Nonalcoholic fatty liver disease (
NAFLD) is known to be associated with
insulin resistance,
atherosclerosis, and low serum IGF1 levels. We have described a large cohort of patients with
isolated GH deficiency (IGHD) due to the c.57+1G→A mutation in the
GHRH receptor gene. These subjects have increased
insulin sensitivity (IS), delayed
atherosclerosis, and normal longevity. We hypothesized that, despite
visceral obesity,
NAFLD would be absent or mild due to the increased IS. To assess the prevalence and severity of
NAFLD in adult subjects with lifetime, congenital, untreated IGHD, we studied 22 IGHD adults and 25 controls (COs) matched for age and sex.
NAFLD was assessed by a comprehensive liver function panel, and ultrasonographic pattern (hyperechogenic pattern, HP) coded as follows: 0, absent; 1, mild; 2, moderate; and 3, severe. Compared with COs, IGHD individual had lower serum IGF1 (P<0.0001), higher total
cholesterol (P=0.027), lower prothrombin time (P=0.017), and similar activated partial thromboplastin time and
fibrinogen values.
Alanine transaminase (ALT) values were similar in the two groups, but
aspartate transaminase was higher in IGHD (P=0.013). However, more IGHD subjects (7/22) than COs (3/23) had ALT above the upper limit of normal (P=0.044). The prevalence of
NAFLD was higher in IGHD than COs (61 vs 29%, P=0.032), and the HP score was higher in IGHD than COs (P=0.041), but severe
NAFLD was not observed in any IGHD (or CO) individual. Liver HP score is increased in lifetime, untreated, congenital IGHD, but the increase in
transaminases is mild, suggesting a lack of advanced forms of
NAFLD.