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Sexual Dimorphisms in Nonalcoholic Fatty Liver Disease

  • Fatty Liver Disease (D Halegoua-De Marzio, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review focuses on how sex differences play a role in the development and progression of NAFLD, describe inconsistencies in current findings, and propose goals for future studies.

Recent Findings

NAFLD prevalence and severity is higher in men than in premenopausal women. After menopause, prevalence of NAFLD increases, suggesting a protective effect of estrogen. Androgen excess may also increase the risk of steatosis in women. Furthermore, there is a strong interplay between hormonal changes and development of visceral adiposity and metabolic syndrome, both closely related to NAFLD progression.

Summary

Despite advancements in research, our understanding of sexual dimorphism in NAFLD remains incomplete. While results are varied, it is apparent that sex differences with regard to endogenous hormones, reproductive stage, metabolic risk factors, and body fat distribution all play a significant role in the development of NAFLD. Future studies should aim to develop sex-specific therapies to mitigate the rising prevalence of NAFLD.

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Abbreviations

ALD:

Alcohol-associated liver disease

BMI:

Body mass index

ERɑ:

Estrogen receptor alpha

HCC:

Hepatocellular carcinoma

HOMA-IR:

Homeostatic model assessment of insulin resistance

HRT:

Hormone replacement therapy

IL-6:

Interleukin-6

LT:

Liver transplant

MetS:

Metabolic syndrome

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

NHANES:

National Health and Nutrition Examination Survey

PCOS:

Polycystic ovarian syndrome

VAI:

Visceral adiposity index

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Acknowledgements

JM—concept and drafting of the article, acquisition of the data and literature review, and critical revision of the article for important intellectual content

EKS—concept and drafting of the article, acquisition of the data and literature review, and critical revision of the article for important intellectual content

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  1. Division of Gastroenterology and Hepatology, Department of Medicine, 4264 MFCB, 1685 Highland Avenue, Madison, WI, 53705, USA

    Jessica Musto, Erin K. Spengler & Margarita N. German

  2. School of Medicine and Public Health, University of Wisconsin, 4000 MFCB, 1685 Highland Avenue, Madison, WI, 53705, USA

    Jessica Musto, Erin K. Spengler & Margarita N. German

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  1. Jessica Musto
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  2. Erin K. Spengler
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  3. Margarita N. German
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Correspondence to Margarita N. German.

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This article is part of the Topical Collection on Fatty Liver Disease

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Musto, J., Spengler, E.K. & German, M.N. Sexual Dimorphisms in Nonalcoholic Fatty Liver Disease. Curr Hepatology Rep 20, 97–107 (2021). https://doi.org/10.1007/s11901-021-00568-8

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