title: Low serum sex hormone-binding globulin is associated with nonalcoholic fatty liver disease in type 2 diabetic patients.
abstract: BACKGROUND
  Studies have indicated that low serum sex hormone-binding globulin (SHBG) and testosterone levels are associated with nonalcoholic fatty liver disease (NAFLD). However, it remains unclear whether an association exists between SHBG and NAFLD independent of testosterone.
  
  
  OBJECTIVE
  This study was aimed to investigate the relationship between SHBG and both total and free testosterone levels with NAFLD.
  
  
  METHODS
  One hundred and twenty patients with NAFLD and 120 age-, sex- and BMI-matched patients with non-NAFLD were enrolled into a case-control study. Serums SHBG, total testosterone (TT), liver enzymes, lipids, insulin, C-peptide and plasma glucose were measured. Free testosterone (FT) and fatty liver index were calculated.
  
  
  RESULTS
  Serum SHBG levels were significantly lower in NAFLD group than in non-NAFLD group (24·5 ± 11·0 vs 37·6 ± 14·4 nm, P < 0·001). After adjustment for age, smoking status, alcohol use, duration of diabetes, BMI and fasting C-peptide, serum SHBG levels in men and women were inversely associated with NAFLD, with odds ratio (OR) and 95% confidence interval (CI) in the forth quartile as 0·05 (0·01-0·30) and 0·25 (0·08-0·77) compared with the first quartile (OR = 1·00). Additional adjustment for TT in men and FT in women did not materially alter the association. The relationship between serum TT (for men) and FT (for women) with NAFLD was attenuated and even diminished after multivariable adjustment for known risk factors and SHBG.
  
  
  CONCLUSIONS
  Low serum SHBG levels, but not TT or FT, are associated with NAFLD in type 2 diabetic patients.
authors.affiliation: Division of Endocrinology, the Affiliated Drum Tower Hospital, Nanjing University, Nanjing, China; Division of Geriatrics, Huai'an First People's Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Hua
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Sun
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Zhong
authors.forename: Wenhuan
authors.initials: W
authors.lastname: Feng
authors.forename: Hong
authors.initials: H
authors.lastname: Huang
authors.forename: Weimin
authors.initials: W
authors.lastname: Wang
authors.forename: Tianyan
authors.initials: T
authors.lastname: Zhang
authors.forename: Yun
authors.initials: Y
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000737:chemistry; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005234:Fatty Liver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood* / Q000175:diagnosis*; D016017:Odds Ratio; D012738:Sex Hormone-Binding Globulin / Q000737:chemistry*; D013739:Testosterone / Q000097:blood / Q000737:chemistry
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone