Women’s health in hepatology: 7 recent reports

Studies that focus on specific patient characteristics and demographics often reveal key strategies to improve health care at the individual patient level. Liver disease research focused on women and mothers has shown that women face fertility risks with hepatitis C and higher risks for liver injury or failure with chronic liver disease.

Healio presents the following recent reports that also include data on preconception hepatic scores to predict pregnancy outcomes, HCV screening rates among women, and increased rate of breast cancer among women with fatty liver.

Preconception hepatic scores predict pregnancy outcomes in women with CLD

Preconception albumin-bilirubin score and aspartate aminotransferase to platelet ratio index accurately predicted pregnancy outcomes in women with chronic liver disease, according to recently published data.

“Preconception [albumin-bilirubin (ALBI)] score was shown to be predictive of live birth, whilst preconception [AST to platelet ratio index (APRI)] score was predictive for gestational length,” Enoka S. Gonsalkorala, MBBS, FRACP, from King’s College Hospital in London, and colleagues wrote. “In carefully selected individuals, once pregnant, liver disease does not appear to worsen significantly throughout the pregnancy nor in subsequent pregnancies.” Read more

Low subcutaneous adiposity linked to mortality risk in women with cirrhosis

A lower subcutaneous adipose tissue index correlated with higher mortality in women with cirrhosis, while lower skeletal muscle predicted mortality in men with cirrhosis, according to a recently published study.

“Besides body composition, sex differences exist regarding other clinical features of liver disease,” Maryam Ebadi, PhD, from the University of Alberta Hospital, Canada, and colleagues wrote. “The findings of our study emphasize the importance of differentiating between muscle, subcutaneous and visceral adipose tissue using cross sectional imaging in patients with liver cirrhosis.” Read more

Acetaminophen-induced liver injury, failure more common in women

Acetaminophen-induced acute liver injury and failure are more common in women than men, according to recently published data. Women also have greater critical care needs and have an increased risk for severe hepatic encephalopathy, potentially related to increased use of sedatives.

“The reasons for increased prevalence and severity of [drug-induced liver injury] in women are not clear, though may relate to greater use of hepatotoxic medications in women and differential drug metabolism by sex,” Jessica B. Rubin, MD, MPH, from the University of California San Francisco, and colleagues wrote. “Despite apparent sex differences in the prevalence and progression of other etiologies of [acute liver failure (ALF)], less is known regarding the natural history of acetaminophen-induced ALF in men and women.” Read more

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HCV screening lags for women, blacks, Hispanics

While hepatitis C screening improved recently, the increased rates are minimal and less than optimal among black individuals, Hispanics and women, according to a recently published study.

“There is substantial room for improvement,” Monica L. Kasting, PhD, from the H. Lee Moffitt Cancer Center, Florida, and colleagues wrote. “The new screening guidelines are meant to augment, not replace risk-based guidelines, but if they are not properly implemented, half of those chronically infected with HCV may fail to be identified.” Read more

Women with HCV face low ovarian reserve, infertility, miscarriage

Women of child-bearing age with hepatitis C showed early signs of menopause, putting them at greater risk for infertility, gestational diabetes and miscarriage, according to a recently published study. Sustained virologic response positively impacted these outcomes.

“We report that the relationship between HCV infection and reproductive status in women is much deeper and broader than previously thought, with profound consequences for reproductive function confirmed in cohorts from different countries,” the researchers wrote. “It remains to be assessed whether antiviral therapy at a very early age can positively influence the occurrence of miscarriages and to prevent ovarian senescence. ... The effect of treatment with new generation antiviral drugs could therefore be prospectively assessed with this dual purpose.” Read more

Fatty liver linked to colorectal cancer in men, breast cancer in women

Researchers observed that nonalcoholic fatty liver disease was associated with hepatocellular carcinoma in general and with colorectal cancer in men and breast cancer in women, according to recently published data.

“These findings suggest that patients with NAFLD require multidisciplinary evaluation with attention given to the development of malignancy,” the researchers wrote. Read more

Fatty liver increases risk for cardiovascular events in women

Women with nonalcoholic fatty liver disease saw significantly higher rates of subsequent cardiovascular events compared with men and saw them occur at a younger age, according to a speaker at The Liver Meeting 2017.

“Sex is such an important risk modifier that it’s included in all the calculators we use in daily practice to estimate someone’s risk of developing future cardiovascular events,” Alina M. Allen, MD, from the department of gastroenterology and hepatology at the Mayo Clinic, Rochester, Minn., said during a press conference. “It is known that in the general population, the female sex is protective for cardiovascular disease, which means that women are less likely than men to have cardiovascular events. What we found in this study is that this does not hold true in people who have NAFLD; we found that women with NAFLD are not more protected than men with NAFLD.” Read more