Endogenous sex hormones and nonalcoholic fatty liver disease in US adults

Abstract

Background and AimsSex steroid hormones and sex hormone‐binding globulin (SHBG) have a role in predisposing individuals to nonalcoholic fatty liver disease (NAFLD), but their effects are known to differ between men and women. The testosterone‐to‐estradiol ratio (T/E2 ratio) and free androgen index (FAI) were known biomarkers for the hormonal milieu. We investigated whether sex steroid hormones, T/E2 ratio, FAI, and SHBG were associated with NAFLD in US adults.MethodsA cross‐sectional analysis using the 2013–2016 National Health and Nutrition Examination Survey (NHANES) was performed. NAFLD was defined by utilizing the Hepatic Steatosis Index (HSI) and the US fatty liver index (USFLI) without other causes of chronic liver disease.ResultsOut of 8687 subjects (49.5% male), low total testosterone levels were associated with progressively higher odds of NAFLD in men. Increasing T/E2 ratio was inversely associated with higher odds of NAFLD in men. Low serum SHBG levels were independently associated with an increased risk of NAFLD regardless of sex and menopausal status. Increasing FAI was independently associated with NAFLD. When we additionally adjusted for SHBG, T/E2 ratio, not total testosterone, was inversely associated with NAFLD in a dose‐dependent manner. Increasing FAI was associated with higher odds of NAFLD in premenopausal women and marginally associated with NAFLD in postmenopausal women.ConclusionThe T/E2 ratio and SHBG were inversely associated with an increased risk of NAFLD in men. In women, increasing FAI was associated with NAFLD, whereas SHBG was inversely associated with NAFLD.

Probiotic consumption and hepatic steatosis: results from the NHANES 2011–2016 and Mendelian randomization study

“…HSI was calculated using the following formula: HSI = 8 × ALT/AST + BMI + 2 (if diabetes) + 2 (if female). HSI = 36 was considered the cut-off value for HS ( 26 , 27 ).…”

Association between Lifestyle Modification and All-Cause, Cardiovascular, and Premature Mortality in Individuals with Non-Alcoholic Fatty Liver Disease

“…NHANES collected demographic data, physical examination data, laboratory data, dietary data, and lifestyle information from participants. NAFLD was defined using the HSI and USFLI in the absence of any causes of chronic liver disease and excessive alcohol consumption [16]. We calculated the HSI using this equation: HSI = 8 × (ALT/AST ratio) + body mass index (BMI) (+2, if diabetes; +2, if women).…”

“…The management of NAFLD is like that of other metabolic disorders in that lifestyle changes are the cornerstone and core of NAFLD management [4]. A variety of dietary Nutrients 2024, 16, 2063 2 of 16 patterns, including the Mediterranean diet, have demonstrated efficacy in enhancing the prognosis of NAFLD individuals, including their liver enzyme levels, liver fat, and histology [5,6]. Similarly, the healthy lifestyles of aerobic exercise, non-smoking, non-alcohol consumption, and adequate sleep have all been observed to have beneficial effects [7,8].…”