The aim of this study was to investigate the association between type 2 diabetes and hepatic fat content while taking into account the contribution of obesity and insulin resistance. The study population included 13 diabetic obese (DO), 10 nondiabetic obese (NDO), and 9 normal-weight control (C) men aged 28-65 years. DO subjects were treated with diet (n=8) or diet and metformin (n=5) in optimal blood glucose control (HbA1c=6.8±0.8%). Liver fat content was measured by 1H-magnetic resonance spectroscopy (1H-MRS), abdominal fat distribution by magnetic resonance imaging (MRI) and insulin sensitivity by hyperinsulinemic-euglycemic clamp. Results showed that DO patients had a significantly greater hepatic fat content than both lean controls and nondiabetic, similarly obese individuals. The obese subjects with and without diabetes were all normotriglyceridemic men with no significant differences in body mass index, waist circumference, intra-abdominal (visceral) fat and whole-body insulin sensitivity suggesting that there are other factors specifically related to diabetes that could explain the association between diabetes and hepatic fat content. Abdominal subcutaneous fat was significantly lower in DO than in NDO subjects. Thus, these results suggest that the association between type 2 diabetes and increased liver fat was independent of obesity and whole-body insulin resistance and that liver fat in DO patients may reflect in part the incapacity of subcutaneous fat to store the excess energy.
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