A systematic review and meta-analysis, published recently in Clinical Gastroenterology and Hepatology, evaluated the relationship between sex and NAFLD, nonalcoholic steatohepatitis (NASH), and advanced NAFLD fibrosis.

Balakrishnan et al identified studies reporting on sex-stratified NAFLD prevalence among population-based samples and either NASH or advanced fibrosis among patients with biopsy-proven NAFLD from MEDLINE, EMBASE, and Cochrane databases through December 2017.

Overall, 54 studies were included in the analysis. Samples sizes included 62,239 for the NAFLD analysis, 5428 for the NASH analysis, and 6444 for advanced fibrosis analysis. Women were found to have a 19% lower risk of NAFLD compared to men in the general population (pooled risk ratio [RR], 0.81; 95% CI, 0.68-0.97; I2, 97.5%), but had a similar risk of NASH (RR, 1.00; 95% CI, 0.88-1.14; I2, 85.1%) and a 37% increased risk of advanced fibrosis (RR, 1.37; 95% CI, 1.12-1.68; I2, 74.0%), compared to men. Age was shown to alter 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 considerably higher in women in populations with average age >50 years. There was attenuation of sex differences in NASH and advanced fibrosis among younger populations.

This systematic review and meta-analysis revealed that women have a lower risk of NAFLD than men. Once NAFLD is established, women tend to have a higher risk of advanced fibrosis than men, particularly beyond age 50 years.

Source: Balakrishnan M, Patel P, Dunn-Valadez S, et al. Women have Lower Risk of Nonalcoholic Fatty Liver Disease but Higher Risk of Progression vs Men: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020 Apr 30.