Hepatic glucose utilization in hepatic steatosis and obesity

Hepatic steatosis is associated with obesity and insulin resistance. Whether hepatic glucose utilisation rate (glucose phosphorylation rate; MRglu) is increased in steatosis and/or obesity is uncertain. Our aim was to determine the separate relationships of steatosis and obesity with MRglu. Sixty patients referred for routine PET/CT had dynamic PET imaging over the abdomen for 30 min post-injection of F-18-fluorodeoxyglucose (FDG), followed by Patlak-Rutland graphical analysis of the liver using abdominal aorta for arterial input signal. The plot gradient was divided by the intercept to give hepatic FDG clearance normalised to hepatic FDG distribution volume (ml/min/100 ml) and multiplied by blood glucose to give hepatic MRglu (mmol/min/100 ml). Hepatic steatosis was defined as CT density of ≤40 HU measured from the 60 min whole body routine PET/CT and obesity as body mass index of ≥30 kg/m2 Hepatic MRglu was higher in patients with steatosis (3.3 ± 1.3 mmol/min/100 ml) than those without (1.7 ± 1.2 mmol/min/100 ml; p<0.001) but there was no significant difference between obese (2.5 ± 1.6 mmol/min/100 ml) and non-obese patients (2.1 ± 1.3 mmol/min/100 ml). MRglu was increased in obese patients only if they had steatosis. Non-obese patients with steatosis still had increased MRglu. There was no association between MRglu and chemotherapy history. We conclude that MRglu is increased in hepatic steatosis probably through insulin resistance, hyperinsulinaemia and upregulation of hepatic hexokinase, irrespective of obesity.