Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Liver Center, Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas, USA.
Liver Int. 2024 Feb;44(2):460-471. doi: 10.1111/liv.15786. Epub 2023 Nov 27.
Sex 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.
A 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.
Out 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.
The 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.
性激素和性激素结合球蛋白（SHBG）在导致个体易患非酒精性脂肪性肝病（NAFLD）方面发挥作用，但它们在男性和女性中的作用是不同的。睾酮-雌二醇比值（T/E2 比值）和游离雄激素指数（FAI）是已知的激素环境生物标志物。我们调查了性激素、T/E2 比值、FAI 和 SHBG 是否与美国成年人的 NAFLD 相关。
使用 2013-2016 年全国健康和营养调查（NHANES）进行了横断面分析。NAFLD 是通过利用肝脂肪变性指数（HSI）和美国脂肪肝指数（USFLI）定义的，没有其他慢性肝病的原因。
在 8687 名受试者（49.5%为男性）中，低总睾酮水平与男性 NAFLD 的患病几率呈正相关。T/E2 比值升高与男性 NAFLD 的患病几率呈负相关。血清 SHBG 水平低与 NAFLD 的风险增加独立相关，无论性别和绝经状态如何。FAI 升高与 NAFLD 独立相关。当我们额外调整了 SHBG、T/E2 比值时，不是总睾酮，而是与 NAFLD 呈负相关，呈剂量依赖性。FAI 升高与绝经前妇女的 NAFLD 患病几率呈正相关，与绝经后妇女的 NAFLD 患病几率呈边缘正相关。
T/E2 比值和 SHBG 与男性 NAFLD 的风险增加呈负相关。在女性中，FAI 升高与 NAFLD 相关，而 SHBG 与 NAFLD 呈负相关。
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