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1 Turku PET Centre, University of Turku, Turku, Finland
2 Turku PET Centre, University of Turku, Turku, Finland; Department of Radiology, University of Turku, Turku, Finland
3 Turku PET Centre, University of Turku, Turku, Finland; Instutute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
4 Department of Radiology, University of Turku, Turku, Finland
5 Department of Clinical Chemistry, University of Tampere and Tampere University Hospital, Tampere, Finland
6 Medicity Research Laboratory, University of Turku; Department of Medical Microbiology, University of Turku; and Department of Bacterial and Inflammatory Diseases, National Public Health Institute, Turku, Finland
7 Department of Medicine, University of Turku, Turku, Finland
8 Turku PET Centre, University of Turku, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland
* To whom correspondence should be addressed. E-mail: pirjo.nuutila{at}utu.fi.
Nonalcoholic fatty liver (NAFL) is a common co-morbidity in patients with type 2 diabetes and it links to the risk of coronary syndromes. The aim was to determine the manifestations of metabolic syndrome in different organs in patients with liver steatosis. We studied 55 type 2 diabetic patients with coronary artery disease using positron emission tomography. Myocardial perfusion was measured with [15O]H2O and myocardial and skeletal muscle glucose uptake with [18F]FDG during hyperinsulinemic euglycemia. Liver fat content was determined by magnetic resonance proton spectroscopy. Patients were divided based on their median (8%) into two groups with low (4.6±2.0%) and high (17.4±8.0%) liver fat content. The groups were well matched for age, BMI and fasting plasma glucose. In addition to insulin resistance in the whole-body level (P=0.012) and muscle (P=0.002), high liver fat group had lower insulin-stimulated myocardial glucose uptake (P=0.040) and glucose extraction rate (P=0.0006) as compared to the low liver fat group. In multiple regression analysis, liver fat content was the most significant explanatory variable for myocardial insulin resistance. In addition, the high liver fat group had increased concentrations of hsCRP, soluble forms of E-selectin, VAP-1 and ICAM-1 (P<0.05) and lower coronary flow reserve (P=0.02) as compared to the low liver fat group. In conclusion, in patients with type 2 diabetes and coronary artery disease liver fat content is a novel independent indicator of myocardial insulin resistance and reduced coronary functional capacity. Further studies will reveal the effect of hepatic fat reduction on myocardial metabolism and coronary function.
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