Women at Lower Risk for Nonalcoholic Fatty Liver Disease But at Greater Risk for Progression

liver cirrhosis
A systematic review and meta-analysis of observational studies was conducted to assess the prevalence of nonalcoholic fatty liver disease in the general population.

Women were found to have a lower risk for developing nonalcoholic fatty liver disease (NAFLD) than men; however, once NAFLD was established, women were at greater risk for advanced fibrosis than men. These findings from a systematic review and meta-analysis were published in the Clinical Gastroenterology and Hepatology.

Publication databases were searched through December of 2017. Studies of NAFLD prevalence that stratified participants by sex were included. A total of 54 studies encompassing 62,239 patients with NAFLD, 5428 patients with nonalcoholic steatohepatitis (NASH), and 6444 patients with advanced fibrosis were included; 17 were population based, 22 were of NASH in the setting of biopsy-proven NAFLD, and 21 were of advanced fibrosis among biopsy-proven NAFLD (6 studies encompassed both NASH and advanced fibrosis).

The 17 population-based studies were performed in China (n=7), the Middle East (n=4), the United States (n=3), South Asia (n=2), and South America (n=1). Studies detected NAFLD by ultrasound (n=13), liver enzymes (n=2), magnetic resonance spectography (n=1), and a combination of ultrasound and computed tomographic imaging (n=1).

Among the study population, 35,119 were women and 27,120 were men. Ages ranged from 35.5 to 58.5 years, the average body mass index ranged from 19.6 to 31.0 kg/m2, and the prevalence of impaired glucose tolerance or type 2 diabetes was between 4% and 30%.

The investigators observed that women overall had a 19% lower risk for NAFLD when compared with men (risk ratio [RR], 0.81; 95% CI, 0.68-0.97; I2, 97.5%). Women had a 37% higher risk for advanced fibrosis when compared with men (RR, 1.37; 95% CI, 1.12-1.68; I2, 74.0%). Women were found to be at similar risk for NASH as men (RR, 1.00; 95% CI, 0.88-1.14; I2, 85.1%).

When age was accounted for, women were found to have an even higher risk for advanced fibrosis (RR, 1.56; 95% CI, 1.36-1.80; I2, 0) and a significant risk for NASH (RR, 1.17; 95% CI, 1.01-1.36) compared with men.

No evidence for publication bias was detected (Egger test: t, -1.36; degrees of freedom, 19; P =.189).

A limitation of this study was that some heterogeneity in the data was detected, which can be observed by asymmetry in the funnel plots.

The conclusions drawn from these data were that women were found to be at lower risk for NAFLD; however, once NAFLD was established, the risk for advanced fibrosis was increased. After 50 years of age, the risk for NASH among women was also higher compared with that for men.

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Balakrishnan M, Patel P, Dunn-Valadez S, et al. Women have a lower risk of nonalcoholic fatty liver disease but a higher risk of progression vs men: a systematic review and meta-analysis [published online April 30, 2020]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.04.067