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Thyroid Function and the Risk of Nonalcoholic Fatty Liver Disease: The Rotterdam Study
Arjola Bano1, Layal Chaker1, Elisabeth P C Plompen1
1Department of Internal Medicine (A.B., L.C., R.P.P.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; Rotterdam Thyroid Center (A.B., L.C., R.P.P.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; Department of Epidemiology (A.B., L.C., E.P.C.P., A.H., A.D., O.H.F., S.D.M., R.P.P.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; Department of Gastroenterology and Hepatology (E.P.C.P., H.L.A.J., S.D.M.), Erasmus University Medical Center, 3015 GE, Rotterdam, The Netherlands; and Toronto Centre for Liver Disease (H.L.A.J.), Toronto Western and General Hospital, University Health Network, Toronto, Ontario, M5G 2C4 Canada.
Context:
Although thyroid function is associated with several risk factors of nonalcoholic fatty liver disease (NAFLD), its role in NAFLD development remains unclear.
Objective:
We aimed to prospectively investigate the association between variations in thyroid function and NAFLD.
Design And Setting:
The Rotterdam Study, a large population-based, prospective cohort study.
Participants And Main Outcome Measures:
Participants with thyroid function measurements at baseline and NAFLD data (ie, at baseline fatty liver index/at follow-up ultrasound) were eligible. Transient elastography was performed to assess the presence of fibrosis in patients with NAFLD, using the liver stiffness measurements more than or equal to 8 kPa as cutoff for clinically relevant fibrosis. The association between thyroid parameters and incident NAFLD was explored by using logistic regression models.
Results:
A total of 9419 participants (mean age, 64.75 y) were included. The median follow-up time was 10.04 years (interquartile range, 5.70-10.88 y). After adjusting for age, sex, cohort, follow-up time, use of hypolipidemic drugs, and cardiovascular risk factors, higher free T4 levels were associated with a decreased risk of NAFLD (odds ratio, 0.42; 95% confidence interval [CI], 0.28-0.63). In line, higher TSH levels were associated with an increased risk of having clinically relevant fibrosis in NAFLD (odds ratio, 1.49; CI, 1.04-2.15). Compared with euthyroidism, hypothyroidism was associated with a 1.24-fold higher NAFLD risk (CI, 1.01-1.53). Moreover, NAFLD risk decreased gradually from hypothyroidism to hyperthyroidism (P for trend = .003).
Conclusion:
Lower thyroid function is associated with an increased NAFLD risk. These findings may lead to new avenues regarding NAFLD prevention and treatment.
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