Endocrine Abstracts

Background: Non-alcoholic liver disease (NAFLD) affects up to 30% of adults worldwide. With the prevalence of NAFLD increasing after menopause, women aged >55 years are more likely to progress to advanced fibrosis than men. Moreover, liver decompensation secondary to NAFLD is more frequent in women compared to men. However, the causes of these differential outcomes are not fully understood.

Methodology: We performed a retrospective cohort study utilising a database of consecutive patients followed up in the specialist multi-disciplinary NAFLD Clinic at Imperial College Healthcare NHS Trust (London, UK) with their first clinic review between 2009 and 2020. NAFLD was diagnosed either clinically or histologically. Clinical, biochemical, radiological and histological data were collected up to December 2022. Postmenopausal women were defined as women aged ≥55 years at their first clinic visit. Cirrhosis was diagnosed based on a combination of clinical, biochemical and/or radiological features or based on histology, when available. Multivariate logistic regression was performed to identify variables independently associated with cirrhosis. Statistical significance was set at P<0.05.

Results: 750 patients with NAFLD were included in this study, with a median (IQR) follow-up of 6 (3-8) years; 293 (39%) were female, 323 (43%) Caucasian, 161 (22%) South Asian, 75 (10%) Middle Eastern, median (IQR) age: 52 (42-60) years. At initial clinic review, fewer postmenopausal women (compared to age-matched men) had a Fibrosis-4 (FIB-4) score >1.3 (73% v 84%, P<0.05). However, similar proportions of postmenopausal women and age-matched men had an initial liver stiffness measurement ≥8 kPa (64% v 68%, P=0.27). Initial prevalence of type 2 diabetes, cardiovascular disease and obesity, as well as use of GLP-1 receptor agonists and SGLT2 inhibitors were similar between the two groups. Overall, postmenopausal women (n=156) had increased risks of being diagnosed with cirrhosis (OR 2.18 (95%CI 1.11-4.26), P<0.05) when compared to all other patients, as well as compared to age-matched men (n=149) alone (OR 2.58 (95%CI 1.14-6.02), P<0.05). There were insufficient data on reproductive hormone use for this variable to be included in the analyses.

Conclusions: In this diverse cohort from a tertiary care centre, being a postmenopausal woman is associated with worse outcomes than being a man of any age or a younger woman. These disparities occur despite postmenopausal women presenting to specialised secondary care clinics with similar co-morbidities and receiving similar medication to age-matched men. Therefore, tailored management strategies may be required to improve outcomes in postmenopausal women with NAFLD.