{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:19:08Z","timestamp":1792725548970,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2006,2,9]],"date-time":"2006-02-09T00:00:00Z","timestamp":1139443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2006,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objectives\u2002<\/jats:bold>\n                    To assess associations between the activity of hypothalamo\u2010pituitary\u2010adrenal (HPA) axis and liver histology in patients with nonalcoholic fatty liver disease (NAFLD).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design and patients\u2002<\/jats:bold>\n                    In a cross\u2010sectional study, we enrolled 50 consecutive, overweight, NAFLD patients and 40 control subjects who were comparable for age, sex and body mass index (BMI).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Measurements\u2002<\/jats:bold>\n                    NAFLD (by liver biopsy), HPA axis activity (by 24\u2010hour urinary free cortisol [UFC] excretion and serum cortisol levels after 1\u00a0mg dexamethasone), insulin resistance (by homeostasis model assessment: HOMA\u2010IR), and metabolic syndrome (MetS) features.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results\u2002<\/jats:bold>\n                    NAFLD patients had markedly higher (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0\u00b7001) 24\u2010h UFC (149 \u00b1 24\n                    <jats:italic>vs<\/jats:italic>\n                    . 90 \u00b1 16 nmol\/day) and postdex suppression cortisol concentrations (32 \u00b1 10\n                    <jats:italic>vs<\/jats:italic>\n                    . 16 \u00b1 7 nmol\/l) than controls. The MetS and its individual components were more frequent among NAFLD patients. The marked differences in urinary\/serum cortisol concentrations that were observed between the groups were little affected by adjustment for age, sex, BMI, waist circumference, systolic blood pressure, triglycerides, homeostasis model assessment for insulin resistance score and presence of diabetes. Importantly, 24\u2010h UFC and postdex cortisol concentrations strongly correlated to hepatic necroinflammatory grade (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0\u00b701) and fibrosis stage (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0\u00b7001) among NAFLD patients. By logistic regression analysis, 24\u2010h UFC (odds ratio (OR) 1\u00b780, 95%CI 1\u00b73\u20132\u00b78) or postdex cortisol concentrations (OR 1\u00b795, 95%CI 1\u00b74\u20133\u00b71) independently predicted the severity of hepatic fibrosis, but not necroinflammation, after adjustment for potential confounders.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions\u2002<\/jats:bold>\n                    These results suggest that NAFLD patients have a subtle, chronic overactivity in the HPA axis (that is closely associated with the severity of liver histopathology) leading to subclinical hypercortisolism that might be implicated in the development of NAFLD.\n                  <\/jats:p>","DOI":"10.1111\/j.1365-2265.2006.02466.x","type":"journal-article","created":{"date-parts":[[2006,2,9]],"date-time":"2006-02-09T11:14:33Z","timestamp":1139483673000},"page":"337-341","source":"Crossref","is-referenced-by-count":88,"title":["Associations between liver histology and cortisol secretion in subjects with nonalcoholic fatty liver disease"],"prefix":"10.1111","volume":"64","author":[{"given":"Giovanni","family":"Targher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Bertolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Rodella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Zoppini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Zenari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Falezza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,2,9]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra011775"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2005.01748.x"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)11222-8"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-003-1284-4"},{"key":"e_1_2_5_6_2","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1126\/science.1066285","article-title":"A transgenic model of visceral obesity and the metabolic syndrome","volume":"7","author":"Masuzaki H.","year":"2001","journal-title":"Science"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M103676200"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-030596"},{"key":"e_1_2_5_9_2","first-page":"771","article-title":"The association of dehydroepiandrosterone, obesity, waist\u2010hip ratio and insulin resistance with fatty liver in postmenopausal women. 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