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Women with NAFLD, especially users of HT, more susceptible to severe liver tissue injury

Women with nonalcoholic fatty liver disease who are premenopausal or those using synthetic hormones — birth control or hormone replacement therapy — show more severe hepatic injury and inflammation than their male counterparts, according to research published in Clinical Gastroenterology and Hepatology.

“We investigated the relationships of [nonalcoholic steatohepatitis] histologic severity to gender, reproductive status and hormone therapies at given levels of metabolic stress, Ju Dong Yang, MD, of the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., and colleagues wrote. “We also assessed the associations of the histologic features to women-specific reproductive variances — menstrual abnormality, oral contraceptive use and hormone replacement therapy — in premenopausal and postmenopausal women.”

In this cross-sectional study, researchers looked at 1,112 patients who underwent a liver biopsy less than 6 months before the study began. Patients did not drink an exorbitant amount of alcohol, were void of histological criteria for NAFLD and the women were in various stages of menopause. Fourteen percent of the patients were premenopausal women, 44% were postmenopausal women and the remaining 42% were men.

According to researchers, postmenopausal women were less likely to develop serious lobular inflammation and Mallory-Denk bodies (P < .01). Men had similar results, and were also at lower risk for developing hepatocyte ballooning (P < .01). A premenopausal woman using oral contraceptives was more likely to have lobular inflammation and Mallory-Denk bodies (P < .01; P = .01). Hormone replacement therapy was associated with an increased risk for lobular inflammation in postmenopausal women (P = .04). These findings did not change even after adjusting for a patient’s susceptibility to hypertension, their race, smoking and drinking habits.

“It is noteworthy that despite their enhanced hepatocyte injury and inflammation, premenopausal women were associated with lower stage of hepatic fibrosis compared with postmenopausal women and men,” researchers wrote.

Premenopausal women were less likely to develop hepatic fibrosis compared with postmenopausal women with portal inflammation and an increase in liver cells in the “stand-alone population” was similar to previous studies, according to researchers.

The researchers suggested future studies should explore sex differences in NASH clinical pathophysiology and phenotypes with the goal of developing a personalized approach to patients with NAFLD.  – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.