Liu Chia-Chu, Huang Shu-Pin, Hsieh Tusty-Jiuan, Lee Cheng-Hsueh, Cheng Kai-Hung, Huang Tsung-Yi, Geng Jiun-Hung, Li Ching-Chia, Wu Wen-Jeng, Lee Yung-Chin
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Andrology. 2021 May;9(3):863-872. doi: 10.1111/andr.12979. Epub 2021 Feb 10.
Non-alcoholic fatty liver disease (NAFLD) is suggested to be a precursor of metabolic syndrome (MetS) and could influence the risk of testosterone deficiency (TD). Fatty liver index (FLI) is a simple and useful screening tool for NAFLD. We determined the association between the risk of NAFLD assessed by FLI and TD in aging Taiwanese men, especially those without MetS.
A free health screening program was conducted for men (age: >40 years) in a medical center in Kaohsiung, Taiwan. All participants underwent a physical examination; answered a questionnaire assessing demographics, medical history, and clinical symptoms of TD; and provided 20-mL whole blood samples for biochemical, adipocytokine, and hormonal evaluations. The risk of NAFLD was evaluated using FLI. The presence of NAFLD was ruled out if FLI value was <25 and ruled in if FLI value was ≥35.
A total of 552 men (mean age: 54.7 ± 7.7 years) were enrolled. The prevalence rates of TD and MetS were significantly higher among men with NAFLD than those without NAFLD (both p < 0.001). FLI was significantly correlated with total testosterone (TT) and adipocytokines associated with insulin resistance, such as adiponectin, leptin, and retinol-binding protein-4 (RBP-4) levels, respectively (all p < 0.001). Among men without MetS, those at risk of and with NAFLD had a 3.82 and 8.50 times higher risk of TD, respectively, than those without NAFLD after adjusting for potential covariates.
The FLI is associated with the risk of TD in aging Taiwanese men, especially in those without MetS. Our findings also suggest that insulin resistance may be an important link among the inter-relationships of NAFLD, MetS, and TD. Further population-based studies with larger sample sizes of different ethnicities are warranted to confirm these preliminary results.
非酒精性脂肪性肝病（NAFLD）被认为是代谢综合征（MetS）的前驱疾病，并且可能影响睾酮缺乏（TD）的风险。脂肪肝指数（FLI）是一种用于NAFLD的简单且有用的筛查工具。我们确定了通过FLI评估的NAFLD风险与台湾老年男性，尤其是那些没有MetS的男性的TD之间的关联。
在台湾高雄的一家医疗中心为年龄大于40岁的男性开展了一项免费健康筛查项目。所有参与者均接受了体格检查；回答了一份评估人口统计学、病史和TD临床症状的问卷；并提供了20毫升全血样本用于生化、脂肪细胞因子和激素评估。使用FLI评估NAFLD风险。如果FLI值<25，则排除NAFLD；如果FLI值≥35，则判定为NAFLD。
共纳入552名男性（平均年龄：54.7±7.7岁）。NAFLD男性的TD和MetS患病率显著高于无NAFLD的男性（均p<0.001）。FLI分别与总睾酮（TT）以及与胰岛素抵抗相关的脂肪细胞因子，如脂联素、瘦素和视黄醇结合蛋白4（RBP-4）水平显著相关（均p<0.001）。在没有MetS的男性中，在调整潜在协变量后，有NAFLD风险和患有NAFLD的男性患TD的风险分别是无NAFLD男性的3.82倍和8.50倍。
FLI与台湾老年男性，尤其是没有MetS的男性的TD风险相关。我们的研究结果还表明，胰岛素抵抗可能是NAFLD、MetS和TD相互关系中的一个重要环节。有必要开展进一步基于不同种族更大样本量的人群研究来证实这些初步结果。
