ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health and Nutrition
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1617550
Positive and linear association of hepatic steatosis index with female infertility in US women: results from the National Health and Nutrition Examination Survey 2013-2018
Provisionally accepted
- 1Department of Clinical Medicine, Jining Medical University, Jining, China
- 2Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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Background:Female infertility is a global reproductive health challenge. The hepatic steatosis index (HSI) is a simple and non-invasive screening tool for steatosis. We herein explore the association of HSI with female infertility through the National Health and Nutrition Examination Survey (NHANES) 2013-2018.This cross-sectional study included 2,133 reproductive-age women from 15 U.S. states, with data collected through standardized questionnaires, physical examinations, and laboratory tests across three survey cycles (2013)(2014)(2015)(2016)(2017)(2018).HSI was assessed based on body mass index, ALT/AST, sex, and diabetes status. Female infertility status was ascertained through standardized questionnaire items reflecting clinical diagnostic criteria (≥1 year of unprotected intercourse without conception), though not verified by medical records or fertility testing. Female infertility status was determined by self-report. Multivariable logistic regression analysis was used to explore the association between HSI and female infertility and to calculate the odds ratio (OR) and 95% confidence interval (CI). Restricted cubic spline (RCS) and stratified analyses were further employed to examine potential nonlinear relationships and subgroup disparities. explored the factors affecting HSI through multivariate analysis Results: A total of 2,133 reproductive-age women were enrolled, of whom 271 had infertility. There was no significant trend in HSI levels across cycles. In the fully adjusted model, HSI showed positive cross-sectional associations with self-reported infertility status HSI was positively associated with the odds of female infertility (OR 1.02, 95% CI 1.01-1.04, p=0.005). Compared to Q1, HSI at Q4 was associated with a 72% increase in the odds of female infertility (p=0.003). Restricted cubic spline (RCS) analysis indicated that this association was linear (p for nonlinear = 0.9698). Stratified analyses suggested that this association was more pronounced among those <35 years of age and those with
Keywords: Female infertility, Hepatic Steatosis Index, Reproductive Health, steatosis, NHANES
Received: 24 Apr 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Wu, Zhang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lin Zhang, Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, 272000, Shandong Province, China
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