Non-alcoholic fatty liver disease in non-obese subjects of African origin has atypical metabolic characteristics

Abstract

Background: Non-obese non-alcoholic fatty liver disease (NAFLD) is reported in several populations. However, as persons of African origin display unique fat accumulation, insulin resistance and lipid profiles, we investigated fatty liver in non-obese persons of African origin. Method: We recruited 78 urban Jamaican volunteers. CT scan was used to estimate liver and abdominal fat; body composition by D-EXA. Fasting blood was collected for lipids, alanine aminotransferase (ALT), adiponectin and fetuin-A. Homeostatic model assessment of insulin resistance (HOMA), whole body insulin sensitivity index (WBISI), insulinogenic index (IGI) and oral disposition index (oDI) were calculated after a 75-g oral glucose tolerance test. Results: 52% of the participants were male; mean age 28.5±7.8 years and BMI 22.4±3.0 kg/m2 (±SDs). Mean liver attenuation (MLA) and liver: spleen (LS) ratio, both inversely correlated to liver fat, were 62.8±4.3 HU and 1.2±0.1 respectively, and 3.8% of the participants had liver fat >30% (LS ratio<1). In age, sex and BMI-adjusted correlations, MLA was negatively associated with weight (r=-0.30, p=0.009) and height (r=-0.28, p=0.017) and associated with fasting glucose (r=0.23, p=0.05), fasting insulin (r=0.42, p ≤ 0.001) and HOMA-IR (r=0.35, p=0.004). Serum lipids, ALT, adiponectin, fetuin A, WBISI, IGI and oDI were not associated with liver fat. Conclusions: In non-obese Afro-Caribbean participants, greater liver fat (lower MLA) was associated with weight and height and lower fasting insulin. Hyperinsulinaemia appears to be influential in the reduction of NAFLD in this group. These findings may be influenced by ethnicity, body size and the method of estimating liver fat.

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ORCID for Christopher Byrne: orcid.org/0000-0001-6322-7753

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