Liver steatosis is associated with insulin resistance in skeletal muscle rather than in the liver in J apanese patients with non‐alcoholic fatty liver disease

Aims/Introduction To examine the association between liver histological features and organ‐specific insulin resistance indices calculated from 75‐g oral glucose tolerance test data in patients with non‐alcoholic fatty liver disease. Materials and Methods Liver biopsy specimens were obtained from 72 patients with non‐alcoholic fatty liver disease, and were scored for steatosis, grade and stage. Hepatic and skeletal muscle insulin resistance indices (hepatic insulin resistance index and Matsuda index, respectively) were calculated from 75‐g oral glucose tolerance test data, and metabolic clearance rate was measured using the euglycemic hyperinsulinemic clamp method. Results The degree of hepatic steatosis, and grade and stage of non‐alcoholic steatohepatitis were significantly correlated with Matsuda index (steatosis r  = −0.45, P  < 0.001; grade r  = −0.54, P  < 0.001; stage r  = −0.37, P  < 0.01), but not with hepatic insulin resistance index. Multiple regression analyses adjusted for age, sex, body mass index and each histological score showed that the degree of hepatic steatosis (coefficient = −0.22, P  < 0.05) and grade (coefficient = −0.40, P  < 0.01) were associated with Matsuda index, whereas the association between stage and Matsuda index (coefficient = −0.07, P  = 0.593) was no longer significant. A similar trend was observed for the association between steatosis and metabolic clearance rate (coefficient = −0.62, P  = 0.059). Conclusions Liver steatosis is associated with insulin resistance in skeletal muscle rather than in the liver in patients with non‐alcoholic fatty liver disease, suggesting a central role of fatty liver in the development of peripheral insulin resistance and the existence of a network between the liver and skeletal muscle.