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Estrogen may protect against severe liver fibrosis in NASH
Premenopausal women with nonalcoholic steatohepatitis appear to have a lower risk for severe liver fibrosis when compared with men and postmenopausal women with the disease, according to results of a new study.
“While most [nonalcoholic fatty liver disease] patients have a mild disease known as fatty liver or hepatic steatosis, some patients present with [nonalcoholic steatohepatitis], which is more severe and increases overall mortality,” researcher Ayako Suzuki, MD, PhD, MSc, of the Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences in Little Rock, said in a press release. “Our study aim was to investigate whether gender and menopause significantly impact fibrosis severity among adult patients with [nonalcoholic fatty liver disease].”
Suzuki and colleagues evaluated 541 adults with nonalcoholic steatohepatitis (NASH) enrolled in the Duke Liver Clinics and the Duke Metabolic and Weight Loss Surgery Program. The mean age of the participants was 48 years, and the cohort was composed of 35.1% men, 28.4% premenopausal women and 36.5% postmenopausal women.
According to study results, 22% had advanced fibrosis. After adjustment for certain covariates, including enrolling site, degrees of portal inflammation and hepatocyte ballooning, and potential confounders, such as age, race, BMI, diabetes/prediabetes and hypertension, adjusted cumulative ORs for greater fibrosis severity were 1.4 (95% CI, 0.9-2.1) for postmenopausal women and 1.6 (95% CI, 1-2.5) for men, with premenopausal women serving as a reference.
The researchers also analyzed patients according to age, dividing the cohort at age 50 years — the average age of menopause in the United States — and found an interaction between age younger than 50 years and risk for greater fibrosis severity among women only. For patients younger than 50 years, the adjusted cumulative OR for greater fibrosis severity in men vs. women was 1.8 (95% CI, 1.1-2.9), and for those aged at least 50 years, the adjusted cumulative OR was 1.2 (95% CI, 0.7-2.1).
Of the 199 postmenopausal women included in the study, 23 were under estrogen therapy. After adjustment for covariates, results linked estrogen replacement to a 50% reduction in risk for greater fibrosis severity, but this finding was not statistically significant (P=.11).
“Our findings suggest a protective effect from estrogen against development of severe fibrosis,” Suzuki said. “Further study of the impact of estrogen on fibrosis progression in NASH patients is needed.”
Disclosure: The researchers report no relevant financial disclosures.