Early changes in hepatic energy metabolism and lipid content in recent-onset type 1 and 2 diabetes mellitus

J Hepatol. 2021 May;74(5):1028-1037. doi: 10.1016/j.jhep.2020.11.030. Epub 2020 Nov 28.


Background & aims: Non-alcoholic fatty liver disease (NAFLD) is associated with abnormal mitochondrial capacity. While oxidative capacity can be increased in steatosis, hepatic ATP decreases in long-standing diabetes. However, longitudinal studies on diabetes-related NAFLD and its relationship to hepatic energy metabolism are lacking.

Methods: This prospective study comprised volunteers with type 1 (T1DM, n = 30) and type 2 (T2DM, n = 37) diabetes. At diagnosis and 5 years later, we used 1H/31P magnetic resonance spectroscopy to measure hepatocellular lipid (HCL), γATP and inorganic phosphate (Pi) concentrations, and to assess adipose tissue volumes. Insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamps.

Results: At diagnosis, individuals with T2DM had higher HCL and adipose tissue volumes, but lower whole-body insulin sensitivity than those with T1DM, despite comparable glycemic control. NAFLD was present in 38% of individuals with T2DM and 7% with T1DM. After 5 years, visceral adipose tissue only increased in individuals with T2DM, while HCL almost doubled in this group (p <0.001), resulting in a 70% prevalence of NAFLD (independent of diabetes treatment). Changes in HCL correlated with adipose tissue volume and insulin resistance (r = 0.50 and r = 0.44, both p <0.05). Pi decreased by 17% and 10% in individuals with T2DM and T1DM (p <0.05), respectively. In T1DM, HCL did not change, whereas γATP decreased by 10% and correlated negatively with glycated hemoglobin (r = -0.56, p <0.05).

Conclusions: The rapid increase in HCL during the early course of T2DM likely results from enlarging adipose tissue volume and insulin resistance in response to impaired hepatic mitochondrial adaptation. The decrease of phosphorus metabolites in T1DM may be due to pharmacological insulin supply.

Lay summary: Previous studies suggested that the impaired function of mitochondria, the power plants of cells, can promote fatty liver and type 2 diabetes mellitus. This study now shows that during the first 5 years of type 2 diabetes the increase in body fat content rapidly leads to a doubling of liver fat content, whereas the energy metabolism of the patients' livers progressively declines. These data suggest that fat tissue mass and liver mitochondria have an important role in the development of fatty liver disease in humans with diabetes.

Clinical trial number: NCT01055093.

Keywords: body composition; hepatocellular lipid content; insulin resistance; magnetic resonance spectroscopy; phosphorus metabolites.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue* / diagnostic imaging
  • Adipose Tissue* / metabolism
  • Adipose Tissue* / pathology
  • Body Composition / physiology
  • Body Fat Distribution
  • Diabetes Mellitus, Type 1* / diagnosis
  • Diabetes Mellitus, Type 1* / metabolism
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / metabolism
  • Energy Metabolism / physiology*
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Insulin Resistance / physiology
  • Lipid Metabolism / physiology
  • Liver* / metabolism
  • Liver* / pathology
  • Magnetic Resonance Spectroscopy / methods
  • Male
  • Middle Aged
  • Mitochondria, Liver / physiology*
  • Non-alcoholic Fatty Liver Disease* / diagnosis
  • Non-alcoholic Fatty Liver Disease* / metabolism


  • Glycated Hemoglobin A

Associated data

  • ClinicalTrials.gov/NCT01055093