Women have lower NAFLD risk than men but more likely to progress to advanced fibrosis

Women are less likely to develop nonalcoholic fatty liver disease (NAFLD), although they are at higher risk of progression to advanced fibrosis once NAFLD is established as compared with men, a study reports.

Researchers accessed multiple online databases and conducted a systematic review of studies exploring sex-stratified NAFLD prevalence among population-based samples and either nonalcoholic steatohepatitis (NASH) or advanced fibrosis among patients with biopsy-proven NAFLD.

The meta-analysis included 54 studies, with the total population consisting of 62,239 patients with NAFLD, 5,428 with NASH, and 6,444 with advanced fibrosis.

Pooled data revealed that in the general population, the risk of NAFLD was lower by 19 percent in women than in men (risk ratio [RR], 0.81, 95 percent confidence interval [CI], 0.68–0.97; I², 97.5 percent). There was no significant between-group difference in the risk of NASH (RR, 1.00, 95 percent CI, 0.88–1.14; I², 85.1 percent).

However, women had a 37-percent greater risk of advanced fibrosis (RR, 1.37, 95 percent CI, 1.12–1.68; I², 74.0 percent) than men.

Age modified the effect of sex on NAFLD severity. In study populations with average ages of ≥50 years, women had markedly higher risks of NASH (RR, 1.17, 95 percent CI, 1.01–1.36) and advanced fibrosis (RR, 1.56, 95 percent CI, 1.36–1.80; I², 0 percent) than men. These sex-related differences were attenuated in younger populations.