposition in obese patients. In contrast, there was no significant correlation between NAFPD and either insulin resistance or beta-cell function, suggesting that the metabolic impact of pancreatic steatosis may be different. These findings may help to guide clinical strategies for detecting and treating metabolic disorders in obesity.
KW  - Non-Alcoholic Fatty Liver Disease
KW  - Non-Alcoholic Fatty Pancreas Disease
KW  - Insulin Resistance
KW  - Obesity
KW  - HOMA Index
KW  - Ultrasound Imaging
N2  - Amaç: Bu çalışmanın amacı, diyabet mellitus tanısı olmayan obez hastalarda, rutin muayeneler sırasında yaygın bir non-invaziv tanı aracı olan ultrason (US) kullanılarak, non alkolik yağlı karaciğer hastalığı (NAFLD), non alkolik yağlı pankreas (veya pankreatik) hastalığı (NAFPD) ve HOMA indeksleri arasındaki ilişkiyi araştırmaktır.Yöntemler: Bu tek merkezli, retrospektif çalışmada, 2023 yılında obezite polikliniğine başvuran hastaların kayıtları gözden geçirilmiştir. Dijital kayıtlar taranmış ve yaş, cinsiyet, vücut kitle indeksi (VKİ), açlık plazma glikozu, açlık plazma glikozu, C-peptid seviyesi ve pankreatik ve hepatik steatoz derecesini belirten abdominal ultrason raporlarına sahip hastalar çalışmaya dahil edilmiştir. Bilinen kronik hastalığı veya diyabet mellitusu olan ve belirli ilaçları kullanan hastalar çalışma dışı bırakılmıştır. Homa indeksleri, açlık plazma glikozu ve C-peptid seviyeleri kullanılarak hesaplanmıştır.Sonuçlar: Toplam 62 hasta dahil edilmiştir. Ortalama vücut kitle indeksi 39.1, %91’inde NAFLD ve %82’sinde NAFPD bulunmuştur. VKİ ile NAFLD ve NAFPD arasında anlamlı pozitif bir korelasyon saptanmıştır. HOMA skorları, NAFLD'nin insülin direnci (HOMA-IR) ve insülin hassasiyeti (HOMA-S) üzerinde istatistiksel olarak anlamlı bir etkisi olduğunu, ancak beta-hücre fonksiyonu (HOMA-B) üzerinde anlamlı bir etkisinin olmadığını ortaya koymuştur. NAFPD'nin HOMA skorları üzerinde anlamlı bir etkisi gözlenmemiştir.Sonuç: Bulgular, NAFLD ile insülin direnci arasındaki ilişkiyi vurgulamakta ve obez hastalarda ektopik yağ birikiminin metabolik yükünü ön plana çıkarmaktadır. Buna karşın, NAFPD ile insülin direnci veya beta-hücre fonksiyonu arasında anlamlı bir korelasyon bulunmamıştır, bu da pankreatik steatozun metabolik etkisinin farklı olabileceğini öne sürmektedir. Bu bulgular, obezitede metabolik bozuklukların tespiti ve tedavisi için klinik stratejileri yönlendirmede yardımcı olabilir.
CR  - 1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of
Obesity Among Adults and Youth: United States, 2011-2014.
NCHS Data Brief. 2015; (219):1-8.
CR  - 2. Katsiki N, Athyros VG, Mikhailidis DP. Abnormal Peri-Organ
or Intra-organ Fat (APIFat) Deposition: An Underestimated
Predictor of Vascular Risk?. Curr Vasc Pharmacol. 2016;14
(5):432-441. doi:10.2174/1570161114666160722112738
CR  - 3. Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease.
Circulation. 2011;124 (24):e837-e841. doi:10.1161/CIRCULATIONAHA.
111.077602
CR  - 4. Smits MM, van Geenen EJ. The clinical significance of pancreatic
steatosis. Nat Rev Gastroenterol Hepatol. 2011;8 (3):169-
177. doi:10.1038/nrgastro.2011.4
CR  - 5. Majumder S, Philip NA, Takahashi N, Levy MJ, Singh VP,
Chari ST. Fatty Pancreas: Should We Be Concerned?. Pancreas.
2017;46 (10):1251-1258. doi:10.1097/MPA.0000000000000941
CR  - 6. Heni M, Machann J, Staiger H, et al. Pancreatic fat is negatively
associated with insulin secretion in individuals with
impaired fasting glucose and/or impaired glucose tolerance:
a nuclear magnetic resonance study. Diabetes Metab Res Rev.
