Endocrine Abstracts

Background: Non-alcoholic fatty liver disease (NAFLD), encompasses hepatic steatosis alone (NAFL), steatohepatitis (NASH), NAFL/NASH with fibrosis and cirrhosis. Severe fibrosis and cirrhosis are associated with increased risk of morbidity and mortality (due to cardiovascular events, end-stage liver failure and cancer). Postmenopausal women are a high-risk group of patients that have worse outcomes, but the specific factors that place them at higher risk are incompletely understood.

Methods: We performed a retrospective analysis of patients with clinically or histologically diagnosed NAFLD, followed-up in the multi-disciplinary Metabolic Hepatology Clinic at Imperial College Healthcare NHS Trust, with an initial clinic visit between 2010 and 2017.

Results: Within this cohort of 220 patients, 34% were women ≥55 years (presumed to be postmenopausal), 31% were men ≥55 years, 45% were White. In terms of outcomes, 22% had cirrhosis and 8% died during the follow-up period (up to 11 years). 11 (65%) of the patients who died and 11 (23%) of the patients with cirrhosis were postmenopausal women. There was a significantly higher proportion of women ≥55 years who had a baseline FibroScan liver stiffness measurement (LSM) ≥8kPa (increased risk of advanced fibrosis) compared to men ≥55 years, (59% vs 41%, P = 0 .032, using chi-squared tests). Multivariate logistic regression demonstrated that women ≥55 years were more likely to have follow-up LSM ≥8Pa (OR 2.5 [1.1-5.8], P = 0 .019) and type 2 diabetes (OR2.4 [1.0-5.5], P = 0 .026), whilst men ≥55 years were more likely to have ischaemic heart disease/stroke (P = 0.032).

Conclusions: Postmenopausal women represent a significant proportion of NAFLD patients referred to specialist care, and they may be more likely to have advanced fibrosis when they are initially reviewed. Some co-morbidities may be more prevalent in postmenopausal women compared to other groups. Further work is required to fully phenotype these patients, so that modifiable factors can be targeted to improve outcomes.