title: Fertile females with nonalcoholic fatty liver disease (NAFLD) have higher levels of ALT than postmenopausal females: implications for the influence of fertility on NAFLD.
abstract: OBJECTIVE
  Insulin resistance recently has been reported to play a major role in nonalcoholic fatty liver disease (NAFLD). We evaluated the influence of fertility on fatty liver injury in fertile and postmenopausal women with insulin resistance.
  
  
  METHODS
  We investigated 152 patients with noninsulin-dependent diabetes mellitus without insulin treatment; 46 males, 52 fertile women and 54 postmenopausal women. All had liver damage and/or steatosis recognized by ultrasonography. We measured the fasting serum levels of C-peptide and insulin, as markers of insulin resistance, and the serum levels of ALT. The severity of liver steatosis was judged by ultrasonography.
  
  
  RESULTS
  Fertile females had significantly higher levels of ALT and demonstrated a more significant correlation between serum levels of ALT and C-peptide or insulin than did the postmenopausal females or males. Fertile females with moderate to severe steatosis had significantly higher levels of ALT than those with mild or no steatosis, although such a significant difference was not found in postmenopausal females or males.
  
  
  CONCLUSIONS
  We demonstrate that fertility is an important factor in fatty liver damage of NAFLD with insulin resistance, suggesting that estrogen may exacerbate nonalcoholic steatohepatitis.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kotoh
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakamuta
authors.forename: Marie
authors.initials: M
authors.lastname: Fukushima
authors.forename: Shusuke
authors.initials: S
authors.lastname: Morizono
authors.forename: Munechika
authors.initials: M
authors.lastname: Enjoji
authors.forename: Hajime
authors.initials: H
authors.lastname: Nawata
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D002096:C-Peptide / Q000097:blood; D018450:Disease Progression; D004967:Estrogens / Q000502:physiology*; D005234:Fatty Liver / Q000201:enzymology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged
chemical_list: D002096:C-Peptide; D004967:Estrogens; D000410:Alanine Transaminase