한국 비당뇨 성인에서 비알코올지방간질환 선별검사로 Homeostatic Model Assessment of Insulin Resistance의 활용 가능성 = Homeostatic Model Assessment of Insulin Resistance as a Potential Screening Test for Non-Alcoholic Fatty Liver Disease in Korean Adults without Diabetes

다국어 초록 (Multilingual Abstract)

Background: Non-alcoholic fatty liver disease (NAFLD) prevalence rapidly increases worldwide and may lead to end-stage liver disease such as cirrhosis or hepatocellular carcinoma. This study aimed to examine the relationship between NAFLD and insulin resistance, evaluate the accuracy of homeostatic model assessment of insulin resistance (HOMA-IR) for NAFLD in Korean adults without diabetes as a screening tool, and estimate the optimal cut-off value for distinguishing NAFLD from non-NAFLD.
Methods: This cross-sectional study included 12,924 Korean adults aged ≥19 years who participated in the Korean National Health and Nutrition Examination Survey, 2019–2021. Subjects were categorized into two groups based on the hepatic steatosis index (≥30 or <30) as a simple screening tool for NAFLD. We used HOMA-IR as a method to measure insulin resistance. The receiver operating characteristic analysis determined the optimal cut-off value for identifying NAFLD. The association between NAFLD and HOMA-IR was examined using logistic regression analysis.
Results: The area under the curve of HOMA-IR to identify NAFLD was 76.3%. The optimal threshold of HOMA-IR for distinguishing NAFLD from non- NAFLD was 1.665. HOMA-IR cut-off was associated with NAFLD (odds ratio, 1.77; 95% confidence interval, 1.53–2.04; P<0.001), independent from general characteristics, triglyceride levels, and body mass index.
Conclusion: HOMA-IR is independently associated with NAFLD in adults without diabetes and could be used as a screening tool in clinical practice.

국문 초록 (Abstract)

연구배경: 비알코올지방간질환은 전 세계적으로 유병률이 급격히 증가하고 있는 질환으로 간경화나 간세포암과 같은 말기 간질환으로 진행될 수 있다. 본 연구는 비알코올지방간질환과 인슐린 저항성의 관계를 평가하고 비당뇨 성인을 대상으로 비알코올지방간질환을예측하기 위한 최적의 homeostatic model assessment of insulin resistance (HOMA-IR) 결정점을 추정하는 것을 목표로 하였다.
방법: 2019–2021년 국민건강영양조사에 참여한 만 19세 이상 성인 중에서 12,924명을 대상자로 하였다. 대상자는 비알코올지방간질환의 선별 지표 중 하나인 hepatic steatosis index값을 이용해 두 그룹(30 이상, 30 미만)으로 분류하였다. 또한, 인슐린 저항성을 나타내는 수치로 HOMA-IR을 이용하였다. 비알코올지방간질환을 예측하기 위한 최적의 HOMA-IR 결정점을 확인하기 위해 receiver operating characteristic curve (ROC curve) analysis를 실시하였고, 해당 결정점이 비알코올지방간질환을 잘 예측하는지 검증하기 위해 로지스틱 회귀분석을 실시하였다.
결과: ROC curve를 통해 확인한 비알코올지방간질환을 예측하기 위한 최적의 HOMA-IR 결정점은 1.665였다(area under the curve=76.3%). 또한 로지스틱 회귀분석을 통해 HOMA-IR 결정점 이상인 경우 비알코올지방간질환이 유의하게 증가함을 확인하였으며, 이는 혼란변수로 작용할 수 있는 일반적인 특성, 중성지방, 체질량지수를 보정한 후에도 유의한 결과를 보였다(odds ratio, 1.77; 95% confidence interval, 1.53–2.04; P<0.001).
결론: HOMA-IR은 당뇨병이 없는 성인에서 비알코올지방간질환과 독립적인 연관성이 있으며, 본 연구를 통해 비알코올지방간질환을 예측하기 위한 선별 도구로 사용할 수 있는 잠재적 가능성을 확인하였다.

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