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Background: Gender and reproductive status differences exist in both non-alcoholic fatty liver disease (NAFLD) and body composition. Our purpose was to investigate the relationship between body composition and the severity of liver steatosis and fibrosis in NAFLD in different gender and reproductive status populations. Methods: This cross-sectional study included 880 participants (355 men, 417 pre-menopausal women, 108 post-menopausal women). Liver steatosis and fibrosis and body composition data were measured using FibroScan and a bioelectrical impedance body composition analyzer (BIA), respectively. Multiple ordinal logistic regression (MOLR) was used to analyze the correlation between body composition indicators and liver steatosis grade and fibrosis stage in different gender and menopausal status populations. Results: Men have higher waist circumference (WC), appendicular skeletal muscle mass (ASM), appendicular skeletal muscle mass index (ASMI), fat free mass (FFM), and fat free mass to fat mass ratio (FFM/FM) than pre- or post-menopausal women, while pre-menopausal women have higher percent body fat (PBF), visceral fat area (VFA), and fat mass (FM) than the other two groups (p < 0.001). Besides, men have greater controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) values (p < 0.001). For MOLR, after adjusting for confounding factors, WC (OR, 1.07; 95% CI, 1.02-1.12; P = 0.011) and FFM/FM (OR, 0.52; 95% CI, 0.31-0.89; P = 0.017) in men and visceral obesity (OR, 4.16; 95% CI, 1.09-15.90; P = 0.037) in post-menopausal women are independently associated with liver steatosis grade. WC, PBF, and visceral obesity are independently associated with liver fibrosis stage in men (OR, 1.05; 95% CI, 1.01-1.09, P = 0.013; OR, 1.08; 95% CI, 1.01-1.15; P = 0.018; OR, 3.92; 95% CI, 1.97-7.81; P < 0.001, respectively). Conclusions: Increased WC and low FFM/FM in men and visceral obesity in post-menopausal women are independent correlates of aggravated liver steatosis. In addition, increased WC, PBF, and visceral obesity are independent correlates of worsening liver fibrosis in men. These data support the gender- and reproductive status-specific management of NAFLD.

BackgroundUse of gonadotropin-releasing hormone (GnRH) antagonists during the late follicular phase can prevent premature luteinizing hormone (LH) surge. Many patients demonstrate an insufficient endogenous LH concentration during ovarian stimulation. Previous studies have demonstrated that ultra-low LH concentration influences pregnancy outcomes. However, affected patients cannot be distinguished prior to ovarian stimulation using baseline characteristics alone. With traditional fixed or flexible GnRH antagonist protocols, antagonist administration may further reduce LH activity. Previously, we proved that LH can be used as an indicator for the timing and dosage of antagonist. Patients with a persistently low LH concentration during ovarian stimulation may not require antagonists, whereas antagonist administration can affect reproductive outcomes. To further explore this hypothesis, we designed a randomized clinical trial to compare the LH-based flexible GnRH antagonist protocol with traditional flexible GnRH antagonist protocol in women with normal ovarian response. MethodsThis study was a multicenter, parallel, prospective, randomized, non-inferiority study. The primary efficacy endpoint was cumulative ongoing pregnancy rate per cycle. The study aimed to prove the non-inferiority of cumulative ongoing pregnancy rate per cycle with a LH-based flexible GnRH antagonist protocol versus traditional flexible GnRH antagonist protocol. Secondary endpoints were the high-quality embryo rate, clinical pregnancy rate, and cancellation rate. Differences in cost-effectiveness and adverse events were evaluated. The cumulative ongoing pregnancy rate per cycle in women with normal ovarian response was 70%. Considering that a non-inferiority threshold should retain 80% of the clinical effect of a control treatment, a minimal clinical difference of 14% (one-sided: α, 2.5%; β, 20%) and a total of 338 patients were needed. Anticipating a 10% dropout rate, the total number of patients required was 372.DiscussionThis is the first randomized controlled trial to compare the efficacy of a LH-based treatment regimen with a traditional flexible GnRH antagonist protocol during ovarian stimulation. We hypothesized no significant difference in cumulative ongoing pregnancy rate per cycle between the two protocols. Moreover, patients with insufficient endogenous LH during ovarian stimulation may benefit from LH-based GnRH antagonist protocols. The results will provide new information on when to introduce antagonists and the appropriate dosage of antagonist.Trial registration: ClinicalTrials.gov, ChiCTR1800018077. Registered on 29 August, 2018.

Background: Obesity is associated with reproductive disorders and infertility. Autophagy is upregulated during decidualization, but is diminished in obesity models with impaired decidualization. Defects in autophagy are related to the occurrence of inflammatory diseases, but its role in endometrial decidualization with obese patients is unknown.Methods: The levels of autophagy-related factors (LC3B-II and Beclin 1), and autophagy-related proteins which have a correlation with endometrial decidualization (ATG3, ATG5, ATG7 and foxo1), as well as autophagy-related inflammatory cytokines in endometrium of lean and obese patients was assessed. We then investigated the the role of autophagic flux during decidualization in ‘obese’- vs ‘lean’- treated cells from matched patients.Results: Alteration in autophagic flux and the expression of autophagy-related genes revealed impaired autophagy in obese patients compared with lean. Autophagy-related proinflammatory cytokines were upregulated in the uterine cavity of obese patients, who also showed impaired decidualization.Conclusions: Obesity downregulates the expression of autophagy-related genes and impairs endometrial stromal cell autophagic flux, and induces inflammation. These alterations in autophagy are associated with increased activation of autophagy-related proinflammatory cytokines might decrease basic uterine receptivity.