Published online Aug 28, 2018. doi: 10.3748/wjg.v24.i32.3663
Peer-review started: May 31, 2018
First decision: July 4, 2018
Revised: July 6, 2018
Accepted: July 16, 2018
Article in press: July 16, 2018
Published online: August 28, 2018
To determine whether fasting C-peptide is an independent predictor for non-alcoholic fatty liver disease (NAFLD) in United States population.
Using the National Health and Nutrition Examination Survey (NHANES) 1988-1994, NAFLD participants aged 20 or greater without any other liver diseases were included in this study. Excessive alcohol intake is defined as > 2 drinks per day for males and > 1 drink per day for females. C-peptide and 27 other factors known to be associated with NAFLD (e.g., age, gender, body mass index, waist circumference, race/ethnicity, liver chemistries, and other diabetes tests) were tested in both univariate and multivariate level using logistic regression with a P-value 0.05.
Of 18825 participants aged ≥ 20, 3235 participants (n = 3235) met inclusion criteria. There were 23 factors associated with NAFLD by univariate analysis. 9 factors, ranked by the highest change in pseudo R2, were found to be significant predictors of NAFLD in multivariate model: waist circumference, fasting C-peptide, natural log of alanine aminotransferase (ALT), total protein, being Mexican American, natural log of glycated hemoglobin, triglyceride level, being non-Hispanic white, and ferritin level.
Together with waist circumference and ALT, fasting C-peptide is among three most important predictors of NAFLD in United States population in the NHANES data set. Further study is needed to validate the clinical utility of fasting C-peptide in diagnosis or monitoring insulin resistance in NAFLD patients.
Core tip: Non-alcoholic fatty liver disease (NAFLD) is a growing global epidemic and associated with many conditions and factors, including insulin resistance. However, C-peptide has not been used in practice to assess insulin resistance in NAFLD patients. Using a large national dataset, we demonstrated that three most important risk factors for NAFLD are waist circumference, fasting C-peptide, and alanine aminotransferase, respectively. Such results revealed that C-peptide superior to measurement of fasting insulin levels and can potentially be used for screening or monitoring the degree of insulin resistance in NAFLD.