Prolactin is a Key Factor for Nonalcoholic Fatty Liver Disease in Obese Children

Abstract

This study investigates whether serum prolactin (PRL) is a key factor for nonalcoholic fatty liver disease (NAFLD) in children. A total of 691 obese childred participated in this study and were divided into a NAFLD group (n=366) and simple obesity (SOB) group (n=325) according to the hepatic ultrasound results. The two groups were matched for gender, age, pubertal development, and body mass index (BMI). All patients underwent an OGTT test, and fasting blood samples were collected to measure prolactin. Stepwise logistic regression was performed to identify significant predictors of NAFLD. Serum prolactin levels were significantly lower in NAFLD subjects than in the SOB subjects [82.4 (56.36, 118.70) vs. 99.78 (63.89, 153.82), p<0.001] (mIU/l). NAFLD was strongly associated with insulin resistance (HOMA-IR) and prolactin, with lower levels of prolactin increasing the risk of NAFLD (adjusted ORs = 1.741; 95% CI: 1.059–2.860) across the prolactin concentration tertiles after adjustment for confounders. Low serum prolactin levels are associated with the presence of NAFLD; thus, increased circulating prolactin might be a compensatory response for obesity in children.

Gender differences in non-alcoholic fatty liver disease in obese children and adolescents: a large cross-sectional study

“…Another study by Shao et al [26] found that hepatic TG accumulation could be reduced in female mice, and liver steatosis could be alleviated in male mice when given PRL in a high-fat diet-induced NAFLD model. Considering that a decrease in PRL has been observed in NAFLD patients of both genders [24,27], whether there are sexual differences between serum PRL and NAFLD remains unknown. During this study, we observed a weak correlation between sex hormones and ALT (Supplementary Table 3).…”

Re: Prolactin is a Key Factor for Nonalcoholic Fatty Liver Disease in Obese Children

“…The study of Zhang et al [ 1 ] exhibits a signifi cant selection bias, which should have been addressed. It is not understandable, why patients with hyperprolactinemia were excluded from the study population, when prolactin levels are the main factor under investigation.…”

Reply to the Letter to the Editor on “Prolactin is a Key Factor for Nonalcoholic Fatty Liver Disease in Obese Children”

“…

Dear Editor,The authors thank the writers [1] of the letter for reviewing and assessing our article [2], "Prolactin is a Key Factor for Nonalcoholic Fatty Liver Disease in Obese Children". Overall, we agree that possible selection bias must be considered.

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“…Hyperprolactinemia was used as an exclusion criterion in the study. According to the Chinese consensus on hyperprolactinemia diagnosis and management 3 , hyperprolactinemia is a clinical diagnosis based on a comprehensive analysis of clinical manifestations and serum prolactin levels. Clinical manifestations usually include galactorrhea in girls, breast development, and tumor masses in boys.…”