Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis - PubMed (original) (raw)

Comparative Study

. 2014 Apr;59(4):1406-14.

doi: 10.1002/hep.26761. Epub 2014 Feb 18.

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Comparative Study

Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis

Ju Dong Yang et al. Hepatology. 2014 Apr.

Abstract

Estrogens inhibit stellate cell activation and fibrogenesis. Thus, gender and reproductive states may influence the degree of fibrosis in patients with nonalcoholic steatohepatitis (NASH). To investigate the association between gender, menopause, and the severity of liver fibrosis in patients with NASH, we analyzed 541 adult patients enrolled from our Duke Liver Clinics (n = 338) and the Duke Metabolic and Weight Loss Surgery Program (n = 203) who had a histologic diagnosis of NASH. Multiple ordinal logistic regression models were used to assess the association between gender, menopause, and severity of liver fibrosis. Overall, men, premenopausal, and postmenopausal women composed 35.1%, 28.4%, and 36.5% of the population, respectively. The mean age was 48 years and 22% had advanced fibrosis. After adjusting for covariates (enrolling site, grades of portal inflammation, and hepatocyte ballooning) and potential confounders (race, body mass index, diabetes/prediabetes, hypertension), adjusted cumulative odd ratio (ACOR) and 95% confidence interval (CI) for greater fibrosis severity was 1.4 (0.9, 2.1) (P = 0.17) for postmenopausal women and 1.6 (1.0, 2.5) (P = 0.03) for men, having premenopausal women as a reference. There was borderline interaction between gender and age group divided by age 50, the average age at menopause in the U.S. (P = 0.08): ACOR and 95% CI of having greater fibrosis severity in men compared to women was 1.8 (1.1, 2.9) for patients with age <50 years (P = 0.02) and 1.2 (0.7, 2.1) for patients with age ≥50 years (P = 0.59).

Conclusion: Men are at a higher risk of having more severe fibrosis compared to women before menopause, while postmenopausal women have a similar severity of liver fibrosis compared to men. These findings may be explained by the protective effects of estrogen against fibrogenesis.

© 2014 by the American Association for the Study of Liver Diseases.

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Conflict of interest statement

Disclosure: The authors do not have conflict of interest related to this work.

Figures

Figure 1

Figure 1. Conditional Inference Tree Model

The figure demonstrates a decision tree developed with the same set of the variables used for ordinal logistic regression models. In the tree, variables with the strongest association fibrosis severity were split in a hierarchical manner. Detailed methodological explanation and relevant references were provided in the method section. Numbers in blue: median fibrosis stage in the groups DM: diabetes mellitus; Pre-MP: pre-menopausal women

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