Non-alcoholic fatty liver disease is an influencing factor for the association of SHBG with metabolic syndrome in diabetes patients

Xiaomin Hua,Man Li,Yunyun Xiao,Yun Hu,Wenxia Cui,Fenghui Pan

doi:10.1038/s41598-017-15232-9

Abstract

Metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) have been identified as risk factors affecting serum sex hormone binding globulin (SHBG) levels. We conducted this cross-sectional study to delineate whether MS or NAFLD has more impact on circulating SHBG levels in type 2 diabetes (T2D) patients. Anthropometric and biochemical parameters including serums SHBG, testosterone (TT), liver enzymes, lipids, insulin, C-peptide and plasma glucose were measured. Regardless of the MS status, SHBG level was significantly lower in NAFLD patients than in non-NAFLD patients (P < 0.001). In the multiple linear regression analysis, lower serum SHBG level was strongly correlated with a higher incidence of NAFLD, but not MS components. In logistic regression analyses, after adjusted for age, sex, duration of diabetes, smoking status, and alcohol use, the ORs and 95%CI for presence of MS was 2.26 (95%CI 1.91–2.68) and for presence of NAFLD was 6.36 (95%CI 4.87–8.31) with per one SD decrease in serum SHBG (both P < 0.001). In conclusion, lower serum SHBG is associated with a higher prevalence of NAFLD, compared with MS and other metabolic disorders, in T2D patients. NAFLD might be an important influencing factor for the association of circulating SHBG with MS in T2D patients.

Highlights

Sex hormone binding globulin (SHBG) is a glycoprotein made primarily in the liver[1] and is well known as a transporter of sex steroids and regulates their bioavailability at tissue levels[2]
All type 2 diabetes (T2D) patients were divided into non-alcoholic fatty liver disease (NAFLD) group (n = 453, age: 54.60 ± 12.92 years) and non-NAFLD group (n = 548, age: 61.75 ± 13.29 years). 71.9% (n = 326) patients were diagnosed with Metabolic syndrome (MS) in NAFLD group, and
The difference of serum sex hormone binding globulin (SHBG) levels between MS and non-MS subgroups was only statically significant in non-NAFLD group (P = 0.002), but not in NAFLD group (P > 0.05) (Fig. 1A). This analysis shows that the NAFLD condition contributed more to the SHBG reduction (~43% decrease) in both non-MS and MS patients, whereas the MS status contributed to a less degree of SHBG reduction (~10.3%) in non-NAFLD patients (Fig. 1A)

Summary

Introduction

Sex hormone binding globulin (SHBG) is a glycoprotein made primarily in the liver[1] and is well known as a transporter of sex steroids and regulates their bioavailability at tissue levels[2]. Several studies have highlighted the relationship between low SHBG with fatty liver. Our previous study has found that low serum SHBG, but not androgen, is independently associated with non-alcoholic fatty liver disease (NAFLD) in T2D patients[7]. A 9-month lifestyle interventional study has reported a significant correlation between magnetic resonance (MR) measured liver fat content and serum SHBG levels, but the relationship is independent of the changes in total body fat or abdominal fat mass[8]. Many common metabolic disorders of MS and NAFLD have been identified as factors tightly related to SHBG3,4. The association between serum SHBG, MS and NAFLD is complex. We conducted this study aiming to delineate the relationship of serum SHBG with MS and NAFLD in T2D patients

Methods

Results

Conclusion