Patient Sex, Reproductive Status, and Synthetic Hormone Use Associate With Histologic Severity of Nonalcoholic Steatohepatitis

Ju Dong Yang, Manal F. Abdelmalek, Cynthia D. Guy, Ryan M. Gill, Joel E. Lavine, Katherine Yates, Jagpal Klair, Norah A. Terrault, Jeanne M. Clark, Aynur Unalp-Arida, Anna Mae Diehl, Ayako Suzuki, Srinivasan Dasarathy, Jaividhya Dasarathy, Carol Hawkins, Arthur J. McCullough, Mangesh Pagadala, Rish Pai, Ruth Sargent, Mustafa BashirStephanie Buie, Christopher Kigongo, Yi Ping Pan, Dawn Piercy, Naga Chalasani, Oscar W. Cummings, Samer Gawrieh, Marwan Ghabril, Smitha Marri, Linda Ragozzino, Kumar Sandrasegaran, Raj Vuppalanchi, Debra King, Pat Osmack, Joan Siegner, Susan Stewart, Brent A. Neuschwander-Tetri, Susan Torretta, Brandon Ang, Cynthia Behling, Archana Bhatt, Rohit Loomba, Michael Middleton, Heather Patton, Claude Sirlin, Bradley Aouizerat, Nathan M. Bass, Danielle Brandman, Linda D. Ferrell, Bilal Hameed, Claudia Ramos, Ashley Ungermann, Pradeep Atla, Brandon Croft, Rebekah Garcia, Sonia Garcia, Muhammad Sheikh, Mandeep Singh, Sherry Boyett, Laura Carucci, Melissa J. Contos, Kenneth Kraft, Velimir A.C. Luketic, Puneet Puri, Arun J. Sanyal, Jolene Schlosser, Mohhamad S. Siddiqui, Ben Wolford, Sarah Ackermann, Shannon Cooney, David Coy, Katie Gelinas, Kris V. Kowdley, Maximillian Lee, Tracey Pierce, Jody Mooney, James E. Nelson, Cheryl Shaw, Asma Siddique, Chia Wang, Elizabeth M. Brunt, Kathryn Fowler, David E. Kleiner, Gilman D. Grave, Edward C. Doo, Jay H. Hoofnagle, Patricia R. Robuck, Averell Sherker, Patricia Belt, Michele Donithan, Erin Hallinan, Milana Isaacson, Kevin P. May, Laura Miriel, Alice Sternberg, James Tonascia, Aynur Ünalp-Arida, Mark Van Natta, Ivana Vaughn, Laura Wilson

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61 Scopus citations


Background & Aims Sex and sex hormones can affect responses of patients with nonalcoholic fatty liver disease (NAFLD) to metabolic stress and development of hepatocyte injury and inflammation. Methods We collected data from 3 large U.S. studies of patients with NAFLD (between October 2004 and June 2013) to assess the association between histologic severity and sex, menopause status, synthetic hormone use, and menstrual abnormalities in 1112 patients with a histologic diagnosis of NAFLD. We performed logistic or ordinal logistic regression models, adjusting for covariates relevant to an increase of hepatic metabolic stress. Results Premenopausal women were at an increased risk of lobular inflammation, hepatocyte ballooning, and Mallory-Denk bodies than men and also at an increased risk of lobular inflammation and Mallory-Denk bodies than postmenopausal women (P <.01). Use of oral contraceptives was associated with an increased risk of lobular inflammation and Mallory-Denk bodies in premenopausal women, whereas hormone replacement therapy was associated with an increased risk of lobular inflammation in postmenopausal women (P <.05). Conclusions Being a premenopausal woman or a female user of synthetic hormones is associated with increased histologic severity of hepatocyte injury and inflammation among patients with NAFLD at given levels of hepatic metabolic stress.

Original languageEnglish
Pages (from-to)127-131.e2
JournalClinical Gastroenterology and Hepatology
Issue number1
StatePublished - Jan 1 2017


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