Anabolic-androgenic steroids: a possible new risk factor of toxicant-associated fatty liver disease

• Published in: Liver international 2011-03, Vol.31 (3), p.348-353
• Main Authors: Schwingel, Paulo Adriano, Cotrim, Helma P., Salles, Bernardo Rios, Almeida, Carlos Eduardo, dos Santos Jr, Crimério Ribeiro, Nachef, Bruno, Andrade, Antonio Ricardo, Zoppi, Cláudio C.
• Format: Article
• Language: English
• Subjects: Adult; anabolic agents; Anabolic Agents - administration & dosage; Anabolic Agents - adverse effects; Androgens - administration & dosage; Androgens - adverse effects; Blood levels; Brazil - epidemiology; Case-Control Studies; Chemical and Drug Induced Liver Injury - blood; Chemical and Drug Induced Liver Injury - epidemiology; Chemical and Drug Induced Liver Injury - etiology; Creatine kinase; Data processing; Diabetes mellitus; Drug abuse; drug use; Drugs; Ethanol; Fatty liver; Fatty Liver - epidemiology; Fatty Liver - etiology; Glucose; Historical account; Homeostasis; Humans; Injections, Intramuscular; Insulin; Insulin Resistance - physiology; Lipids; Liver; Liver - drug effects; Liver diseases; Male; Non-alcoholic Fatty Liver Disease; Obesity; Performance-Enhancing Substances - adverse effects; Recreation areas; Risk factors; Sports; steatosis; Steroid hormones; Steroids; Substance-Related Disorders - epidemiology; Substance-Related Disorders - etiology; toxicant-associated fatty liver disease; Toxins; Transaminases - blood; Ultrasound; Young Adult
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/j.1478-3231.2010.02346.x

Background: Industrial toxin and drugs have been associated with non‐alcoholic fatty liver disease (NAFLD); in these cases, the disease has been termed toxicant‐associated steatohepatitis (TASH). Aim: This study hypothesizes that the use of anabolic‐androgenic steroids (AAS) could also be a risk factor to TASH or better toxicant‐associated fatty liver disease (TAFLD) development. Methodology: Case–control study including 180 non‐competitive recreational male bodybuilders from August/2007 to March/2009. Ninety‐five had a history of intramuscular AAS use (cases; G1) and 85 were non‐users (controls; G2). They underwent a clinical evaluation and abdominal ultrasound, and their blood levels of aminotransferases, creatine phosphokinase (CPK), lipids, glucose and insulin were measured. TAFLD criteria: history of AAS use >2 years; presence of hepatic steatosis on ultrasound and/or aminotransferase alterations with normal CPK levels; exclusion of ethanol intake ≥20 g/day or use of other drugs; and exclusion of obesity, dyslipidaemia, diabetes and other liver diseases. Homeostasis model assessment for insulin resistance ≥3 was considered insulin resistant. Independent t‐test, odds ratio (OR) and 95% confidence intervals (95% CI) were calculated. Results: All cases were asymptomatic. Clinical and laboratorial data were similar in G1 and G2 (P>0.05). TAFLD criteria were observed in 12.6% of the G1 cases and 2.4% of controls had criteria compliant with non‐alcoholic fatty liver related to metabolic conditions. OR was 6.0 (95% CI: 1.3–27.6). Conclusions: These results suggest that AAS could be a possible new risk factor for TAFLD. In this type of fatty liver disease, the individuals had a low body fat mass and they did not present insulin resistance.