Disorders of menstrual function during puberty and the risk of nonalcoholic fatty liver disease with comorbid diseases of the gastrointestinal tract
DOI:
https://doi.org/10.14739/mmt.2024.3.301976Keywords:
menstruation disorders, teenage girls, non-alcoholic fatty liver disease, metabolic disordersAbstract
The aim of the study was to determine the relationship between disorders of menstrual function in adolescence and the risk of nonalcoholic fatty liver disease (NAFLD) with comorbid gastrointestinal pathology.
Materials and methods. We examined 129 adolescent girls aged 12–17 years with menstrual disorders (61 with abnormal uterine bleeding (AUB) and 68 with oligomenorrhea (OM)) and measured anthropometrics, indices of lipid and carbohydrate metabolism and liver enzymes. Data are presented in the form of mean (M), standard deviation (SD) and median (Me), a factorial model was developed.
Results. The study shows the peculiarities of the clinical course of menstrual function disorders in girls of puberty age. Patients with AUB were characterized by significantly lower average body mass indices, they were younger compared to patients with OM. The nature of metabolic changes that depended on the type of menstrual disorders in teenage girls was clarified. Adolescents with AUB had statistically significantly higher average levels of immunoreactive insulin, HOMA index, triglycerides, very low-density lipoprotein cholesterol, aspartate aminotransferase. This creates conditions for the formation of nonalcoholic fatty liver disease. A model was created regarding the participation of dyslipoproteinemia, changes in the carbohydrate spectrum and levels of liver enzymes in the formation of nonalcoholic fatty liver disease in girls with menstrual cycle disorders.
Conclusions. Disorders of menstrual function are associated with an increased risk of NAFLD formation. Adolescent girls with menstrual disorders need metabolic screening. The atherogenic profile of lipoproteinemia, marked changes in the carbohydrate spectrum and increased serum levels of liver enzymes in girls with menstrual cycle disorders are the basis for the formation of nonalcoholic fatty liver disease.
References
De Sanctis V, Soliman AT, Tzoulis P, Daar S, Di Maio S, Millimaggi G, et al. Hypomenorrhea in Adolescents and Youths: Normal Variant or Menstrual Disorder? Revision of Literature and Personal Experience. Acta Biomed. 2022;93(1):e2022157. doi: https://doi.org/10.23750/abm.v93i1.12804
Gruber N, Modan-Moses D. Menstrual Cycle in Adolescents: Updating the Normal Pattern. J Clin Endocrinol Metab. 2021;106(1):e372-4. doi: https://doi.org/10.1210/clinem/dgaa688
Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classificat ion of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. doi: https://doi.org/10.1002/ijgo.12666
Yaşa C, Güngör Uğurlucan F. Approach to Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol. 2020;12(1):1-6. doi: https://doi.org/10.4274/jcrpe.galenos.2019.2019.S0200
Hillard PJ. Using the Menstrual Cycle as a Vital Sign: What We Still Want to Know about Adolescent Menstrual Cycles. J Pediatr Adolesc Gynecol. 2022;35(4):413-4. doi: https://doi.org/10.1016/j.jpag.2022.06.004
Kim W. Epidemiologic Landscape of Nonalcoholic Fatty Liver Disease Is Changed During Lifetime by Menstrual and Reproductive Status and Sex Hormonal Factors. Clin Gastroenterol Hepatol. 2021;19(6):1114-6. doi: https://doi.org/10.1016/j.cgh.2020.10.054
Watt MJ, Miotto PM, De Nardo W, Montgomery MK. The Liver as an Endocrine Organ-Linking NAFLD and Insulin Resistance. Endocr Rev. 2019;40(5):1367-93. doi: https://doi.org/10.1210/er.2019-00034
Cho IY, Chang Y, Kang JH, Kim Y, Sung E, Shin H, et al. Long or Irregular Menstrual Cycles and Risk of Prevalent and Incident Nonalcoholic Fatty Liver Disease. J Clin Endocrinol Metab. 2022;107(6):e2309-17. doi: https://doi.org/10.1210/clinem/dgac068
