Thursday, November 7, 2013

In nonalcoholic steatohepatitis, men more likely to have severe fibrosis


In nonalcoholic steatohepatitis, men more likely to have severe fibrosis

Last Updated: 2013-11-06 11:30:25 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Men with nonalcoholic steatohepatitis (NASH) are more likely to have severe fibrosis than are premenopausal women with the disease, according to a new study.

"Our findings suggest a protective effect from estrogen against development of severe fibrosis," Dr. Ayako Suzuki from Central Arkansas Veterans Healthcare System in Little Rock, Arkansas, said in a statement. "Further study of the impact of estrogen on fibrosis progression in NASH patients in needed."

Dr. Suzuki and colleagues used data from the Duke University Health System NAFLD (non-alcoholic fatty liver disease) Clinical Database to assess whether gender and menopause are associated with the severity of liver fibrosis. Their study, online October 1 in Hepatology, included 541 adult patients with a histological diagnosis of NASH.

Just over a third of the patients were men, 28% were premenopausal women, and 37% were postmenopausal women. After adjusting for site, grade of portal inflammation, hepatocyte ballooning, black race, body mass index, diabetes and hypertension, the risk of having severe liver fibrosis (stage 3 or 4) was 60% higher in men than in premenopausal women (p=0.03) and 40% higher in postmenopausal women (p=0.17).

Age of 50 years or older, the average age of menopause in the U.S., was also associated with a significantly increased risk of having more advanced fibrosis among women, but not among men.

In an exploratory analysis, estrogen replacement (in 23 of the 199 postmenopausal women) was associated with a 50% reduction in the risk of severe fibrosis, although this fell short of statistical significance.

"Considering the findings from previous animal experiments, the observed association between premenopausal women and a decreased risk of hepatic fibrosis may be explained by protective effects of estrogens in fibrogenesis," the researchers conclude.

"Further studies are warranted to investigate the impact of estrogen on fibrosis progression in patients with NASH and potential preventive and/or therapeutic effects of estrogen among postmenopausal women with NASH."

Dr. Suzuki did not respond to a request for comments.


Hepatology 2013.

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