Association between hypothyroidism and metabolic dysfunction-associated steatohepatitis in adults with obesity without diabetes

Background

Metabolic dysfunction-associated steatohepatitis (MASH), often linked with obesity-related fat deposition, is increasingly prevalent as global obesity rates rise. Data from Latin America, and particularly Peru, remain limited. Research suggests that hypothyroidism may contribute to MASH development through mechanisms such as dysregulated fatty acids, elevated FGF21 concentrations, mitochondrial dysfunction, oxidative stress, and altered leptin levels, all of which may drive the associated inflammatory processes.

Objectives

To assess the association between hypothyroidism and MASH in adults living with obesity without a history of diabetes mellitus.

Methods

This cross-sectional study included adults seeking bariatric surgery at a private center in Peru. MASH was defined via biopsy results, and hypothyroidism was diagnosed based on medical history or laboratory values. The association of interest was assessed using generalized linear models to calculate prevalence ratios (PR), adjusting for confounders.

Results

Data from 398 patients were analyzed; the mean age was 34.3 years, and 70.6 % were female. Hypothyroidism and MASH prevalences were 9.5 % and 84 %, respectively. After adjustments for sex, age, BMI, insulin resistance, and smoking, hypothyroidism was associated with a 1.18-fold increased prevalence of MASH (adjusted PR: 1.18; 95 % CI: 1.07–1.30, p = 0.001).

Conclusion

Hypothyroidism was significantly associated with MASH in adults with obesity and without diabetes mellitus. This suggests a critical role of thyroid dysfunction in MASH pathogenesis, also underscoring the importance of considering thyroid health in MASH management strategies.