Background: Non-alcoholic fatty liver disease (NAFLD) is reported to be more prevalent in patients with GH deficiency (GHD) than in the general population. Case control studies have not however been undertaken. Recognition of NAFLD is important due to its association with cardiovascular disease and chronic liver disease.
Aims: To determine i) the prevalence of NAFLD in patients with severe GHD compared to age and BMI-matched controls, and, ii) the effect of 6 months GH replacement (GHR) onliver fat.
Patients and methods: Twelve patients (7 males) with GHD for >12 months (Peak GH <3 μg/l on glucagon stimulation test) and 12 controls matched for age, gender and BMI were studied. GHD patients were studied before and 6 months after initiation of GHR. Anthropometric measures as well as AST, ALT γGT, IGF1 and lipid profiles were measured at each visit. Intrahepatocellular lipid (IHCL) was measured by magnetic resonance spectroscopy, with NAFLD defined as liver fat >5.5%. Ethics committee approval was obtained.
Results: Values are quoted as median (range). Age of patients was 44.5 (35, 63) years versus controls 48.5 (33, 66) years (P=0.68). Patient BMI was 30.8 kg/m2 (22.4, 45.3) versus controls 31.7 kg/m2 (24.3, 43). IGF1 was significantly lower in the patient group, (11.5 vs 16 nmol/l P=0.03). There was no significant difference in ALT, AST, γGT, Cholesterol, HDL, LDL or percentage IHCL (3.6% (0.2, 44.8) patients versus 6.6% (0.5, 32.1) controls, P=0.68). 5 patients and 6 controls had IHCL>5.5%. Of the patients with elevated IHCL, 4 commenced GH. Liver fat reduced from 28.1% (20.4, 44.8) pre treatment to 16.3% (5.5, 20.6) post treatment (P=0.06).
Conclusions: Patients with GHD do not have an increased prevalence of NAFLD compared to matched healthy controls. GH replacement may reduce liver fat in patients with GHD. This is significant as patients with GHD have elevated cardio-metabolic risk.