<a><b>Objective</b></a>: The rs738409(G) single-nucleotide polymorphism (SNP)
in the patatin-like phospholipase domain-containing 3 (<i>PNPLA3</i>) gene associates with increased risk and progression of
nonalcoholic fatty liver disease (NAFLD). As the recently-described severe
insulin-resistant diabetes (SIRD) cluster specifically relates to NAFLD, this
study examined whether this SNP differently associates with hepatic lipid
content (HCL) and insulin sensitivity in recent-onset diabetes mellitus.
<p><b>Research Design and Methods</b>: A total of 917 participants of the German Diabetes
Study underwent genotyping, hyperinsulinemic-euglycemic clamps with stable
isotopic tracer dilution and magnetic resonance spectroscopy. </p>
<p><b>Results:</b> The G allele associated positively with HCL (β=0.36, p<0.01), independent
of age, sex and BMI across the whole cohort, but not in the individual
clusters. SIRD exhibited lowest whole-body insulin sensitivity compared to
severe insulin-deficient (SIDD), moderate obesity-related (MOD), moderate
age-related (MARD) and severe autoimmune diabetes clusters (SAID; all p<0.001).
Interestingly, SIRD presented with higher prevalence of the rs738409(G) SNP compared
to other clusters and the glucose-tolerant control group (p<0.05). HCL was
higher in SIRD [13.6 (5.8;19.1)%] compared to MOD [6.4 (2.1;12.4)%, p<0.05],
MARD [3.0 (1.0;7.9)%, p<0.001], SAID [0.4 (0.0;1.5)%, p<0.001] and the
glucose tolerant group [0.9 (0.4;4.9)%, p<0.001]. Although the <i>PNPLA3</i> polymorphism did not directly
associate with whole-body insulin sensitivity in SIRD, the G allele carriers had
higher circulating free fatty acid concentrations and greater adipose-tissue
insulin resistance compared to non-carriers (both p<0.001).</p>
<b>Conclusions:</b> Members
of the severe insulin resistant diabetes cluster are more frequently carriers
of the rs738409(G) variant. The SNP-associated adipose-tissue insulin
resistance and excessive lipolysis may contribute to their NAFLD.