Friday, November 1, 2013

Estrogen may Guard Against Effects of Fatty Liver

Estrogen may help protect women from some of the more serious consequences of non-alcoholic steatohepatitis (NASH), researchers reported.

In a cross-sectional study of NASH patients, pre-menopausal women had a lower risk of severe fibrosis than men. But post-menopausal women had roughly the same risk as men, hinting at a protective effect for estrogen.

The findings suggest a protective effect from estrogen against development of severe fibrosis. But the researchers cautioned, the study was a snapshot and can't be used to establish a causal relationship between estrogen and NASH risk. Further study of the impact of estrogen on fibrosis progression in NASH patients is needed.

The prevalence of non-alcoholic fatty liver disease -- or NAFLD -- has been rising, to the point where some estimates put it at 10% to 30% in the U.S., the researchers noted. Most people with NAFLD have no symptoms, they added, but a subset develop NASH, which can lead to increased fibrosis and cirrhosis and which has been shown to increase mortality.

Studies have suggested that estrogen might play a role in NASH, the researchers noted. For instance, an Italian clinical trial showed that blocking estrogen led to a greater incidence of NASH.

The researchers hypothesized that pre-menopausal women with NASH would be at lower risk of fibrosis progression than either men or post-menopausal women.

To test the idea, they studied 541 adults with NASH. On average, the participants were 48 and 35% were men, 28% were pre-menopausal women, and 37% were post-menopausal women.

Analysis showed that 22% of the cohort had severe fibrosis, the researchers reported.

Post-menopausal women had a 1.6-fold increased risk of having greater severity of liver fibrosis. Men had a 1.7-fold increase in risk.

In other words, the researchers commented, "at any given degree of hepatocyte ballooning and portal inflammation, post-menopausal women and men have 60% to 70% increased risk of having a more severe fibrosis stage when compared to pre-menopausal women."


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