June 1, 2021

Most Common Liver Disease in America Affects Women and Men Differently

woman holding drawing of sad liver

By Dezimey Kum, SWHR Communications and Policy Intern

This post is part of SWHR’s blog series to raise awareness about women’s liver health. June 10, 2021, marks International Nonalcoholic Steatohepatitis (NASH) Day. Read below to learn about NASH and its impact on women.

The liver is the organ with the greatest capacity for regenerating itself, but it can be damaged in permanent ways due to a variety of diseases. An estimated 30% of U.S. adults have extra fat in their liver, a condition called nonalcoholic fatty liver disease (NAFLD), which can progress to more serious liver disease, nonalcoholic steatohepatitis (NASH).

NASH affects about 5% of the U.S. population and occurs when a buildup of fat in the liver causes inflammation and the development of scar tissue, known as fibrosis. Fibrosis can lead to cirrhosis, in which severe scarring results in poor liver function and eventually liver failure. People with NAFLD and NASH often do not experience outward symptoms, making it difficult to diagnose.

While men are more likely to develop NAFLD, a recent study suggests that women with NAFLD are more likely to progress to NASH and fibrosis than men. Specifically, the study showed that women had a 19% lower risk of NAFLD than men, but once they had NAFLD, women had a 37% higher risk of advanced fibrosis. The gender difference was even greater when examining the data based on age, with women over age 50 (generally postmenopausal) showing a 17% higher risk for NASH and a 56% higher risk for advanced fibrosis compared with men.

In addition, a recent meta-analysis in the Biology of Sex Differences identified the existence of differences between men and premenopausal women in specific biological processes and molecular functions relevant to NAFLD.

The increased risk of NAFLD in postmenopausal women compared to premenopausal women may be linked to the decline in the production of estrogen, which is thought to be a protective factor against NAFLD. As such, women who have NAFLD should be identified as at increased risk for developing NASH after menopause and should have their disease closely monitored.

There are currently no FDA-approved medical treatments for NAFLD or NASH, though researchers are studying drugs that may improve the condition. Weight loss through diet and exercise is the recommended treatment in order to reduce liver inflammation and scarring. Hormone replacement therapy (HRT) may potentially benefit postmenopausal women at risk for or with NAFLD by supplementing the estrogen the body loses during menopause; however, clinical research in the area is limited and more study is needed.

Evidence shows sex and gender differences influence women’s liver health, including in the prevalence, risk factors, fibrosis, and clinical outcomes of NAFLD. A better understanding of both biological and lifestyle factors affecting NASH development and treatment will lead to better health outcomes for all.

Read SWHR’s #LiverHealth4Women blogs here:

SWHR’s blog series on women’s liver health is supported by a grant from Intercept Pharmaceuticals Inc. SWHR maintains editorial control and independence over blog content.