The usefulness of metabolic score for insulin resistance for the prediction of incident non-alcoholic fatty liver disease in Korean adults

Abstract

[GRAPHICS] Study Highlights NAFLD is closely related to insulin resistance. We determined which insulin resistance index (METS-IR and HOMA-IR) is more useful to predict the prevalence of NAFLD as well as the incidence of NAFLD by analyzing data from a community-based, prospective Korean cohort study. METS-IR showed higher predictive power for the incidence of NAFLD than HOMA-IR (iAUC: 0.683 vs. 0.551, P<0.001). Moreover, METS-IR and HOMA-IR showed similar predictive powers for the prevalence of NAFLD (AUC: 0.824 vs. 0.831, P= 0.276). Our findings suggest that METS-IR can be a more useful for the early detection and prevention of NAFLD than the HOMA-IR. Background/Aims: The early detection and prevention of non-alcoholic fatty liver disease (NAFLD) has been emphasized considering the burden of this disease. Both hepatic and peripheral insulin resistances are strongly associated with NAFLD. We aimed to compare the predictive powers of a hepatic insulin resistance index, the homeostatic model assessment for insulin resistance (HOMA-IR), and a novel peripheral insulin resistance index, the metabolic score for insulin resistance (METS-IR), for the prediction of prevalent and incident NAFLD. Methods: Data from 8,360 adults aged 40- 69 years at baseline and 5,438 adults without NAFLD who were followed-up at least once after the baseline survey in the Korean Genome and Epidemiology Study were analyzed. The survey was performed biennially, up to the eighth follow-up. Results: The predictive powers of the METS-IR and HOMA-IR for prevalent NAFLD were not significantly different (area under the receiver operating characteristic [ROC] curve [95% confidence interval]: METS-IR, 0.824 [0.814-0.834]; HOMAIR, 0.831 [0.821-0.842]; P=0.276). The area under the time-dependent ROC curve (Heagerty&apos;s integrated area under the curve) of the METS-IR for incident NAFLD was 0.683 (0.671-0.695), significantly higher than that of the HOMA-IR (0.551 [0.539-0.563], P<0.001). Conclusions: The METS-IR is superior to the HOMA-IR for the prediction of incident NAFLD and is not inferior to the HOMA-IR for the prediction of prevalent NAFLD. This suggests that the METS-IR can be a more useful insulin resistance index than the HOMA- IR for the early detection and prevention of NAFLD in Korean population.