Skip to main content

Advertisement

SpringerLink
Log in

Non-alcoholic fatty liver disease through the female lifespan: the role of sex hormones

  • Review
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

The prevalence of non-alcoholic fatty liver disease (NAFLD) differs between various stages of the female lifespan. The aim of this review is to summarize current evidence on the association of NAFLD and circulating sex hormones and to explore the pathogenesis of NAFLD within the context of (1) sex hormone changes during the reproductive, post-reproductive female life and beyond and (2) the in vitro and in vivo evidence on pharmacological modulation in women on menopausal hormone treatment (MHT) or endocrine therapy after breast cancer. The fluctuation in estrogen concentrations, the relative androgen excess, and the age-related reduction in sex hormone-binding globulin are related to increased NAFLD risk. Moreover, the peri-menopausal changes in body composition and insulin resistance might contribute to the increased NAFLD risk. Whether MHT prevents or improves NAFLD in this population remains an open question. Studies in women with breast cancer treated with tamoxifen or non-steroidal aromatase inhibitors point to their adverse effects on NAFLD development, although a more pronounced effect of tamoxifen is reported. Future studies focusing on the underlying pathogenesis should identify subgroups with the highest risk of NAFLD development and progression into more aggressive forms, as well as elucidate the role of hormone therapies, such as MHT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dewidar B et al (2020) Metabolic liver disease in diabetes—from mechanisms to clinical trials. Metabolism 111S:154299

    Article  PubMed  CAS  Google Scholar 

  2. Pafili K, Maltezos E, Papanas N (2018) Ipragliflozin and sodium glucose transporter 2 inhibitors to reduce liver fat: will the prize we sought be won? Expert Opin Pharmacother 19(3):185–187

    Article  CAS  PubMed  Google Scholar 

  3. Gunn NT, Shiffman ML (2018) The use of liver biopsy in nonalcoholic fatty liver disease: when to biopsy and in whom. Clin Liver Dis 22(1):109–119

    Article  PubMed  Google Scholar 

  4. Pafili K, Roden M (2020) Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans. Mol Metab 50:101122

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Kahl S et al (2014) Comparison of liver fat indices for the diagnosis of hepatic steatosis and insulin resistance. PLoS ONE 9(4):e94059

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Long MT, Gandhi S, Loomba R (2020) Advances in non-invasive biomarkers for the diagnosis and monitoring of non-alcoholic fatty liver disease. Metabolism 111S:154259

    Article  PubMed  CAS  Google Scholar 

  7. Polyzos SA, Mantzoros CS (2016) Nonalcoholic fatty future disease. Metabolism 65(8):1007–1016

    Article  CAS  PubMed  Google Scholar 

  8. Gouni-Berthold I, Papanas N, Maltezos E (2014) The role of oral antidiabetic agents and incretin mimetics in type 2 diabetic patients with non-alcoholic fatty liver disease. Curr Pharm Des 20(22):3705–3715

    Article  CAS  PubMed  Google Scholar 

  9. Zaharia OP et al (2019) Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study. Lancet Diabetes Endocrinol 7(9):684–694

    Article  PubMed  Google Scholar 

  10. Clayton JA, Collins FS (2014) Policy: NIH to balance sex in cell and animal studies. Nature 509(7500):282–283

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kur P et al (2020) Sex hormone-dependent physiology and diseases of liver. Int J Environ Res Public Health 17(8):2620

    Article  CAS  PubMed Central  Google Scholar 

  12. Fernandez-Perez L et al (2014) Lipid profiling and transcriptomic analysis reveals a functional interplay between estradiol and growth hormone in liver. PLoS ONE 9(5):e96305

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Davis SR et al (2015) Menopause. Nat Rev Dis Primers 1:15004

    Article  PubMed  Google Scholar 

  14. Markopoulos MC et al (2015) Hyperandrogenism after menopause. Eur J Endocrinol 172(2):R79-91

    Article  CAS  PubMed  Google Scholar 

  15. Lonardo A et al (2019) Sex differences in nonalcoholic fatty liver disease: state of the art and identification of research gaps. Hepatology 70(4):1457–1469

    Article  CAS  PubMed  Google Scholar 

  16. Ryu S et al (2015) Age at menarche and non-alcoholic fatty liver disease. J Hepatol 62(5):1164–1170

    Article  PubMed  Google Scholar 

  17. Yi KH et al (2017) Early menarche is associated with non-alcoholic fatty liver disease in adulthood. Pediatr Int 59(12):1270–1275

    Article  CAS  PubMed  Google Scholar 

  18. Lu J et al (2017) Age at menarche is associated with the prevalence of non-alcoholic fatty liver disease later in life. J Diabetes 9(1):53–60

    Article  CAS  PubMed  Google Scholar 

  19. Wang J et al (2021) Associations between reproductive and hormone-related factors and risk of nonalcoholic fatty liver disease in a multiethnic population. Clin Gastroenterol Hepatol 19(6):1258-1266e1

    Article  CAS  PubMed  Google Scholar 

  20. Mueller NT et al (2015) Earlier menarche is associated with fatty liver and abdominal ectopic fat in midlife, independent of young adult BMI: the CARDIA study. Obesity (Silver Spring) 23(2):468–474

    Article  Google Scholar 

  21. Ajmera VH et al (2016) Gestational diabetes mellitus is strongly associated with non-alcoholic fatty liver disease. Am J Gastroenterol 111(5):658–664

