Predictors of Nonalcoholic Steatohepatitis in Patients With Type 1 Diabetes

Fatty liver, liver steatosis. Photomicrograph showing large vacuoles of triglyceride fat accumulated inside liver cells, it occurs in alcohol overuse, under action of toxins, in diabetes
Investigators sought to determine if a relationship exists between nonalcoholic fatty liver and adipose tissue, waist-to-height ratio, and body mass index in patients with type 1 diabetes.

In patients with type 1 diabetes, increased visceral adipose tissue was found to be associated with nonalcoholic fatty liver, according to the results of a study published in Diabetes Care.

Data were analyzed from the ongoing prospective Finnish Diabetic Nephropathy (FinnDiane) Study and were collected at 93 centers in Finland from 2011 to 2017. The study participants (N=121) were assessed for liver and kidney health, body composition, and insulin sensitivity.

The median age of participants was 38.5 years (interquartile range [IQR], 32.3-43.7), 52.1% were women, 50.4% had central obesity (waist-to-height ratio ≥0.5), and 11.6% had nonalcoholic fatty liver. Individuals with nonalcoholic fatty liver had a longer duration of diabetes (median, 27.8 vs 20.6 y; P =.049), higher triglycerides (median, 2.05 vs 0.86 mmol/L; P <.001), glycated hemoglobin (mean, 9.0% vs 8.0%; P =.002), liver fat fraction (10.5% vs 0.8%; P <.001), and waist-to-height ratio (mean, 0.60 vs 0.49; P <.001). Nonalcoholic fatty liver was associated with increased visceral (median, 1.83% vs 0.55%; P =.012) and android (median, 3.47% vs 2.40%; P =.023) adipose tissues.

In the fully adjusted multivariate model, the only compartments of body adipose tissue that were significantly associated with nonalcoholic fatty liver were visceral adipose tissue percentage (adjusted odds ratio [aOR], 4.09; 95% CI, 1.22-13.74; P =.02) and area (aOR, 1.001; 95% CI, 1.000-1.002; P =.03). Additional predictors of nonalcoholic fatty liver included waist-to-height ratio (aOR, 7.50; P =1.40 x 10-4) and body mass index (BMI) (aOR, 1.22; P =.004).

The best cutoffs for waist-to-height ratio and BMI were determined to be 0.5 (sensitivity, 86%; specificity, 55%) and 26.6 kg/m2 (sensitivity, 79%; specificity, 57%) for predicting nonalcoholic fatty liver in patients with type 1 diabetes, respectively.

The association of nonalcoholic fatty liver with waist-to-height ratio was stronger (area under the curve [AUC], 0.823; 95% CI, 0.692-0.955; P <.001) than with BMI (AUC, 0.720; 95% CI, 0.572-0.955; P <.007).

This study was limited by not assessing individuals for fibrosis, dietary habits, or physical activity. However, the study data indicated that assessing individuals with type 1 diabetes for visceral adipose tissue and waist-to-height ratio may be effective in screening for the risk of nonalcoholic fatty liver in this population.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Parente EB, Dahlström EH, Harjutsalo V, et al; on behalf of the FinnDiane Study Group. The relationship between body fat distribution and nonalcoholic fatty liver in adults with type 1 diabetes. Diabetes Care. Published online May 24, 2021. doi:10.2337/dc20-3175