Laparoscopically confirmed endometriosis and the risk of incident NAFLD: a prospective cohort study

Hangkai Huang, Zhening Liu, Jiaqi Ruan, Zejun Fang, Chengfu Xu
Reproductive biology and endocrinology : RB&E · 2025 · vol. 23(1) , pp. 55 · doi:10.1186/s12958-025-01391-2 · PMID:40205408 · PMC11983926 · W4409286947
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

Laparoscopically confirmed endometriosis was positively associated with the risk of incident nonalcoholic fatty liver disease, with hysterectomy/oophorectomy, hypercholesterolemia, hypertension, and infertility partly mediating this association.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This prospective cohort study used data from the Nurses’ Health Study II (61,649 women followed 1995–2017) to examine whether laparoscopically confirmed endometriosis is associated with the risk of incident nonalcoholic fatty liver disease (NAFLD), using Cox proportional hazards models. During 1,313,067 person-years, 4,774 incident NAFLD cases occurred, and in multivariable adjustment laparoscopically confirmed endometriosis was positively associated with incident NAFLD (HR 1.17, 95% CI 1.07–1.29), with a significant age interaction (P=0.01). Mediation analyses suggested that hysterectomy/oophorectomy (31.6%) partly explained the association, along with hypercholesterolemia, hypertension, and infertility. The paper’s main caveats include reliance on self-reported diagnoses for both endometriosis and physician-diagnosed NAFLD and limitation to laparoscopy-confirmed endometriosis to reduce misclassification, which may affect generalizability. This paper is centrally about endometriosis — it specifically tests whether laparoscopically confirmed endometriosis increases the risk of incident NAFLD.

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Abstract

BACKGROUND: To investigate whether endometriosis is associated with the risk of incident nonalcoholic fatty liver disease (NAFLD). METHODS: Data were retrieved from Nurses' Health Study II with participants followed up from 1995 to 2017. A total of 61,649 participants were included in this prospective cohort study. The exposure of this study was laparoscopically confirmed endometriosis. We performed Cox proportional hazard regression analyses to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) of the association between endometriosis and NAFLD. RESULTS: A total of 4,774 incident NAFLD cases were recorded during a 1,313,067 person-years of follow-up. In the multivariable adjusted model, laparoscopically confirmed endometriosis was positively associated with the risk of NAFLD (HR: 1.17, 95% CI: 1.07 - 1.29). The results of the mediation analyses revealed that the association was partly attributable to hysterectomy/oophorectomy (31.6% mediated, 95% CI: 18.8-47.9%), hypercholesterolemia, hypertension and infertility. Further analysis revealed that the interaction effect of age was significant for the association between endometriosis and NAFLD (P = 0.01). CONCLUSIONS: Laparoscopically confirmed endometriosis was positively associated with the risk of incident NAFLD. Awareness of the potential NAFLD risk should be raised for clinicians and patients during the regular follow-up of endometriosis.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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