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Abstract Details
Effect of TSH on Non-Alcoholic Fatty Liver Disease (NAFLD) Independent of Obesity in Children of Predominantly Hispanic/Latino Ancestry by Causal Mediation Analysis
PLoS One. 2020 Jun 22;15(6):e0234985. doi: 10.1371/journal.pone.0234985. eCollection 2020.
Presley H Nichols1, Yue Pan2, Benjamin May3, Martina Pavlicova2, John C Rausch14, Ali A Mencin4, Vidhu V Thaker4
Author information
1Department of Pediatrics, New York Presbyterian-Columbia University Irving Medical Center, New York, New York, United States of America.
2Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
3Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, United States of America.
4Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, United States of America.
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Abstract
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is a common co-morbidity of obesity. Elevated TSH levels (eTSH), also associated with obesity, may contribute to the dysmetabolic state that predisposes to NAFLD.
Objective: To assess the relationship between TSH levels and NAFLD in children with biopsy-proven NAFLD compared to controls.
Design and methods: In this retrospective study of children with biopsy-proven NAFLD and age-matched controls, the association of eTSH with NAFLD was investigated and the role of TSH as a mediator between obesity and NAFLD was assessed.
Results: Sixty-six cases and 4067 controls (69.7 vs 59% Hispanic/Latino ancestry, p = 0.1) of the same age range seen in the same time duration at an urban Children's Hospital were studied. Children with NAFLD were more likely to be male (74.6 vs 39.4%, p < 0.001), have higher modified BMI-z scores (median 2.4 (IQR 1.7) vs 1.9 (IQR 1.7), p < 0.001), and abnormal metabolic parameters (TSH, ALT, HDL-C, non-HDL-C, and TG). Multivariate analyses controlling for age, sex and severity of obesity showed significant association between the 4th quartile of TSH and NAFLD. Causal mediation analysis demonstrates that TSH mediates 33.8% of the effect of modified BMI-z score on NAFLD. This comprises of 16.0% (OR = 1.1, p = 0.002) caused by the indirect effect of TSH and its interaction with modified BMI-z, and 17.7% (OR = 1.1, p = 0.05) as an autonomous effect of TSH on NAFLD. Overall, 33.8% of the effect can be eliminated by removing the mediator, TSH (p = 0.001).
Conclusions: The association of eTSH and biopsy-proven NAFLD is demonstrated in children of Hispanic/Latino ancestry. Further, a causal mediation analysis implicates an effect of TSH on NAFLD, independent of obesity.