Fatty Liver Index may detect diabetes even when blood sugar and IR levels normal

Incidence of Diabetes  is on the rise globally. One of the underlying mechanisms of type 2diabetes is uncontrolled metabolism of glucose . The liver plays an important role in controlling blood sugar in various pathways, including glycogenesis, glycogenolysis, glycolysis, and gluconeogenesis, and several studies have focused on the relationship between liver dysfunction and Type 2 diabetes.

The fatty liver index (FLI) can be very useful for managing fatty liver and preventing related diseases. As of now no large-scale and long-term follow-up prospective studies have investigated the relationship between FLI and incident type 2 diabetes (T2DM) independent of baseline insulin resistance status.

Researchers have found in a new study  that baseline fatty liver index could be a promising guide for the early detection of type 2 diabetes even when prior blood sugar or insulin (HOMA-IR) levels are normal.

The study has been published in the journal Cardiovascular Diabetology. 

Blood sugar provides energy to cells of body and acts as fuel, driving our cells, tissues, muscles and organs to perform their respective tasks. In some individuals cells of body defy the signals that insulin sends and refuse to absorb sugar from the blood and this is called insulin resistance.

When insulin resistance develops blood sugar levels begin to soar and the same leads to development of diabetes. 

Type 2 diabetes (T2DM) is a significant cause of mortality and comorbidity in various cardiovascular diseases and many other types of cancer. Fatty liver disease is commonly associated with T2DM. It is necessary to diagnose fatty liver and identify disease status to prevent liver-related diseases. The fatty liver index (FLI), an easily available tool in clinical practice, can be very useful for managing fatty liver and preventing related diseases. There is not much literature to investigate the relationship between FLI and incident type 2 diabetes (T2DM) independent of baseline insulin resistance status. Hence, researchers from Korea conducted a study to evaluate the association between FLI and incident T2DM and to determine if FLI could be used as an indicator of T2DM using a large-sample, community-based Korean cohort over 12 years. 

Of the 10,030 participants, 7,777 participants with 3,676 men and 4,101 women without diabetes were selected from the present study's Korean Genome and Epidemiology Study (KoGES). FLI is graded into 3 groups low FLI with a score of < 30; intermediate, FLI from 30–59; and high, FLI ≥ 60. The hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM were calculated using multivariate Cox proportional hazards regression models after adjusting for potentially confounding variables. 

Results

• In total, 1,490 individuals (19.2%) developed T2DM during follow-up.
• After adjusting for potentially confounding variables, including the HOMA-IR marker, the HRs of incident T2DM for the FLI (30–59), and FLI (≥ 60) increased compared to the reference FLI (< 30). 
• FLI was positively related to incident T2DM independent of baseline insulin resistance after adjusting for potential confounding variables. 

Thus, the present study throws light on how high FLI precedes and significantly predicts the future development of T2DM among community-dwelling and middle-aged older Korean adults. 

Further reading: Seo, IH., Lee, H.S. & Lee, YJ. Fatty liver index as a predictor for incident type 2 diabetes in community-dwelling adults: longitudinal findings over 12 years. Cardiovasc Diabetol 21, 209 (2022). https://doi.org/10.1186/s12933-022-01642-1