Department of Endocrinology, Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Shandong Provincial Hospital, Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, China.
Obes Facts. 2023;16(6):588-597. doi: 10.1159/000533962. Epub 2023 Oct 5.
The study aimed to determine if hepatic steatosis assessed by fatty liver index (FLI) was an independent risk factor for male low testosterone level and whether the FLI was the strongest risk factor for low testosterone level in two different age groups.
Two cross-sectional studies were performed. A total of 3,443 male participants (aged 46-75) were recruited into study A (part of lONgitudinal study (REACTION)). Then a total of 267 male participants (aged 25-45) were recruited into study B. Serum total testosterone (TT) and sex hormone-binding globulin (SHBG) levels, indicators for assessing hepatic steatosis were measured. The Pearson correlation and regression analysis were performed to investigate the risk factors for low testosterone level.
The FLI had the strongest negative correlation with serum testosterone in the study A (r = -0.436) and B (r = -0.542). Compared with patients with a FLI lower than 30, the risk for low testosterone level increased by 3.48-fold in subjects with a FLI higher than 60 adjusted for potential risk factors in study A. In study B, the odds ratio of low testosterone level in patients with potential hepatic steatosis was 4.26 (1.57-11.60) after adjusted for age and homeostasis model assessment of insulin resistance (HOMA-IR) and 0.59 (0.14-2.60) after adjusted for age, HOMA-IR, waist circumference, body mass index, and SHBG.
FLI was the strongest risk factor for male low testosterone level independent of insulin resistance in male populations of different ages; however, the association can be modulated by SHBG levels in the young.
In the study, FLI was the strongest negative risk factor for low testosterone level in the Chinese adult male population. The results suggested that hepatic steatosis assessed by the FLI was the main risk factor for male low testosterone level, independent of age, insulin resistance, smoking, and drinking status; however, the association of FLI and TT levels can be modulated by SHBG levels. Taken together these findings indicate that clinical physicians should pay more attention to the FLI index and hepatic steatosis, so that they can take advantage of them for assessing the risk of developing of low testosterone level in the male population.
本研究旨在确定通过脂肪肝指数（FLI）评估的肝脂肪变性是否是男性低睾酮水平的独立危险因素，以及 FLI 是否是两个不同年龄组低睾酮水平的最强危险因素。
进行了两项横断面研究。共招募了 3443 名 46-75 岁的男性参与者（A 部分为 lONgitudinal 研究（REACTION）的一部分）。然后招募了 267 名 25-45 岁的男性参与者（B 部分）。测量了血清总睾酮（TT）和性激素结合球蛋白（SHBG）水平，这些指标用于评估肝脂肪变性。进行了 Pearson 相关性和回归分析，以研究低睾酮水平的危险因素。
在研究 A（r = -0.436）和 B（r = -0.542）中，FLI 与血清睾酮呈最强负相关。与 FLI 低于 30 的患者相比，在研究 A 中，经潜在危险因素调整后，FLI 高于 60 的患者发生低睾酮水平的风险增加了 3.48 倍。在研究 B 中，在调整年龄和胰岛素抵抗稳态模型评估（HOMA-IR）后，有潜在肝脂肪变性的患者低睾酮水平的比值比为 4.26（1.57-11.60），在调整年龄、HOMA-IR、腰围、体重指数和 SHBG 后为 0.59（0.14-2.60）。
FLI 是不同年龄段男性人群低睾酮水平的最强独立危险因素，与胰岛素抵抗无关；然而，这种关联可以通过年轻人群中 SHBG 水平来调节。
在这项研究中，FLI 是中国成年男性人群低睾酮水平的最强负风险因素。结果表明，通过 FLI 评估的肝脂肪变性是男性低睾酮水平的主要危险因素，与年龄、胰岛素抵抗、吸烟和饮酒状况无关；然而，FLI 和 TT 水平之间的关联可以通过 SHBG 水平来调节。综合这些发现表明，临床医生应更加关注 FLI 指数和肝脂肪变性，以便利用它们评估男性人群中低睾酮水平发生的风险。
