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. 2023 May 8:14:1133991.
doi: 10.3389/fendo.2023.1133991. eCollection 2023.

Blood lactate levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease in type 2 diabetes: a real-world study

Yi-Lin Ma  1 , Jiang-Feng Ke  2 , Jun-Wei Wang  1 , Yu-Jie Wang  1 , Man-Rong Xu  1 , Lian-Xi Li  1
Affiliations

Blood lactate levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease in type 2 diabetes: a real-world study

Yi-Lin Ma et al. Front Endocrinol (Lausanne). .

Abstract

Aim: To investigate the association between blood lactate levels and metabolic dysfunction-associated fatty liver disease (MAFLD) in type 2 diabetes mellitus (T2DM).

Methods: 4628 Chinese T2DM patients were divided into quartiles according to blood lactate levels in this real-world study. Abdominal ultrasonography was used to diagnosis MAFLD. The associations of blood lactate levels and quartiles with MAFLD were analyzed by logistic regression.

Results: There were a significantly increased trend in both MAFLD prevalence (28.9%, 36.5%, 43.5%, and 54.7%) and HOMA2-IR value (1.31(0.80-2.03), 1.44(0.87-2.20), 1.59(0.99-2.36), 1.82(1.15-2.59)) across the blood lactate quartiles in T2DM patients after adjustment for age, sex, diabetic duration, and metformin use (all p<0.001 for trend). After correcting for other confounding factors, not only increased blood lactate levels were obviously associated with MAFLD presence in the patients with (OR=1.378, 95%CI: 1.210-1.569, p<0.001) and without taking metformin (OR=1.181, 95%CI: 1.010-1.381, p=0.037), but also blood lactate quartiles were independently correlated to the increased risk of MAFLD in T2DM patients (p<0.001 for trend). Compared with the subjects in the lowest blood lactate quartiles, the risk of MAFLD increased to 1.436-, 1.473-, and 2.055-fold, respectively, in those from the second to the highest lactate quartiles.

Conclusions: The blood lactate levels in T2DM subjects were independently associated with an increased risk of MAFLD, which was not affected by metformin-taking and might closely related to insulin resistance. Blood lactate levels might be used as a practical indicator for assessing the risk of MAFLD in T2DM patients.

Keywords: HOMA2-IR; insulin resistance; lactate; metabolic dysfunction-associated fatty liver disease; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparisons of MAFLD prevalence and blood lactate level in T2DM patients stratified by sex, metformin use, age, and DD. (A) Comparison of MAFLD prevalence stratified by sex after adjusting for metformin use, age, and DD (p<0.001). (B) Comparison of MAFLD prevalence stratified by metformin use after adjusting for the sex, age and DD (p<0.001). (C) Comparison of MAFLD prevalence stratified by age after adjusting for sex, metformin use, and DD (p<0.001 for trend). (D) Comparison of MAFLD prevalence stratified by DD after adjusting for sex, metformin use, and age (p<0.001 for trend). (E) Comparison of blood lactate level stratified by sex after adjusting for metformin use, age, and DD (p<0.001). (F) Comparison of blood lactate level stratified by metformin use after adjusting for the sex, age, and DD (p<0.001). (G) Comparison of blood lactate level stratified by age after adjusting for sex, metformin use, and DD (p=0.114 for trend). (H) Comparison of blood lactate level stratified by DD after adjusting for sex, metformin use, and age (p=0.002 for trend).
Figure 2
Figure 2
Comparisons of blood lactate level between the T2DM patients with and without MAFLD and MAFLD prevalence across the lactate quartiles. (A) Comparison of blood lactate level between the T2DM patients with and without MAFLD (p<0.001). (B) Comparison of MAFLD prevalence across the blood lactate quartiles (p<0.001 for trend). (C) Comparison of blood lactate level among the T2DM patients with different degree of obesity (p=0.218 for trend). (D) Comparison of blood lactate level among the T2DM patients with different degree of abdominal obesity (p=0.106 for trend).
Figure 3
Figure 3
Comparisons of serum ALT and γ-GT level in different groups. (A) Comparisons of serum ALT level between the T2DM patients with and without MAFLD (p < 0.001). (B) Comparisons of serum ALT level across the blood lactate quartile (p= 0.208 for trend). (C) Comparisons of serum γ-GT level between the T2DM patients with and without MAFLD (p < 0.001). (D) Comparisons of serum γ-GT levels across the blood lactate quartile (p < 0.001 for trend).
Figure 4
Figure 4
Correlation of blood lactate with insulin resistance. (A) Comparison of HOMA2-IR between the T2DM patients with and without MAFLD (p<0.001). (B) Correlation of blood lactate level with HOMA2-IR after adjusting for sex, age, metformin use, and DD (p<0.001). (C) Comparison of HOMA2-IR across the blood lactate quartile (p<0.001 for trend).
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