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Pathophysiology/Complications

Influence of Hepatic Steatosis (Fatty Liver) on Severity and Composition of Dyslipidemia in Type 2 Diabetes

  1. Frederico G.S. Toledo, MD1,
  2. Allan D. Sniderman, MD2 and
  3. David E. Kelley, MD1
  1. 1Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
  2. 2Mike Rosenbloom Laboratory for Cardiovascular Research, Royal Victoria Hospital, Montreal, Quebec, Canada
  1. Address correspondence and reprint requests to Frederico G.S. Toledo, MD, 807N Montefiore Hospital, 3459 Fifth Ave., Pittsburgh, PA 15213. E-mail: toledofs{at}upmc.edu
Diabetes Care 2006 Aug; 29(8): 1845-1850. https://doi.org/10.2337/dc06-0455
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  • Figure 1—
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    Figure 1—

    Correlation between serum triglycerides and hepatic steatosis (L/S ratio). A: Across the whole spectrum of steatosis (r = −0.40, P < 0.01). B: Correlation analyzed within the group with none or minimal steatosis, i.e., L/S ratios ≥1.0 (r = −0.69, P < 0.01).

  • Figure 2—
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    Figure 2—

    Measurements of insulin sensitivity in groups with normal, moderate, and severe steatosis. A: Insulin sensitivity measured by the euglycemic-hyperinsulinemic clamp. LBM, lean body mass; Rd, systemic glucose disposal rate. B: Estimated insulin resistance under fasting conditions by the homeostasis model assessment of insulin resistance (HOMA-IR). C: Fasting EGP rates. D: Insulin-suppressed EGP rates during the euglycemic clamp. *P < 0.05, †P < 0.01 vs. normal group.

Tables

  • Figures
  • Table 1—

    Patient characteristics stratified by L/S ratio

    L/S ratio tertiles
    Upper: normalMid: moderate steatosisLower: severe steatosis
    n222322
    Range of L/S ratio1.006–1.3460.793–0.9970.153–0.784
    L/S ratio1.16 ± 0.020.89 ± 0.01*0.64 ± 0.03*†
    Percent women596155
    Age (years)52.87 ± 1.7150.34 ± 1.4552.32 ± 1.84
    A1C (%)8.27 ± 0.308.45 ± 0.387.88 ± 0.28
    Fasting glucose (mmol/l)10.00 ± 0.4810.23 ± 0.5610.10 ± 0.61
    Fasting insulin (pmol/l)76.20 ± 17.52109.4 ± 11.16‡114.1 ± 10.50‡
    Fasting FFAs (mmol/l)0.64 ± 0.030.74 ± 0.030.67 ± 0.03
    BMI (kg/m2)30.91 ± 0.9136.52 ± 1.31‡33.87 ± 0.85
    Percent body fat35.15 ± 2.0740.90 ± 1.5436.74 ± 1.36
    STAT (cm2)113.77 ± 13.55135.62 ± 13.74102.49 ± 10.21
    SAT (cm2)403.27 ± 30.35459.24 ± 25.58409.49 ± 25.06
    VAT (cm2)176.38 ± 15.97271.99 ± 19.35*273.36 ± 16.03*
    • Data are means ± SE.

    • *

      ↵* P < 0.01 vs. normal group.

    • †

      ↵† P < 0.05 for marked vs. moderate steatosis groups.

    • ‡

      ↵‡ P < 0.05 vs. normal group. SAT, subcutaneous abdominal (adipose) tissue; STAT, subcutaneous thigh adipose tissue.

  • Table 2—

    Serum lipoprotein profile, particle size, and numbers

    NormalModerate steatosisSevere steatosis
    Serum lipids (mmol/l)
        Triglycerides1.57 ± 0.122.07 ± 0.15*2.28 ± 0.20†
        HDL cholesterol1.28 ± 0.061.12 ± 0.05*1.01 ± 0.04†
        LDL cholesterol3.25 ± 0.163.38 ± 0.173.25 ± 0.16
        Total cholesterol5.12 ± 0.175.27 ± 0.195.05 ± 0.19
        ApoB (g/l)0.94 ± 0.051.04 ± 0.041.03 ± 0.05
    Particle size (nm)
        VLDL53.37 ± 1.4058.73 ± 2.34*60.88 ± 1.82*
        LDL21.23 ± 0.1820.95 ± 0.2620.35 ± 0.20*
        HDL8.74 ± 0.108.52 ± 0.09*8.33 ± 0.05*‡
    Particle concentration
        Chylomicrons (nmol/l)0.03 ± 0.000.02 ± 0.000.03 ± 0.01
        VLDL (nmol/l)71.20 ± 7.6077.88 ± 5.4378.77 ± 6.90
        LDL (μmol/l)1.22 ± 0.081.38 ± 0.071.49 ± 0.10
        Small, dense LDL0.65 ± 0.080.81 ± 0.11*1.12 ± 0.12†
        Large, buoyant LDL0.51 ± 0.050.49 ± 0.080.30 ± 0.05*‡
        IDL0.06 ± 0.010.08 ± 0.010.08 ± 0.01
        HDL (μmol/l)23.34 ± 1.6622.95 ± 1.9523.19 ± 1.58
    • Data are means ± SE.

    • *

      ↵* P < 0.05,

    • †

      ↵† P < 0.01 vs. normal group;

    • ‡

      ↵‡ P < 0.05 for severe vs. moderate steatosis groups.

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Diabetes Care: 29 (8)

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Influence of Hepatic Steatosis (Fatty Liver) on Severity and Composition of Dyslipidemia in Type 2 Diabetes
Frederico G.S. Toledo, Allan D. Sniderman, David E. Kelley
Diabetes Care Aug 2006, 29 (8) 1845-1850; DOI: 10.2337/dc06-0455

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Influence of Hepatic Steatosis (Fatty Liver) on Severity and Composition of Dyslipidemia in Type 2 Diabetes
Frederico G.S. Toledo, Allan D. Sniderman, David E. Kelley
Diabetes Care Aug 2006, 29 (8) 1845-1850; DOI: 10.2337/dc06-0455
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