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Meta-Analysis
. 2021 Jan;19(1):61-71.e15.
doi: 10.1016/j.cgh.2020.04.067. Epub 2020 Apr 30.

Women Have a Lower Risk of Nonalcoholic Fatty Liver Disease but a Higher Risk of Progression vs Men: A Systematic Review and Meta-analysis

Maya Balakrishnan  1 , Parth Patel  2 , Sydney Dunn-Valadez  2 , Cecilia Dao  3 , Vinshi Khan  3 , Hiba Ali  2 , Laith El-Serag  3 , Ruben Hernaez  3 , Amy Sisson  4 , Aaron P Thrift  5 , Yan Liu  6 , Hashem B El-Serag  7 , Fasiha Kanwal  6
Affiliations
Meta-Analysis

Women Have a Lower Risk of Nonalcoholic Fatty Liver Disease but a Higher Risk of Progression vs Men: A Systematic Review and Meta-analysis

Maya Balakrishnan et al. Clin Gastroenterol Hepatol. 2021 Jan.

Abstract

Background & aims: The risk of nonalcoholic fatty liver disease (NAFLD) and its progression may differ between men and women. We conducted a systematic review and meta-analysis to determine the relationship between sex and NAFLD, nonalcoholic steatohepatitis (NASH), and advanced NAFLD fibrosis.

Methods: Studies reporting sex-stratified NAFLD prevalence among population-based samples and either NASH or advanced fibrosis among patients with biopsy-proven NAFLD were identified from MEDLINE, EMBASE, and Cochrane databases through December 2017. We calculated pooled relative risk ratios comparing women vs men for each outcome.

Results: Our final analysis comprised 54 studies. Samples sizes were 62,239 for the NAFLD analysis, 5428 for the NASH analysis, and 6444 for the advanced fibrosis analysis. Women had a 19% lower risk of NAFLD than men in the general population (pooled risk ratio [RR], 0.81; 95% CI, 0.68-0.97; I2 = 97.5%). Women had a similar risk of NASH (RR, 1.00; 95% CI, 0.88-1.14; I2 = 85.1%), and a 37% higher risk of advanced fibrosis (RR, 1.37; 95% CI, 1.12-1.68; I2 = 74.0%) than men. Age modified the effect of sex on NAFLD severity. Risks of NASH (RR, 1.17; 95% CI, 1.01-1.36) and advanced fibrosis (RR, 1.56; 95% CI, 1.36-1.80; I2 = 0) were substantially higher in women in study populations with average ages of 50 years and older; sex differences in NASH and advanced fibrosis were attenuated in younger populations.

Conclusions: In a systematic review and meta-analysis, we found women to have a lower risk of NAFLD than men. However, once NAFLD is established, women have a higher risk of advanced fibrosis than men, especially after age 50 years.

Keywords: Chronic Liver Disease; Comparison; Gender Disparities; Metabolic.

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Conflict of interest statement

Conflict of Interest: The authors do not report any conflicts of interest.

Figures

Figure 1.
Figure 1.
Risk of NAFLD in women versus men among population-based studies.
Figure 2.
Figure 2.
Risk of NASH in women versus men with biopsy proven NAFLD.
Figure 3.
Figure 3.
Risk of NASH in women versus men with biopsy proven NAFLD, stratified by geography.
Figure 4.
Figure 4.
Risk of advanced fibrosis in women versus men with biopsy proven NAFLD.
Figure 5.
Figure 5.
Risk of advanced fibrosis in women versus men with biopsy proven NAFLD, stratified by geography.
Figure 6.
Figure 6.
Risk of advanced fibrosis in women versus men with biopsy proven NAFLD, stratified by advanced fibrosis definition.
See this image and copyright information in PMC

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