Nov. 22, 2013 | New research led by a University of Arkansas for Medical Sciences (UAMS) hepatologist suggests that estrogen protects women with nonalcoholic steatohepatitis (NASH) from severe liver fibrosis.

The study, led by Ayako Suzuki, Ph.D., M.D., an associate professor in the UAMS College of Medicine and director of hepatology with the Central Arkansas Veterans Healthcare System, shows that premenopausal women have a reduced risk of having more severe liver fibrosis compared to men, but after menopause fibrosis severity is comparable between men and women.

The finding was recently published online in Hepatology, a journal of the American Association for the Study of Liver Diseases, and was done at Duke University before Suzuki joined UAMS and the VA.

If the findings of the study are confirmed by further research, then they could personalize preventative care for patients with NASH, especially ones with high risk, such as those with obesity, insulin resistance and diabetes mellitus.

Nonalcoholic fatty liver disease (NAFLD) includes a range of liver disorders from simple fatty liver to NASH (fatty liver with inflammation), NASH with fibrosis and cirrhosis. With the rapid rise in obesity, diabetes and metabolic syndrome, the prevalence of NAFLD — the result of insulin resistance — has steadily increased. Studies suggest that 10 to 30 percent of the U.S. population currently have some level of NAFLD, making it the most common liver disease in the United States.

“While most NAFLD patients have a mild disease known as fatty liver or hepatic steatosis, some patients present with NASH, which is more severe and increases overall mortality,” Suzuki said. “Our study aim was to investigate whether gender and menopause significantly impact fibrosis severity among adult patients with NAFLD.”

Suzuki’s research team analyzed data from 541 adults with NASH who were seen at Duke University Liver Clinics and the university’s bariatric surgery center. The average age of people participating in the study was 48. Twenty-eight percent were premenopausal women, 37 percent were post-menopausal and 35 percent were men.

“I wanted to look at this to better characterize ’risk’ of developing more advanced disease among patients with NAFLD,” Suzuki said. “Even back in Japan, NAFLD is quite prevalent. Now, it’s becoming a much more important health issue because obese patients develop metabolic problems, and NAFLD is one of the manifestations.”

Suzuki’s previous research looked at the relationship between NAFLD and development before and after puberty and theorized that differences in physiological levels of sex hormones related to gender, pubertal development, and menopause may modify disease progression of NAFLD. She said the study published recently was an extension of that research.

“Next, we are trying to look at the impact of gender, menopause and hormone replacement therapy on inflammatory features, as opposed to fibrosis, in NAFLD patients,” she said. “Better understanding of how gender and reproductive life cycle influence disease severity will help us to individualize our patient care.”

Through grants, the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Disease funded the study.