Endocrine Abstracts

Introduction

Menopausal transition is associated with an increase in the cardiovascular risk, possibly related with the sharp decrease of estrogen levels. Menopausal symptoms and more specifically hot flushes have been previously linked with an increase in cardiovascular risk. On the other hand, non-alcoholic fatty liver disease is considered as another presentation of the metabolic syndrome, conferring additional cardiovascular risk to the affected individual. This study aimed to evaluate any possible link between the severity of menopausal hot flushes and indicators of liver steatosis or fibrosis, expressed indirectly by the Fibrosis 4 score (Fib4) and the hepatic steatosis index (HSI).

Methods

This was a cross sectional study, consisting of 5.995 non-obese postmenopausal women, retrieved from the Menopause Clinic of the Aretaieio Hospital, Athens, Greece. All participants underwent hormonal and biochemical assessment and the HSI as well as Fibrosis 4 score (Fib4) were calculated, according to the biographically available algorithm. The intensity of hot flushes was evaluated as none, mild or moderate-to-severe.

Results

Our women were aged 56.7 ± 7.5years, with a menopausal age 8.9 ± 6.7years and body mass index 25.0 ± 2.7 kg/m². HSI values were 34.8 ± 4.2 (range 23.7–62.3), Fib4 values were 1.15 ± 0.4 (range 0.11–4.70), Fib4 values < 1.45 were found in 20.1% of women, while Fib4 values > 3.25 were found in 0.3% of women. HSI > 36, implying likely NAFLD, was evident in 75.5% of the sample. Moderate to severe hot flushes were evident in 18.3% of our women (993/5438). We observed a gradient linear increase in mean values of HSI and linear decrease in mean values of Fib4, according to increasing severity of hot flushes (none vs mild vs moderate-to-severe: HSI, 34.6 ± 4.1 vs 34.7 ± 4.1 vs 35.6 ± 4.4; Fib4, 1.17 ± 0.45 vs 1.14 ± 0.43 vs 1.08 ± 0.41 P-value < 0.001 ANOVA for linear trend, univariate). Multivariable logistic regression analysis showed that presence of moderate to severe hot flushes was associated with mean values of HIS (OR=1.060, P-value=0.002) and menopausal age (OR=0.884, P -value < 0.001) in a stepwise model that also included age, BMI, triglycerides, HDL, HOMA-IR, smoking alcohol, physical activity. No linear or dichotomous associations were observed between Fib4 values and the severity of hot flushes.

Conclusion

Mean levels of HIS were associated with the severity of menopausal hot flushes, in this large sample of postmenopausal women. We did not observe any associations between mean values of the Fib4 index and the severity of hot flushes.