HbA1C as a Biomarker of Non-alcoholic Fatty Liver Disease: Comparison with Anthropometric Parameters

Background and Aims: Multiple non-invasive methods including radiological, anthropometric and biochemical markers have been reported with variable performance. The present study assessed glycosylated hemoglobin (HbA(1C)) as a biomarker to predict non-alcoholic fatty liver disease (NAFLD) and its severity, compared with body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC) Methods: This case control study included 450 individuals, including 150 cases and 300 age- and gender-matched controls recruited from the Dow Radiology Institute on the basis of radiological findings of fatty infiltration on abdominal ultrasound through convenient sampling. BMI, WHR and WC were measured according to standard protocols. HbA(1C) was determined by turbidimetric inhibition immunoassay Results: Among the cases and controls, 66% and 32% had HbA(1C) levels higher than 5.7% respectively. HbA(1C) and BMI were significantly associated with NAFLD [crude odds ratio (cOR)=4.12, 2.88, 2.25 (overweight) and 4.32 (obese)]. WC was found to be significantly associated with NAFLD for both genders (cOR in males=5.50 and females=5.79, p<0.01). After adjustment for other parameters, HbA(1C) and WC were found to be significantly associated with NAFLD (aOR=3.40, p<0.001) along with WC in males (aOR=2.91, p<0.05) and in females (aOR=4.28, p<0.05). A significant rise in severity of hepatic steatosis was noted with increases in HbA(1C), BMI and WC. HbA(1C) possessed a positive predictive value of 76% for the study population [0.76, confidence interval (CI): 0.715-0.809], 70.6% for males (0.706, CI: 0.629-0.783) and 80% for females (0.80, CI: 0.741-0.858). Conclusions: Higher than normal HbA(1C) and WC measurements possess a more than 70% potential to predict NAFLD. It is the single risk factor that is strongly associated with NAFLD after adjustment for indices of body measurements. HbA(1C) may be presented as a potential biomarker for NAFLD in examination with other anthropometric measures in the adult population.

Automated summary

This study found that higher than normal levels of HbA(1C) and waist circumference measurements can predict NAFLD, with HbA(1C) being a single risk factor strongly associated with NAFLD. Additionally, the severity of hepatic steatosis increases with higher levels of HbA(1C), BMI, and waist circumference.