2010;26 (3):200-205. doi:10.1002/dmrr.1073
CR  - 7. Mathur A, Marine M, Lu D, et al. Nonalcoholic fatty
pancreas disease. HPB (Oxford). 2007;9 (4):312-318.
doi:10.1080/13651820701504157
CR  - 8. Lingvay I, Esser V, Legendre JL, et al. Noninvasive quantification
of pancreatic fat in humans. J Clin Endocrinol Metab.
2009;94 (10):4070-4076. doi:10.1210/jc.2009-0584
CR  - 9. Tariq H, Nayudu S, Akella S, Glandt M, Chilimuri S. Non-Alcoholic
Fatty Pancreatic Disease: A Review of Literature. Gastroenterology
Res. 2016;9 (6):87-91. doi:10.14740/gr731w
CR  - 10. Dasarathy S, Dasarathy J, Khiyami A, Joseph R, Lopez R, Mc-
Cullough AJ. Validity of real time ultrasound in the diagnosis
of hepatic steatosis: a prospective study. J Hepatol. 2009;51
(6):1061-1067. doi:10.1016/j.jhep.2009.09.001
CR  - 11. Lee JS, Kim SH, Jun DW, et al. Clinical implications of fatty
pancreas: correlations between fatty pancreas and metabolic
syndrome. World J Gastroenterol. 2009;15 (15):1869-1875.
doi:10.3748/wjg.15.1869
CR  - 12. Ou HY, Wang CY, Yang YC, Chen MF, Chang CJ. The association
between nonalcoholic fatty pancreas disease and diabetes.
PLoS One. 2013;8 (5):e62561. Published 2013 May 3.
doi:10.1371/journal.pone.0062561
CR  - 13. Lesmana CR, Pakasi LS, Inggriani S, Aidawati ML, Lesmana
LA. Prevalence of Non-Alcoholic Fatty Pancreas Disease
(NAFPD) and its risk factors among adult medical check-up
patients in a private hospital: a large cross sectional study.
BMC Gastroenterol. 2015;15:174. Published 2015 Dec 12.
doi:10.1186/s12876-015-0404-1
CR  - 14. Wang CY, Ou HY, Chen MF, Chang TC, Chang CJ. Enigmatic
ectopic fat: prevalence of nonalcoholic fatty pancreas disease
and its associated factors in a Chinese population. J Am Heart
Assoc. 2014;3 (1):e000297. Published 2014 Feb 26. doi:10.1161/
JAHA.113.000297
CR  - 15. den Biggelaar LJ, Sep SJ, Eussen SJ, et al. Discriminatory ability
of simple OGTT-based beta cell function indices for prediction
of prediabetes and type 2 diabetes: the CODAM study.
Diabetologia. 2017;60 (3):432-441. doi:10.1007/s00125-016-
4165-3
CR  - 16. Stern SE, Williams K, Ferrannini E, DeFronzo RA, Bogardus
C, Stern MP. Identification of individuals with insulin resistance
using routine clinical measurements. Diabetes. 2005;54
(2):333-339. doi:10.2337/diabetes.54.2.333
CR  - 17. Borai A, Livingstone C, Kaddam I, Ferns G. Selection of the
appropriate method for the assessment of insulin resistance.
BMC Med Res Methodol. 2011;11:158. Published 2011 Nov 23.
doi:10.1186/1471-2288-11-158
CR  - 18. Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches
for assessing insulin sensitivity and resistance in vivo: advantages,
limitations, and appropriate usage. Am J Physiol
Endocrinol Metab. 2008;294 (1):E15-E26. doi:10.1152/ajpendo.
00645.2007
CR  - 19. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA
modeling. Diabetes Care. 2004;27 (6):1487-1495. doi:10.2337/
diacare.27.6.1487
CR  - 20. Ahuja V, Kadowaki T, Evans RW, et al. Comparison of HOMA-
IR, HOMA-β% and disposition index between US white
men and Japanese men in Japan: the ERA JUMP study. Diabetologia.
2015;58 (2):265-271. doi:10.1007/s00125-014-3414-6
CR  - 21. European Association for the Study of the Liver (EASL);
European Association for the Study of Diabetes (EASD);
European Association for the Study of Obesity (EASO). EASL-
EASD-EASO Clinical Practice Guidelines for the management
of non-alcoholic fatty liver disease. J Hepatol. 2016;64
(6):1388-1402. doi:10.1016/j.jhep.2015.11.004
CR  - 22. Fan JG, Wei L, Zhuang H; National Workshop on Fatty Liver
and Alcoholic Liver Disease, Chinese Society of Hepatology,
Chinese Medical Association; Fatty Liver Disease
Expert Committee, Chinese Medical Doctor Association.
