Correlation between gynecomastia and endocrine regulation in patients with metabolic dysfunction-associated fatty liver disease: A cross-sectional study

Abstract

Background: Metabolic dysfunction-associated fatty liver disease (MASLD) is a chronic liver disease characterized by hepatocellular steatosis, which is closely related to metabolic syndrome, with annually increasing morbidity in recent years. Gynecomastia (GYN), an abnormal proliferation of breast tissue in males, is common in males with sex hormone imbalance. Currently, there is insufficient research on the morbidity of GYN and its correlation among MASLD patients.

Aim: To investigate the prevalence of GYN and its associated clinical features in patients with MASLD and determine the prevalence of GYN in patients with MASLD and analyze the predictive effect of sex hormones on GYN using receiver operating characteristic (ROC) curves.

Methods: A cross-sectional study was conducted in a tertiary care hospital. Among them, 997 patients met the inclusion criteria and underwent breast ultrasonography to determine the presence of GYN. Anthropometric data, laboratory test data [estradiol (E2), androgens, liver function, glucose, lipids, low-density lipoprotein, high-density lipoprotein, creatinine, and uric acid, etc.], as well as information on medical history, severity of fatty liver (mild, moderate, and severe), and duration of the disease were collected. Package for the Social Sciences version 27 and R software (version 4.3.1) were used for data analysis.

Results: The prevalence of GYN increased with the severity of fatty liver (27.6% for mild, 33.5% for moderate, and 58% for severe, P < 0.001); compared with non-GYN patients, GYN patients were older (54.11 ± 9.71 years vs 47.89 ± 9.92 years, P < 0.001), with significantly higher E2 levels, higher estrogen to androgen ratio (P < 0.001) and significantly lower androgen levels (P < 0.001). In ROC curve analysis, the combined model of testosterone and E2 had a high diagnostic value in predicting GYN in MASLD patients, surpassing a single indicator.

Conclusion: The presence of GYN may suggest more severe metabolic abnormalities in patients with MASLD. Therefore, early recognition of GYN may be crucial for early intervention in metabolic syndrome and endocrine abnormalities in patients with MASLD.

Keywords: Gynecomastia; Metabolic dysfunction-associated fatty liver disease; Metabolic syndrome; Receiver operating characteristic curve; Sex hormones.

Figure 1

Detailed process of personnel screening.

Figure 2

Forest plot. A: Forest plot of effect values of metabolic dysfunction-associated fatty liver disease (MASLD) on gynecomastia (GYN) by subgroups; B: Forest plot of MASLD on the overall impact value of GYN. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; DBP: Diastolic blood pressure; DM: Diabetes mellitus; ETR: Estrogen to androgen ratio; E2: Estradiol; FBG: Fasting blood glucose; GGT: Gamma-glutamyltransferase; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; OR: Odds ratio; SBP: Systolic blood pressure; T: Testosterone; TC: Total cholesterol; TG: Triglycerides; UA: Uric acid; WC: Waist circumference.

Figure 3

Receiver operating characteristic curves for the occurrence of gynecomastia in patients with sex hormone-diagnosed metabolic dysfunction-associated fatty liver disease. ETR: Estrogen to androgen ratio; E2: Estradiol; ROC: Receiver operating characteristic.