Fatty liver index is associated with the risk of testosterone deficiency in aging men without metabolic syndrome

Abstract

Objectives 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. Materials and Methods 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. Results 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. Conclusion 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.

The Fatty liver Index (FLI) 15 years later: a reappraisal

“…NAFLD has also been associated with a variety of endocrine derangements [67][68][69] , some of which predisposing to secondary NAFLD forms, whereas other endocrinopathies probably result from pre-existent NAFLD [70] . Does FLI have a role in this setting?…”

Do Leptin Play a Role in Metabolism–Related Psychopathological Symptoms?

“…Another possibility is the effect of sex hormones: oestradiol promotes the secretion and release of leptin in cultured adipose tissue, but this process does not occur in men (53). Testosterone has been shown to have antiregulatory effects, suggesting that males' leptin concentrations may be lower than those in females, even when body fat ratios are similar (54,55). Finally, it is possible that leptin production is higher in the female brain than in the male brain, leading to higher circulating leptin levels in female blood (56,57).…”

Metabolic dysfunction-associated fatty liver disease is an early predictor for testosterone deficiency in aging men without metabolic syndrome

“…The present study utilized cross-sectional data obtained from Taiwanese males aged 40 years and above, which were collected during a free health screening program conducted by a medical center in Kaohsiung City, Taiwan, between June 2012 and August 2014. Subject selection criteria were implemented following previously described methods (see Supplementary Table S1 ) ( 1 , 19 – 21 ). The exclusion criteria included the following: (1) individuals with a documented history of significant psychiatric disorders, substance abuse disorders, advanced liver and/or renal disease, or malignancy; (2) individuals who were currently utilizing hormone therapy, undergoing anti-androgen treatment, consuming steroidal agents, or taking antifungal drugs; and (3) individuals who had incomplete evaluations during the study period ( 1 , 19 – 21 ).…”

“…Subject selection criteria were implemented following previously described methods (see Supplementary Table S1 ) ( 1 , 19 – 21 ). The exclusion criteria included the following: (1) individuals with a documented history of significant psychiatric disorders, substance abuse disorders, advanced liver and/or renal disease, or malignancy; (2) individuals who were currently utilizing hormone therapy, undergoing anti-androgen treatment, consuming steroidal agents, or taking antifungal drugs; and (3) individuals who had incomplete evaluations during the study period ( 1 , 19 – 21 ). The study followed the ethical guidelines stated in the Declaration of Helsinki and obtained approval from the Institutional Research Ethics Committee of the Kaohsiung Medical University Hospital.…”