The Clinical Study Between Reproductive Factors And The Risks Of Non-alcoholic Fatty Liver Disease In Post-menopausal Women

Objective To explore the effect of reproductive factors on the risks of non-alcoholic fatty liver disease(NAFLD)in post-menopausal women.Methods Postmenopausal women,who were admitted to Department of Endocrinology of The First Affiliated Hospital of Guangxi Medical University since May,2014 to December 2014,were interviewed by using standard questionnaires.The basic information,past medical history and reproductive factors of the patients were recorded.After the physical examination had been done,the laboratory results of blood tests were collected.By using semi-quantitative ultrasound diagnostic method,which was published in Obesity by Xia et aL,together with computerized image processing software NIHimage(ImageJ 1.41o,National Institute of Health,Bethesda,MD)to measure the hepato-renal ratio and hepatic attenuation rate,then the percentage of liver fat content(LFC)of the patients was calculated.The patients were stratified according to quartiles for the LFC.NAFLD was diagnosed by using "The management guidelines for NAFLD" which was edited by Chinese Hepatology Society NAFLD workshop in 2010.The correlation between the reproductive factors and the LFC was analysed by using multivariate linear regression.Binary logistic regression model was used to analyze the effect of reproductive factors on the risks of NAFLD.Results Total of 174 postmenopausal women were included,the mean age was 62.60±7.64 years.There were 112 NAFLD with a prevalence rate of 64.4%and 62 non-NAFLD in our study group.Among all groups,age,BMI,metabolic syndrome prevalence,physical activity and hypoglycemic agents using rate were statistically significant(P<0.05).ALT,AST,GGT,TG,uric acid,HbAlc and HDL-C were also significantly different among all groups.Through the LFC quartiles,the mean age at menarche was gradually reduced(P<0.01),and the mean age at menarche of the highest quartile was the youngest.Among 4 groups,the median years since menopause and induced abortion were significantly different(P<0.05).By using multivariate linear regression,age at menarche was negatively correlated with LFC after adjustment for age(P<0.001).In binary logistic regression model,after controlling for age,T2DM course,family history,hypoglycemic agents usage,physical activity and all reproductive factors,age at menarche<14 years was used as reference,the risks of NAFLD in age at menarche 14-16 year and>16 years groups were lower(OR=0.16,95%CI:0.04?0.66 and OR=0.13,95%CI:0.03?0.56,respectively).After controlling for BMI and metabolic syndrome as in model 2 and 3 respectively,the risks of NAFLD in age at menarche 14-16 years and>16 years groups were also statistically reduced(P<0.05).Conclusion In Guangxi,it was the first time using semi-quantitative ultrasound diagnostic method to evaluate and diagnose NAFLD.The prevalence rate of NAFLD in post-menopause is 64.4%.Younger age at menarche is a risk factor for NAFLD in postmenopausal women,independent of BMI and metabolic syndrome.In clinical practice,we should notice and take caution for the woman with a history of younger age at menarche and suggest them screening the NAFLD by doing semi-quantitative ultrasound test and associated laboratory investigations for early detection and prompt treatment.The association between spontaneous abortion,induced abortion,gravidity,parity,breastfeeding duration,age at menopause,years since menopause and the risks of NAFLD in post-menopausal women was not found.