Guidelines of prevention and treatment of nonalcoholic fatty
liver disease (2018, China). J Dig Dis. 2019;20 (4):163-173.
doi:10.1111/1751-2980.12685
CR  - 23. Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy
and reliability of ultrasonography for the detection of fatty
liver: a meta-analysis. Hepatology. 2011;54 (3):1082-1090.
doi:10.1002/hep.24452
CR  - 24. Oh H, Park HJ, Oh J, et al. Hyperechoic pancreas on ultrasonography:
an analysis of its severity and clinical implications.
Ultrasonography. 2022;41 (2):335-343. doi:10.14366/
usg.21099
CR  - 25. Marks WM, Filly RA, Callen PW. Ultrasonic evaluation of
normal pancreatic echogenicity and its relationship to fat deposition.
Radiology. 1980;137 (2):475-479. doi:10.1148/radiology.
137.2.7433680
CR  - 26. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher
DF, Turner RC. Homeostasis model assessment: insulin resistance
and beta-cell function from fasting plasma glucose and
insulin concentrations in man. Diabetologia. 1985;28 (7):412-
419. doi:10.1007/BF00280883
CR  - 27. Levy JC, Matthews DR, Hermans MP. Correct homeostasis
model assessment (HOMA) evaluation uses the computer
program. Diabetes Care. 1998;21 (12):2191-2192. doi:10.2337/
diacare.21.12.2191
CR  - 28. Mooy JM, Grootenhuis PA, de Vries H, Kostense PJ, Popp-
Snijders C, Bouter LM, Heine RJ. Intra-individual variation of
glucose, specific insulin and proinsulin concentrations measured
by two oral glucose tolerance tests in a general Caucasian
population: the Hoorn Study. Diabetologia. 1996;39 (3):298–
305. doi: 10.1007/BF00418345.
CR  - 29. Oxford TUo. HOMA Calculator. 2018. https://www.dtu.ox.ac.
uk/ homacalculator/download.php
CR  - 30. Freeman AM, Acevedo LA, Pennings N. Insulin Resistance.
In: StatPearls. Treasure Island (FL): StatPearls Publishing; August
17, 2023.
CR  - 31. Park SE, Park CY, Sweeney G. Biomarkers of insulin sensitivity
and insulin resistance: Past, present and future. Crit Rev
Clin Lab Sci. 2015;52 (4):180-190. doi:10.3109/10408363.2015
.1023429
CR  - 32. Lee SH, Park SY, Choi CS. Insulin Resistance: From Mechanisms
to Therapeutic Strategies. Diabetes Metab J. 2022;46
(1):15-37. doi:10.4093/dmj.2021.0280
CR  - 33. Salgado AL, Carvalho Ld, Oliveira AC, Santos VN, Vieira JG,
Parise ER. Insulin resistance index (HOMA-IR) in the differentiation
of patients with non-alcoholic fatty liver disease and
healthy individuals. Arq Gastroenterol. 2010;47 (2):165-169.
doi:10.1590/s0004-28032010000200009
CR  - 34. Villanueva-Ortega E, Garcés-Hernández MJ, Herrera-Rosas
A, et al. Gender-specific differences in clinical and metabolic
variables associated with NAFLD in a Mexican pediatric
population. Ann Hepatol. 2019;18 (5):693-700. doi:10.1016/j.
aohep.2019.04.012
CR  - 35. Hossain IA, Rahman Shah MM, Rahman MK, Ali L. Gamma
glutamyl transferase is an independent determinant for the
association of insulin resistance with nonalcoholic fatty liver
disease in Bangladeshi adults: Association of GGT and HOMA-
IR with NAFLD. Diabetes Metab Syndr. 2016;10 (1 Suppl
1):S25-S29. doi:10.1016/j.dsx.2015.09.005
CR  - 36. Gruben N, Shiri-Sverdlov R, Koonen DP, Hofker MH. Nonalcoholic
fatty liver disease: A main driver of insulin resistance
or a dangerous liaison?. Biochim Biophys Acta. 2014;1842
(11):2329-2343. doi:10.1016/j.bbadis.2014.08.004
CR  - 37. Pirgon Ö, Bilgin H, Çekmez F, Kurku H, Dündar BN. Association
between insulin resistance and oxidative stress parameters
in obese adolescents with non-alcoholic fatty liver disease.
