Relationship of Liver Enzymes to Homeostatic Model Assessment Insulin Resistance in Non-Alcoholic Fatty Liver Disease Patients: A Meta-Analysis and Systematic Review

Studies have assessed that the liver enzymes were proven having the association with insulin resistance (IR) in patients with liver disease; however, there were conflicting findings across the reports. The purpose of this study was to assess the association between liver enzymes and Homeostatic Model Assessment Insulin Resistance (HOMA-IR) in patients with non-alcoholic fatty liver disease (NAFLD). We conducted a meta-analysis between April 2022 and August 2022. Data were obtained from articles in PubMed, ScienceDirect, Cochrane Library, and Taylor & Francis. Using a Z test, the liver enzymes and the HOMA-IR among patients with NALD were compared. We included 683 patients with elevated liver enzymes and 3.579 patients with normal liver enzymes, retrieved from five papers. HOMA-IR score appeared higher in patients with NAFLD with elevated alanine aminotransferase (ALT) than in patients with normal ALT [ALT, mean difference (MD): 1.02; 95% confidence interval (CI): 0.49, 1.54]. Conversely, the aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) had no crucial impact in affectting the HOMA-IR when compared between patients with NAFLD and control [(AST, MD: 0.81; 95% CI: 0.21, 1.40), (GGT, MD: 0.77; 95% CI: 0.20, 1.34), and (ALP, MD: 0.90; 95% CI: 0.22, 1.57)]. IR assessed using HOMAIR has a significant association with abnormal liver enzymes in patients with NAFLD.