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Fouad TR, Mohamad NE, Elabd M, Abd-Elwahab R, Elsary AY, Abd-Elghafar TS, Elshimi E, Attia A. Nonalcoholic fatty liver disease and female sexual dysfunction in Egyptian premenopausal women: is there a link between metabolic syndrome and sexual function? J Sex Med 2024:qdae080. [PMID: 39003089 DOI: 10.1093/jsxmed/qdae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a major health problem with a paucity of available information about its impact on female sexual dysfunction (FSD). AIM We aimed to study the association between NAFLD and FSD in Egyptian premenopausal women. METHODS Sexually active married premenopausal women who visited our NAFLD outpatient screening clinic (2019 to 2022) were divided into NAFLD and non-NAFLD (control) groups based on liver ultrasound and fatty liver index data. All participants completed the Arabic Female Sexual Function Index (ArFSFI) questionnaire. The resulting data were used to calculate the domains and total scores. FSD is then graded as follows: no FSD (≥28.2), minimal (21.7-28.1), mild (14.5-21.6), moderate (7.3-14.4), and severe (≤7.2). OUTCOMES We determined the proportions of patients and controls for whom ArFSFI scores indicated dissatisfaction with their sexual lives. RESULTS Of 995 women participants whose FSFI scores were available, NAFLD was detected in 487 (48.9%) and absent in 508 (51.1%). The two groups were comparable in age, socioeconomic level, residence, and history of female genital cutting. The NAFLD patients had significantly much lower mean scores for the sexual arousal, lubrication, orgasm, satisfaction, and pain domains of the FSFI (P < .001 for all), while no statistical difference was noticed in the desire domain for NAFLD patients compared with the controls. NAFLD women had significantly lower mean total FSFI scores than the controls (mean [SD] 16.7 [6.8] vs 21.7 [5.1], respectively; P < .001) with higher rates of FSD (98.5% vs 82.1%; P < .001, respectively). Most NAFLD women had higher FSD grades than controls (%): no FSD (1.5, 17.9), minimal (20.6, 51.8), mild (42.5, 38.8), moderate (26.2, 9.4), and severe (10.7, none), respectively. CLINICAL IMPLICATIONS Given the high prevalence of FSD in patients with NAFLD, greater attention to FSF could improve the quality of life in patients with NAFLD. STRENGTHS AND LIMITATIONS This study was limited by the lack of testing of sex hormones and some other important factors that were not tested (eg, age, socioeconomic level, residence, and female genital cutting), as these characteristics were previously matched. Strengths of the study include the large study size, to our knowledge the largest to date to investigate the possible link between FSD and NAFLD in premenopausal women, together with the inclusion of the detailed version of the validated ArFSFI. CONCLUSIONS In Egyptian premenopausal women, NAFLD could harm their sexual function.
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Affiliation(s)
- Tamer Refaat Fouad
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
| | - Noha Ezzat Mohamad
- Dermatology and Venereology Department, Faculty of Medicine, Fayoum University, Al Faiyum, Faiyum, 2933110, Egypt
| | - Mona Elabd
- Department of Clinical Analysis and Hematology, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
| | - Rokia Abd-Elwahab
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
| | - Asmaa Youness Elsary
- Department of Clinical Analysis and Hematology, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
| | - Tamer Samir Abd-Elghafar
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
| | - Esam Elshimi
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
| | - Ahmed Attia
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Sheebin Al-Kom, Menoufia, 39111, Egypt
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Sobel T, David P. Impact of Chronic Medical Disease on Sexual Function and Other Conditions. Obstet Gynecol Clin North Am 2024; 51:323-340. [PMID: 38777487 DOI: 10.1016/j.ogc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Chronic diseases are prevalent and impact sexual health and function. Screening for and managing sexual dysfunction in women with chronic diseases is important to optimize well-being and quality of life. Clinicians should consider the biopsychosocial impact of chronic diseases on sexual health, screen for direct and indirect factors, and identify medications that may cause dysfunction. The authors recommend a multidisciplinary approach to treat sexual dysfunction in women with chronic diseases, including sexual medicine specialists, sex therapists, and pelvic floor physical therapists when indicated. This review provides a practical approach to assessing and managing sexual dysfunction in women with chronic diseases.
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Affiliation(s)
- Talia Sobel
- Department of Internal Medicine, Division of Women's Health, Mayo Clinic Arizona, 13737 North 92nd Street, Scottsdale, AZ 85260, USA.
