High Parathyroid Hormone Levels Linked to NAFLD

Aunchalee Jaroenlapnopparat, MD

Credit: ResearchGate

High levels of parathyroid hormone (PTH) is significantly associated with non-alcoholic fatty liver disease (NAFLD), according to new data. In fact, the findings from a multinational team of investigators elucidate high PTH may be a biomarker for NAFLD presence.¹

A team of investigators led by Aunchalee Jaroenlapnopparat, MD, of the department of medicine at Mount Auburn Hospital, Beth Israel Lahey Health and Harvard Medical School in Boston, conducted a systematic review and meta-analysis to determine the association between PTH levels and liver diseases including NAFLD and non-alcoholic steatohepatitis (NASH).

They noted that prior studies have implied a potential correlation between the biomarker and prevalence of NAFLD or NASH, though “results from existing studies are inconsistent.”

PTH, associated with the control of phosphorus and vitamin D levels in the body, is a driver of abnormal blood calcium levels depending on its levels. It is measurable in standard blood tests.²

Jaroenlapnopparat and colleagues identified potentially eligible trials for their systematic review and meta-analysis through a pair of public databases, with their search terms including “NASH,” “NAFLD,” and “PTH.” Studies eligible for the analysis included a cohort of NAFLD or NASH patients and a control cohort of healthy participants, as well as measures for mean PTH in both cohorts.

Pooled mean differences were defined for each trial through a random-effects model, and funnel plots helped assess for any publication biases.

The final assessment included 12 of 388 articles that fulfilled eligibility criteria. A meta-analysis of 10 (83.3%) trials showed a significant association between high levels of PTH and NAFLD (pooled mean difference [MD], 5.479; 95% CI, 0.947 – 10.011; I2, 81.0%) without suggestion of publication bias.

A meta-analysis of 4 (33.3%) relevant trials showed the association between high PTH levels and NASH, though, was insignificant (pooled MD, 11.955; 95% CI, -4.703 to 28.614; I2, 81.0%).

“High PTH level is significantly associated with NAFLD and can be used as a marker of NAFLD,” investigators concluded. “However, high PTH level is non-significantly associated with NASH. Further studies are needed to increase the sample size and eliminate the confounding factors.”

References

1. ^{Jaroenlapnopparat A, Rittiphairoj T, Chaisidhivej N, Walker B, Charoenngam N. High parathyroid hormone level as a marker of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: A systematic review and meta-analysis [published online ahead of print, 2023 Jul 7]. Diabetes Metab Syndr. 2023;17(8):102827. doi:10.1016/j.dsx.2023.102827}
2. ^{Cleveland Clinic. Web page. Parathyroid Hormone. Updated December 21, 2021. https://my.clevelandclinic.org/health/articles/22355-parathyroid-hormone#:~:text=Parathyroid%20hormone%20(PTH)%20is%20a,to%20abnormal%20blood%20calcium%20levels.}