Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2025; 17(6): 108096
Published online Jun 27, 2025. doi: 10.4254/wjh.v17.i6.108096
Correlation between gynecomastia and endocrine regulation in patients with metabolic dysfunction-associated fatty liver disease: A cross-sectional study
Ming-Huang Zhang, Ning Meng, Kang-Hui Zhang, Jun-Kang Yu, Chen-Hao Huang, Shu Yang, Ding-Yi Zhu
Ming-Huang Zhang, Ning Meng, Kang-Hui Zhang, Jun-Kang Yu, Chen-Hao Huang, Shu Yang, Ding-Yi Zhu, Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
Author contributions: Zhang MH and Meng N designed the study, analyzed the data and wrote the manuscript; Zhang KH, Yu JK, Huang CH, Yang S and Zhu DY analyzed and collected the data for this study; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Review Board of Hangzhou Normal University Hospital (No. 2025(E2)-KS-045).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning Meng, PhD, Chief Physician, Professor, Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, No. 120 Jinhua Road, Gongchenqiao Street, Gongshu District, Hangzhou 310015, Zhejiang Province, China. mengning0894@126.com
Received: April 7, 2025
Revised: May 6, 2025
Accepted: May 28, 2025
Published online: June 27, 2025
Processing time: 82 Days and 0.2 Hours
Abstract
BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MASLD) is a chronic liver disease characterized by hepatocellular steatosis, which is closely related to metabolic syndrome, with annually increasing morbidity in recent years. Gynecomastia (GYN), an abnormal proliferation of breast tissue in males, is common in males with sex hormone imbalance. Currently, there is insufficient research on the morbidity of GYN and its correlation among MASLD patients.

AIM

To investigate the prevalence of GYN and its associated clinical features in patients with MASLD and determine the prevalence of GYN in patients with MASLD and analyze the predictive effect of sex hormones on GYN using receiver operating characteristic (ROC) curves.

METHODS

A cross-sectional study was conducted in a tertiary care hospital. Among them, 997 patients met the inclusion criteria and underwent breast ultrasonography to determine the presence of GYN. Anthropometric data, laboratory test data [estradiol (E2), androgens, liver function, glucose, lipids, low-density lipoprotein, high-density lipoprotein, creatinine, and uric acid, etc.], as well as information on medical history, severity of fatty liver (mild, moderate, and severe), and duration of the disease were collected. Package for the Social Sciences version 27 and R software (version 4.3.1) were used for data analysis.

RESULTS

The prevalence of GYN increased with the severity of fatty liver (27.6% for mild, 33.5% for moderate, and 58% for severe, P < 0.001); compared with non-GYN patients, GYN patients were older (54.11 ± 9.71 years vs 47.89 ± 9.92 years, P < 0.001), with significantly higher E2 levels, higher estrogen to androgen ratio (P < 0.001) and significantly lower androgen levels (P < 0.001). In ROC curve analysis, the combined model of testosterone and E2 had a high diagnostic value in predicting GYN in MASLD patients, surpassing a single indicator.

CONCLUSION

The presence of GYN may suggest more severe metabolic abnormalities in patients with MASLD. Therefore, early recognition of GYN may be crucial for early intervention in metabolic syndrome and endocrine abnormalities in patients with MASLD.

Keywords: Metabolic dysfunction-associated fatty liver disease; Gynecomastia; Sex hormones; Metabolic syndrome; Receiver operating characteristic curve

Core Tip: This pioneering study investigated the unexplored link between the severity/duration of metabolic dysfunction-associated fatty liver disease (MASLD) and gynecomastia (GYN) in adult males, addressing acritical research gap. By integrating MASLD with body mass index and sex hormone imbalances, we revealed GYN as a novel marker for metabolic disorders (hyperglycemia, hypertension, dyslipidemia), shedding light on MASLD-driven endocrine disruption. Our findings underscore the necessity of holistic metabolic management—targeting obesity, MASLD, and hormonal imbalance—to mitigate GYN progression. This first-of-its-kind analysis provides a transformative clinical framework for early screening and intervention, positioning GYN as a sentinel for underlying metabolic dysfunction, thereby enhancing preventive strategies and therapeutic outcomes for MASLD-related comorbidities.