Key result
A sex hormone binding globulin (SHBG) level below 33.4 nmol/l identified women with a higher probability of having a pathological NAFLD Liver Fat Score compared to those with higher levels.
Why the study?
Diagnosing NAFLD is not practical and the condition risks being overlooked, creating a need for simpler surrogate markers to identify women with a high likelihood of NAFLD.
Cross-Sectional (n=299)
No
SHBG levels below 33.4 nmol/L can serve as a simple, routine biomarker to identify women with PCOS or sexual dysfunction who are at high risk for NAFLD and adverse metabolic profiles.
Answers are grounded in this paper and cite their sources.
Low SHBG flags higher NAFLD-LFS risk in women evaluated for PCOS; cross-sectional data leave open its role in targeted screening.
PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.
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Stasi et al. (2021) conducted a cross-sectional in Oligomenorrhea, hirsutism, and female sexual dysfunction (n=299). SHBG < 33.4 nmol/l vs. SHBG ≥ 33.4 nmol/l was evaluated on Pathological NAFLD-LFS score (p=0.003). A sex hormone binding globulin (SHBG) level below 33.4 nmol/l identified women with a higher probability of having a pathological NAFLD Liver Fat Score compared to those with higher levels.
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