J Clin Res Pediatr Endocrinol. 2013;5 (1):33-39. doi:10.4274/
Jcrpe.825
CR  - 38. Motamed B, Kohansal Vajargah M, Kalantari S, Shafaghi A.
HOMA-IR index in non-diabetic patient, a reliable method
for early diagnosis of liver steatosis. Caspian J Intern Med.
2022;13 (3):519-526. doi:10.22088/cjim.13.3.519
CR  - 39. Motamed N, Miresmail SJ, Rabiee B, et al. Optimal cutoff
points for HOMA-IR and QUICKI in the diagnosis of metabolic
syndrome and non-alcoholic fatty liver disease: A population
based study. J Diabetes Complications. 2016;30 (2):269-
274. doi:10.1016/j.jdiacomp.2015.11.019
CR  - 40. Gutierrez-Buey G, Núñez-Córdoba JM, Llavero-Valero M,
Gargallo J, Salvador J, Escalada J. Is HOMA-IR a potential
screening test for non-alcoholic fatty liver disease in adults
with type 2 diabetes?. Eur J Intern Med. 2017;41:74-78.
doi:10.1016/j.ejim.2017.03.006
CR  - 41. Isokuortti E, Zhou Y, Peltonen M, et al. Use of HOMA-IR to
diagnose non-alcoholic fatty liver disease: a population-based
and inter-laboratory study. Diabetologia. 2017;60 (10):1873-
1882. doi:10.1007/s00125-017-4340-1
CR  - 42. Lozano M, Navarro S, Pérez-Ayuso R, et al. Lipomatosis of the
pancreas: an unusual cause of massive steatorrhea. Pancreas.
1988;3 (5):580-582. doi:10.1097/00006676-198810000-00012
CR  - 43. Carter R, Mouralidarane A, Soeda J, et al. Non-alcoholic fatty
pancreas disease pathogenesis: a role for developmental programming
and altered circadian rhythms. PLoS One. 2014;9
(3):e89505. Published 2014 Mar 21. doi:10.1371/journal.
pone.0089505
CR  - 44. Catanzaro R, Cuffari B, Italia A, Marotta F. Exploring the metabolic
syndrome: Nonalcoholic fatty pancreas disease. World
J Gastroenterol. 2016;22 (34):7660-7675. doi:10.3748/wjg.v22.
i34.7660
CR  - 45. Wong VW, Wong GL, Yeung DK, et al. Fatty pancreas, insulin
resistance, and β-cell function: a population study using
fat-water magnetic resonance imaging. Am J Gastroenterol.
2014;109 (4):589-597. doi:10.1038/ajg.2014.1
CR  - 46. Della Corte C, Mosca A, Majo F, et al. Nonalcoholic fatty
pancreas disease and Nonalcoholic fatty liver disease: more
than ectopic fat. Clin Endocrinol (Oxf). 2015;83 (5):656-662.
doi:10.1111/cen.12862
CR  - 47. Pezzilli R, Calculli L. Pancreatic steatosis: Is it related to either
obesity or diabetes mellitus?. World J Diabetes. 2014;5
(4):415-419. doi:10.4239/wjd.v5.i4.415
CR  - 48. Saisho Y, Butler AE, Meier JJ, et al. Pancreas volumes in humans
from birth to age one hundred taking into account sex,
obesity, and presence of type-2 diabetes. Clin Anat. 2007;20
(8):933-942. doi:10.1002/ca.20543
CR  - 49. Kühn JP, Berthold F, Mayerle J, et al. Pancreatic Steatosis
Demonstrated at MR Imaging in the General Population: Clinical
Relevance. Radiology. 2015;276 (1):129-136. doi:10.1148/
radiol.15140446
CR  - 50. van der Zijl NJ, Goossens GH, Moors CC, et al. Ectopic fat
storage in the pancreas, liver, and abdominal fat depots: impact
on β-cell function in individuals with impaired glucose
metabolism. J Clin Endocrinol Metab. 2011;96 (2):459-467.
doi:10.1210/jc.2010-1722
CR  - 51. Ookura R, Usuki N. Visual assessment of pancreatic fat deposition:
useful grading system and the relation to BMI and diabetes.
Jpn J Radiol. 2023;41 (2):172-179. doi:10.1007/s11604-
022-01334-6
UR  - https://doi.org/10.25048/tudod.1461623
L1  - https://dergipark.org.tr/en/download/article-file/3833297
ER  -