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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

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Volume 57, Issue 8


Fasting serum bile acids concentration is associated with insulin resistance independently of diabetes status

Sang-Guk Lee
  • Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
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/ Yong-ho Lee
  • Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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/ Eunhye Choi
  • Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
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/ Yonggeun Cho
  • Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
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/ Jeong-Ho Kim
  • Corresponding author
  • Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-04-09 | DOI: https://doi.org/10.1515/cclm-2018-0741



Bile acids (BAs) have been demonstrated to exert a variety of metabolic effects and alterations in BAs have been reported in patients with obesity, insulin resistance (IR) and type 2 diabetes mellitus (T2DM). However, it is unclear which metabolic condition is the main contributor to alterations in BAs. In this study, we investigate the associations between different BA profiles with glycemia, obesity or IR status.


Fasting serum concentrations of 15 BA species were determined in a total of 241 individuals (71 drug-naïve patients with T2DM, 95 patients with impaired fasting glucose [IFG], and 75 healthy controls.


A comparison of the mean values of the BAs revealed no significant differences between normoglycemic controls and patients with IFG or T2DM. However, when the entire cohort was divided according to the presence of IR as determined by a homeostasis model assessment of insulin resistance (HOMA-IR) value >2.5, the levels of total BA and most species of BAs were significantly higher in patients with IR than in patients without. In the correlation analysis, most species of BAs, as well as total BA, were significantly associated with HOMA-IR levels. Furthermore, when the subjects were divided into four groups according to IR and diabetic status, subjects with IR had significantly higher total BAs than participants without IR both in diabetic and non-diabetic groups. Ultimately, multiple linear regression analysis identified HOMA-IR as the only significant contributor to most serum BA species.


Our findings support the essential role of IR in regulating BA metabolism and that this effect is independent of diabetic status.

This article offers supplementary material which is provided at the end of the article.

Keywords: bile acids profile; GLP-1; insulin resistance; obesity; type 2 diabetes mellitus


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About the article

Corresponding author: Jeong-Ho Kim, MD, PhD, Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea, Phone: +82-2-2228-2448, Fax: +82-2-313-0956

Received: 2018-07-16

Accepted: 2018-12-20

Published Online: 2019-04-09

Published in Print: 2019-07-26

Author contributions: S-G. L. designed the study, analyzed all data and wrote the manuscript. Y. L. recruited the patients and contributed critical discussions. E. C. performed experiments and researched the data. Y. C. contributed critical discussions and produced the illustrations. J-H. K. researched data, contributed statistical analysis and edited the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Ministry of Science, ICT and Future Planning, Republic of Korea (NRF-2017R1C1B5015044) and the faculty research grant of Yonsei University College of Medicine (6-2017-0051).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 8, Pages 1218–1228, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2018-0741.

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