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Oral contraceptive pill use is associated with reduced odds of nonalcoholic fatty liver disease in menstruating women: results from NHANES III

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Higher prevalence of nonalcoholic fatty liver disease (NAFLD) in men and postmenopausal women than in premenopausal women has suggested a potential role of sex hormones in the pathogenesis of the disease. We sought to evaluate the association between oral contraceptive pills (OCP) and NAFLD and to determine whether adiposity mediates any effect.

Methods

We included 4338 women aged 20–60 years who were enrolled in the Third National Health and Nutrition Examination Survey from 1988 to 1994 in a population-based cross-sectional study. We defined NAFLD as moderate–severe steatosis on ultrasonography in women without excessive alcohol use or other identifiable causes. OCP use was based on self-report and was categorized as never, former or current use.

Results

The overall weighted prevalence of NAFLD was 11.6 % but lower in current (6.7 %) than in former (12.0 %) or never users (15.6 %, P = 0.016). In the multivariable model, current OCP users experienced a 50 % lower odds of NAFLD than never users (adjusted odds ratio 0.50; 95 % confidence interval 0.26, 0.98) after adjusting for age, race/ethnicity, smoking status, history of diabetes or hypertension and education. Further adjustment for body mass index or waist circumference significantly attenuated the OCP–NAFLD relationship.

Conclusions

In this large US-representative population, OCP use was associated with reduced odds of NAFLD. However, this association could be mediated or confounded by adiposity. Prospective studies are needed to further clarify the causal role of sex hormone.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA

    Su-Hsun Liu, Mariana Lazo, W. H. Linda Kao, Ruben Hernaez & Jeanne M. Clark

  2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ayman Koteish, Ruben Hernaez & Jeanne M. Clark

  3. Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Ming-Hsiung Shih

  4. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Susanne Bonekamp

  5. Department of Medicine, Washington Hospital Center/Georgetown University Hospital, Washington, DC, USA

    Ruben Hernaez

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  1. Su-Hsun Liu
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Correspondence to Jeanne M. Clark.

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Liu, SH., Lazo, M., Koteish, A. et al. Oral contraceptive pill use is associated with reduced odds of nonalcoholic fatty liver disease in menstruating women: results from NHANES III. J Gastroenterol 48, 1151–1159 (2013). https://doi.org/10.1007/s00535-012-0715-8

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  • DOI: https://doi.org/10.1007/s00535-012-0715-8

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