Cotter TG, Rinella M. Nonalcoholic Fatty Liver Disease 2020: The State of the Disease. Gastroenterology. 2020;158(7):1851-64. doi: https://doi.org/10.1053/j.gastro.2020.01.052
Zhou JH, Cai JJ, She ZG, Li HL. Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol. 2019;25(11):1307-26. doi: https://doi.org/10.3748/wjg.v25.i11.1307
Eng PC, Forlano R, Tan T, Manousou P, Dhillo WS, Izzi-Engbeaya C. Non-alcoholic fatty liver disease in women - Current knowledge and emerging concepts. JHEP Rep. 2023;5(10):100835. doi: https://doi.org/10.1016/j.jhepr.2023.100835
Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol. 2020;73(1):202-9. doi: https://doi.org/10.1016/j.jhep.2020.03.039
Roeb E. Excess Body Weight and Metabolic (Dysfunction)-Associated Fatty Liver Disease (MAFLD). Visc Med. 2021;37(4):273-80. doi: https://doi.org/10.1159/000515445
Giannouli A, Efthymiou V, Konidari M, Mani I, Aravantinos L, Dourakis SP, et al. The Burden of Non-Alcoholic Fatty Liver Disease in Adolescents with Polycystic Ovary Syndrome: A Case-Control Study. J Clin Med. 2023;12(2):557. doi: https://doi.org/10.3390/jcm12020557
Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-33. doi: https://doi.org/10.1002/hep.29466
Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57. doi: https://doi.org/10.1002/hep.29367
Mazhar K. The Future of Nonalcoholic Fatty Liver Disease Treatment. Med Clin North Am. 2019;103(1):57-69. doi: https://doi.org/10.1016/j.mcna.2018.08.005
Lu Y, Wang Q, Yu L, Yin X, Yang H, Xu X, et al. Revision of serum ALT upper limits of normal facilitates assessment of mild liver injury in obese children with non-alcoholic fatty liver disease. J Clin Lab Anal. 2020;34(7):e23285. doi: https://doi.org/10.1002/jcla.23285
Huang C, Lin B, Yuan Y, Li K, Xu B, Zhang P, et al. Associations of Menstrual Cycle Regularity and Length With Cardiovascular Diseases: A Prospective Study From UK Biobank. J Am Heart Assoc. 2023;12(11):e029020. doi: https://doi.org/10.1161/JAHA.122.029020
Carreau AM, Pyle L, Garcia-Reyes Y, Rahat H, Vigers T, Jensen T, et al. Clinical prediction score of nonalcoholic fatty liver disease in adolescent girls with polycystic ovary syndrome (PCOS-HS index). Clin Endocrinol (Oxf). 2019;91(4):544-52. doi: https://doi.org/10.1111/cen.14062
Zhang J, Hu J, Zhang C, Jiao Y, Kong X, Wang W. Analyses of risk factors for polycystic ovary syndrome complicated with non-alcoholic fatty liver disease. Exp Ther Med. 2018;15(5):4259-64. doi: https://doi.org/10.3892/etm.2018.5932
Ministry of Health of Ukraine. [On approval of the standards of medical care "Obesity in children"]. Order dated 2022 Sep 24, No. 1732. [Internet]. 2022 [cited 2024 Aug 12]. Ukrainian. Available from: http://surl.li/sogcq
Tanner JM, Davies PS. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr. 1985;107(3):317-29. doi: https://doi.org/10.1016/s0022-3476(85)80501-1
Song MJ, Choi JY. Androgen dysfunction in non-alcoholic fatty liver disease: Role of sex hormone binding globulin. Front Endocrinol (Lausanne). 2022;13:1053709. doi: https://doi.org/10.3389/fendo.2022.1053709
Guo Z, Jin F, Chen S, Hu P, Hao Y, Yu Q. Correlation between biochemical and clinical hyperandrogenism parameter in polycystic ovary syndrome in relation to age. BMC Endocr Disord. 2023;23(1):89. doi: https://doi.org/10.1186/s12902-023-01346-x
SadrAzar A, Sanaie S, Tutunchi H, Sheikh B, Faramarzi E, Jourabchi-Ghadim N. Is early age at menarche associated with multimorbidity? Findings from the Azar Cohort study. Eur J Obstet Gynecol Reprod Biol. 2023;287:46-51. doi: https://doi.org/10.1016/j.ejogrb.2023.05.029
Lee JS, Lee YA, Shin CH, Suh DI, Lee YJ, Yon DK. Long-term health outcomes of early menarche in women: an umbrella review. QJM. 2022;115(12):837-47. doi: https://doi.org/10.1093/qjmed/hcac187
Monelli F, Venturelli F, Bonilauri L, Manicardi E, Manicardi V, Rossi PG, et al. Systematic review of existing guidelines for NAFLD assessment. Hepatoma Research. 2021;7:25-37. doi: https://doi.org/10.20517/2394-5079.2021.03
