Insulin Resistance frequent in Non-Diabetics with NAFLD, reports research

A new study published in the journal of BMC Gastroenterology showed that insulin resistance was quite common in non-diabetic individuals with non-alcoholic fatty liver disease (NAFLD), and most patients were obese.

About 25% of adults worldwide suffer from NAFLD, making it the most common liver condition in the world. This illness can range widely, from cirrhosis to hepatocellular carcinoma (HCC), or from basic fatty liver (NAFL) to steatohepatitis (NASH). Lifestyle therapy, such as dietary modifications and physical exercise, are now the first-line treatment for NAFLD.

One of the key underlying mechanisms of NAFLD, in which the body needs more insulin to maintain regular metabolic processes, is insulin resistance (IR). IR is significantly influenced by lipotoxicity and dysregulation of lipid metabolism, which is also a major risk factor for the onset of Type 2 Diabetes Mellitus (T2DM).

By offering localized data on the prevalence of IR in non-diabetic persons with NAFLD, this study seeks to close this knowledge gap and provide fresh data to our understanding of IR and NAFLD. Thus, to assist in creating and reforming healthcare plans and preventative measures in the region, this study will also investigate the relationship between HOMA-IR and liver enzymes (ALT, AST). 

At Karachi's Liaquat National Hospital two groups of 362 non-diabetic individuals with NAFLD were created: one with IR and one without. In order to assess hepatic steatosis, a physical examination, a clinical history, laboratory tests (fasting lipid profile, insulin, fasting glucose, and liver function tests), and abdominal ultrasonography with fibroscan were conducted. Hepatic steatosis was defined as having a Controlled Attenuation Parameter (CAP) score of > 238 dB/m, and metabolic syndrome was identified using certain clinical and laboratory criteria. Data analysis was done with SPSS version 27.

Of the 362 patients that were enrolled, 51.7% were men. Of the individuals, 311 (84.9%) exhibited insulin resistance. For HDL, FPG, LDL, fasting plasma insulin, and GGT, there were notable differences in insulin resistance. Insulin resistance is less common in male patients than in female individuals. individuals with metabolic syndrome are more likely than non-metabolic individuals to have insulin resistance. Overall, this study found that IR is highly prevalent among non-diabetic individuals with NAFLD in Pakistan, and a significant percentage of these patients are also obese.

Reference:

Kamani, L., Siddiqui, M., & Rahat, A. (2025). Frequency of insulin resistance among non-diabetic patients with non-alcoholic fatty liver disease using HOMA-IR: an experience of a tertiary care hospital in Karachi, Pakistan. BMC Gastroenterology, 25(1), 259. https://doi.org/10.1186/s12876-025-03790-6