Association between alcohol intake, insulin resistance, and higher fatty liver index in community residents: the KOBE study

Abstract

Objective: Fatty liver is a phenotype of visceral fat accumulation in the liver, and excessive alcohol consumption is known to be a risk factor for fatty liver. In this study, we investigated the association between drinking habits and homeostatic model assessment for insulin resistance (HOMA-IR), a marker of insulin resistance, and higher levels of fatty liver index (FLI) in community residents.

Methods: We conducted a cross-sectional study using data from 1,078 participants in the baseline survey of the KOBE study, which included men and women aged 40-74 years who had no history of cardiovascular disease and were not receiving treatment for lifestyle-related diseases. Drinking habits were classified into 4 groups for men (none, <1 gou/day, 1-2 gou/day, and ≥2 gou/day) and 3 groups for women (none, <1 gou/day, and ≥1 gou/day) based on the amount of alcohol consumed per day, and higher FLI was defined as FLI 30 or higher, which is suspicious for the presence of fatty liver. The association between drinking habits, HOMA-IR, and higher FLI was examined by multivariate logistic regression analysis, and odds ratios and 95% confidence intervals were calculated.

Results: Among 1,078 subjects (323 men and 755 women, mean age 58.9 years), 172 (16.0%) had higher FLI. Regarding the association between drinking habits and FLI, there was a significant positive association with higher FLI prevalence in the 1-2 gou/day and ≥2 gou/day groups for men, and a significant positive association with higher FLI prevalence in the ≥1 gou/day group for women. HOMA-IR was also significantly positively associated with higher FLI in both men and women. Similar results were obtained in analyses restricted to non-obese individuals.

Conclusions: Current drinkers of ≥1 gou/day was significantly positively associated with higher FLI prevalence in both men and women in community residents, mainly among non-obese individuals. Even among non-obese individuals who drink heavily on a daily basis, moderation in alcohol consumption should be recommended because the increased insulin resistance associated with fatty liver may lead to the development of cardiovascular disease. In addition, FLI reflects insulin resistance even in non-obese individuals.