| | - Paru David
- Department of Internal Medicine, Division of Women's Health, Mayo Clinic Arizona, 13737 North 92nd Street, Scottsdale, AZ 85260, USA
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Li Y, Chen Y, Tian X, Zhang S, Jiao J. Comparison of Clinical Characteristics Between Obese and Non-Obese Patients with Nonalcoholic Fatty Liver Disease (NAFLD). Diabetes Metab Syndr Obes 2021; 14:2029-2039. [PMID: 33986604 PMCID: PMC8110261 DOI: 10.2147/dmso.s304634] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Non-alcoholic fatty liver disease (NAFLD), previously thought to predominantly affect obese individuals, has also been shown to occur in subjects who have a relatively normal body mass index (BMI). Due to the normal BMI, non-obese NAFLD are easily to be ignored and eventually lead to potential liver injuries. METHODS A population-based cross-sectional study was conducted on 1608 cases with normal serum alanine aminotransferase (ALT) levels who were divided into an obese group (BMI ≥25 kg/m2) and a non-obese group (BMI <25 kg/m2). NAFLD was diagnosed by ultrasound and Fibro Scan examination. Non-obese populations were divided into NAFLD group (CAP ≥240 db/m) and non-NAFLD group (CAP <240 db/m). The incidence of NAFLD in the obese and non-obese populations and constituent ratios of genders, age, and serum levels of triglycerides (TG), cholesterol (CHOL), and blood glucose were compared. Risk factors of NAFLD in non-obese people were analyzed by multivariate logistics regression. RESULTS The occurrence of NAFLD was higher in the obese group than in the non-obese group, regardless of gender (P <0.001). In the non-obese group, the occurrence of NAFLD in female patients was lower than that in male (P=0.001). The occurrence of NAFLD increased with age, with 50-59 years being the peak age of incidence in both male and female. The peak age of NAFLD occurrence in non-obese male patients was more delayed than that in obese male patients. BMI (OR=1.311, P=0.000) and TG (OR=2.545, P=0.000) were risk factors for NAFLD in the non-obese population. CONCLUSION Compared with obese population, the incidence of NAFLD in non-obese population was relatively low and more frequently in male than in female, the peak age of NAFLD occurrence in non-obese male patients was also delayed. BMI and TG should still be controlled to avoid the occurrence of NAFLD although the BMI of such patients is normal.
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Affiliation(s)
- Yifang Li
- Department of Gastroenterolgy & Hepatology, China-Japan Union Hospital, Jilin University, Changchun, 130033, People’s Republic of China
| | - Yanzhen Chen
- Department of Gastroenterolgy & Hepatology, China-Japan Union Hospital, Jilin University, Changchun, 130033, People’s Republic of China
| | - Xing Tian
- Department of Gastroenterolgy & Hepatology, China-Japan Union Hospital, Jilin University, Changchun, 130033, People’s Republic of China
| | - Shanshan Zhang
- Department of Gastroenterolgy & Hepatology, China-Japan Union Hospital, Jilin University, Changchun, 130033, People’s Republic of China
| | - Jian Jiao
- Department of Gastroenterolgy & Hepatology, China-Japan Union Hospital, Jilin University, Changchun, 130033, People’s Republic of China
- Correspondence: Jian Jiao Department of Gastroenterology & Hepatology, China-Japan Union Hospital, Jilin University, Changchun, People’s Republic of ChinaTel +86 13756009567Fax +86 0431-84995850 Email
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Lee SM, Kwak SH, Koo JN, Oh IH, Kwon JE, Kim BJ, Kim SM, Kim SY, Kim GM, Joo SK, Koo BK, Shin S, Vixay C, Norwitz ER, Park CW, Jun JK, Kim W, Park JS. Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus. Diabetologia 2019; 62:238-248. [PMID: 30470912 DOI: 10.1007/s00125-018-4779-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Although there is substantial evidence that non-alcoholic fatty liver disease (NAFLD) is associated with impaired glucose homeostasis, the clinical significance of NAFLD in pregnant women has not been well determined. This study investigates the relationship between NAFLD in the first trimester and the subsequent development of gestational diabetes mellitus (GDM). METHODS A multicentre, prospective cohort study was conducted in which singleton pregnant Korean women were assessed for NAFLD at 10-14 weeks using liver ultrasound, fatty liver index (FLI) and hepatic steatosis index (HSI). Maternal plasma adiponectin and selenoprotein P concentrations were measured. Participants were screened for GDM using the two-step approach at 24-28 weeks. RESULTS Six hundred and eight women were included in the final analysis. The prevalence of NAFLD was 18.4% (112/608) and 5.9% (36/608) developed GDM. Participants who developed GDM had a higher prevalence of radiological steatosis (55.6% vs 16.1%; p < 0.001) and higher FLI (40.0 vs 10.7; p < 0.001) and HSI (35.5 vs 29.0; p < 0.001). The risk of developing GDM was significantly increased in participants with NAFLD and was positively correlated with the severity of steatosis. This relationship between NAFLD and GDM remained significant after adjustment for metabolic risk factors, including measures of insulin resistance. Maternal plasma adiponectin and selenoprotein P levels were also correlated with both NAFLD severity and the risk of developing GDM. CONCLUSIONS/INTERPRETATION NAFLD in early pregnancy is an independent risk factor for GDM. Adiponectin may be a useful biomarker for predicting GDM in pregnant women.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Nam Koo
- Seoul Women's Hospital, Incheon, South Korea
| | - Ig Hwan Oh
- Seoul Women's Hospital, Incheon, South Korea
| | - Jeong Eun Kwon
- Seoul Women's Hospital, Incheon, South Korea
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sae Kyung Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 07061, South Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 07061, South Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Laboratory Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chanthalakeo Vixay
- Department of Obstetrics and Gynecology, University of Health Sciences, Vientiane, Lao PDR
| | - Errol R Norwitz
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea
| | - Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 07061, South Korea.
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea.
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