title: Association Between Endogenous Sex Hormones and Liver Fat in a Multiethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  Levels of circulating of sex hormones are associated with glucose metabolism and adiposity, but little is known about their association with ectopic fat. We aimed to characterize the association between circulating sex hormones and liver fat.
  
  
  METHODS
  We conducted a cross-sectional analysis by using data from the Multiethnic Study of Atherosclerosis to assess the association of the circulating levels of bioavailable testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) with fatty liver. Fatty liver was defined as a reduction of ≤40 Hounsfield units, measured by computed tomography, in 2835 postmenopausal women and 2899 men (45-84 years old; white, black, Hispanic, or Chinese) at 6 centers in the United States.
  
  
  RESULTS
  Women in the highest tertile of bioavailable testosterone were significantly more likely to have fatty liver than women in the lowest tertile (odds ratio, 1.77; 95% confidence interval, 1.07-2.92). We found an even greater difference for level of estradiol (odds ratio, 2.49; 95% confidence interval, 1.41-4.39) after adjusting for age, race/ethnicity, waist-to-hip ratio, hypertension, total and high-density lipoprotein cholesterol, smoking, insulin sensitivity, and hormone replacement therapy use. Men in the highest tertile of estradiol level were significantly more likely to have fatty liver than men in the lowest tertile (odds ratio, 2.10; 95% confidence level, 1.29-3.40). Men in the highest tertile of SHBG were less likely to have fatty liver than those in the lowest tertile (odds ratio, 0.46; 95% confidence interval, 0.27-0.77). Other associations between hormone levels and fatty liver were not statistically significant.
  
  
  CONCLUSIONS
  On the basis of a cross-sectional study, postmenopausal women with high levels of bioavailable testosterone are at greater risk for fatty liver. In men, higher levels of SHBG are associated with reduced risk for fatty liver. Higher levels of estradiol are associated with fatty liver in both sexes. This pattern is consistent with the sex-specific associations of sex hormones with other cardiometabolic risk factors.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Electronic address: mlazo@jhu.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: Bronx-Lebanon Hospital Center, Bronx, New York.
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Florida International University, Miami, Florida.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Department of Pathology, Colchester Research Facility, University of Vermont, Colchester, Vermont.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Vaidya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014481:United States
chemical_list: D012739:Gonadal Steroid Hormones
keywords: Epidemiology; Estradiol; MESA; NAFLD; SHBG; Testosterone