Carbohydrate metabolism disorders under conditions of liver steatosis associated with metabolic dysfunction

Abstract

Introduction. To date, the characteristics of carbohydrate metabolism at the early stage of steatotic liver disease associated with metabolic dysfunction – the stage of metabolically associated liver steatosis (MALS) – have not yet been established, since the available literature sources consider it together with steatohepatitis, which determined the relevance and expediency of our study.

The aim was to characterize parameters of carbohydrate metabolism and their correlation links under the conditions of the MALS and to establish their diagnostic value.

Material and methods. 450 patients with cardiorheumatic pathology were examined, they were divided into main groups (n=324) with concomitant MALS and control groups (n=126) with an intact liver. We evaluated the fasting blood glucose level, its correlations, the frequency of hyperglycemia, and the diagnostic value of this sign. In group 2, a standard oral glucose tolerance test was performed also liver sensitivity to insulin according to the HOMA-IR index and sensitivity of peripheral tissues to insulin according to the Gutt and Cederholm indices were determined.

The results were processed statistically, p<0.05 was taken as the level of significance. Results. In patients without diabetes mellitus with MALS, fasting blood glucose was significantly higher than in patients with intact liver conditions (5.67±0.26 vs. 4.86±0.22 mmol/L; p<0.05). Fasting blood glucose level in patients with MALS was significantly correlated with other criteria of metabolic syndrome, parameters of inflammation, endogenous intoxication, structural and functional parameters of liver and heart conditions. Patients with concomitant MALS differed significantly from patients with an intact liver in terms of higher glucose values at 30´, 60´ and 120´ and the area under the glucose curve, which was accompanied by significantly lower values of Gutt and Cederholm indices of insulin sensitivity in peripheral tissue. Fasting hyperglycemia increased the probability of developing MALS by 4.73 times compared to intact liver (95% CI=1.83-12.22; Z-statistic 3.211; p=0.0013).

Conclusions. Carbohydrate metabolism changes already at the stage of liver steatosis, with an increase in insulin resistance of the liver and a decrease in insulin sensitivity of peripheral tissues; therefore, hyperglycemia is an essential feature of the difference between an intact liver and steatosis.