SFEBES2013 Poster Presentations Obesity, diabetes, metabolism and cardiovascular (67 abstracts)
Non-alcoholic fatty liver disease in patients attending the National Severe Insulin Resistance Service
Sarah M Leiter 1 , Alison Sleigh 2 , Claire Adams 1, , Julie Harris 1, , David J Lomas 4, , Michael Allison 6 , Robert Semple 1, , David Savage 1, & Anna Stears 1,
1Metabolic Research Laboratories, University of Cambridge, Cambridge, UK; 2Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK; 3Wolfson Department of Diabetes and Endocrinology, Addenbrookes Hospital, Cambridge, UK; 4Department of Radiology, University of Cambridge, Cambridge, UK; 5Department of Radiology, Addenbrookes Hospital, Cambridge, UK; 6Department of Medicine, Addenbrookees Hospital, Cambridge, UK.
Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) is greatly increased in patients with lipodystrophy and some other forms of severe insulin resistance. Liver biopsy remains the definitive technique for diagnosis and staging of NAFLD. However, non-invasive techniques, such as magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI) are increasingly used to assess response to therapeutic interventions. The National Severe Insulin Resistance (SIR) Service, commissioned by the National Specialist Commissioning Team in 2011, aims to optimise outcomes of patients with lipodystrophy and/or SIR. Selected patients, including all those receiving leptin therapy, are offered annual measurement of liver fat using MRS or MRI.
Patient population: Liver fat was measured in 28 patients (23 female), median (range) age 28 (13–58) years, BMI 25.8 (15.8–34.0) kg/m2. Twenty-four have lipodystrophy and four have SIR of currently unknown cause. None have an insulin receptor mutation. 11 were taking leptin. 13/28 patients were scanned using proton single voxel MRS and 15/28 patients were scanned using in-phase and out of phase gradient-echo MRI with dual flip angles.
Results: 23/28 (82.0%) patients had >5% liver fat. Median (range) liver fat was 22.6% (1.4–102.0) in patients scanned by MRS and 9.0% (2.0–29.0) in those scanned by MRI. Biopsies were available in two patients. Interestingly these patients both have biopsy proven fibrotic liver disease, but relatively low liver fat by MRI of 4.0 and 6.0% respectively.
Conclusion: As expected, there is a very high prevalence of NAFLD in patients with lipodystrophy and/or SIR attending the National SIR Service. MRI/S based assessment of hepatic steatosis may be useful in assessing response to therapy, but a normal result does not preclude the presence of significant NAFLD and may even signify the presence of fibrosis in some cases, though this is yet to be formally proven.
Declaration of funding: The National Severe Insulin Resistance service is funded by the National Specialist Commissioning Team.
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Endocrine Abstracts
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