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lavrentaki A et al (2019) Increased risk of non-alcoholic fatty liver disease in women with gestational diabetes mellitus: A population-based cohort study, systematic review and meta-analysis. J Diabetes Complicat 33(10):107401

    Article  Google Scholar 

  23. Kubihal S et al (2021) Prevalence of non-alcoholic fatty liver disease and factors associated with it in Indian women with a history of gestational diabetes mellitus. J Diabetes Investig 12(5):877–885

    Article  CAS  PubMed  Google Scholar 

  24. Forbes S et al (2011) Increased prevalence of non-alcoholic fatty liver disease in European women with a history of gestational diabetes. Diabetologia 54(3):641–647

    Article  CAS  PubMed  Google Scholar 

  25. Endres LK et al (2015) Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol 125(1):144–152

    Article  PubMed  PubMed Central  Google Scholar 

  26. Paschou SA et al (2020) Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Endocrine 67(1):1–8

    Article  CAS  PubMed  Google Scholar 

  27. Polyzos SA et al (2014) Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: assessment of non-invasive indices predicting hepatic steatosis and fibrosis. Hormones (Athens) 13(4):519–531

    Article  Google Scholar 

  28. Vassilatou E et al (2010) Increased androgen bioavailability is associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome. Hum Reprod 25(1):212–220

    Article  CAS  PubMed  Google Scholar 

  29. Lambrinoudaki I et al (2011) Sex hormones in postmenopausal women receiving low-dose hormone therapy: the effect of BMI. Obesity (Silver Spring) 19(5):988–993

    Article  CAS  Google Scholar 

  30. Moghetti P et al (1996) The insulin resistance in women with hyperandrogenism is partially reversed by antiandrogen treatment: evidence that androgens impair insulin action in women. J Clin Endocrinol Metab 81(3):952–960

    CAS  PubMed  Google Scholar 

  31. Sarkar M et al (2017) Testosterone levels in pre-menopausal women are associated with nonalcoholic fatty liver disease in midlife. Am J Gastroenterol 112(5):755–762

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Park JM et al (2019) Serum testosterone level within normal range is positively associated with nonalcoholic fatty liver disease in premenopausal but not postmenopausal women. J Womens Health (Larchmt) 28(8):1077–1082

    Article  Google Scholar 

  33. Sarkar MA et al (2021) Testosterone is associated with nonalcoholic steatohepatitis and fibrosis in premenopausal women with NAFLD. Clin Gastroenterol Hepatol 19(6):1267-1274e1

    Article  CAS  PubMed  Google Scholar 

  34. Dilimulati D et al (2021) correlation between sex hormones and non-alcoholic fatty liver disease before and after laparoscopic sleeve gastrectomy. Obes Surg 31(11):4901–4910

    Article  PubMed  Google Scholar 

  35. Matsuo K et al (2016) Surgical menopause and increased risk of nonalcoholic fatty liver disease in endometrial cancer. Menopause 23(2):189–196

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sarrel PM, Sullivan SD, Nelson LM (2016) Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril 106(7):1580–1587

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Lefebvre P, Staels B (2021) Hepatic sexual dimorphism - implications for non-alcoholic fatty liver disease. Nat Rev Endocrinol 17(11):662–670

    Article  PubMed  Google Scholar 

  38. Palmisano BT, Zhu L, Stafford JM (2017) Role of estrogens in the regulation of liver lipid metabolism. Adv Exp Med Biol 1043:227–256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Mueller NT et al (2020) Sex hormone relations to histologic severity of pediatric nonalcoholic fatty liver disease. J Clin Endocrinol Metab 105(11):3496–3504

    Article  PubMed Central  Google Scholar 

  40. Jaruvongvanich V et al (2017) Testosterone, sex hormone-binding globulin and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Ann Hepatol 16(3):382–394

    Article  CAS  PubMed  Google Scholar 

  41. Kojima S et al (2003) Increase in the prevalence of fatty liver in Japan over the past 12 years: analysis of clinical background. J Gastroenterol 38(10):954–961

    Article  PubMed  Google Scholar 

  42. Florio AA et al (2019) Oophorectomy and risk of non-alcoholic fatty liver disease and primary liver cancer in the Clinical Practice Research Datalink. Eur J Epidemiol 34(9):871–878

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Bao T et al (2020) Association between serum uric acid and nonalcoholic fatty liver disease in nonobese postmenopausal women: a cross-sectional study. Sci Rep 10(1):10072

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Hong SH et al (2020) Comparison of anthropometric indices for the screening of nonalcoholic fatty liver disease in pre- and postmenopausal women. Menopause 27(1):88–94

    Article  PubMed  Google Scholar 

  45. Kim HB, Lee YJ (2020) Association of resting heart rate with nonalcoholic fatty liver disease in postmenopausal women. Medicine (Baltimore) 99(14):e19529

    Article  CAS  Google Scholar 

  46. Chen Y et al (2019) Association between serum uric acid and non-alcoholic fatty liver disease according to different menstrual status groups. Can J Gastroenterol Hepatol 2019:2763093

    Article  PubMed  PubMed Central  Google Scholar 

  47. Chung GE et al (2015) The influence of metabolic factors for nonalcoholic fatty liver disease in women. Biomed Res Int 2015:131528

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gutierrez-Grobe Y et al (2010) Prevalence of non alcoholic fatty liver disease in premenopausal, posmenopausal and polycystic ovary syndrome women. The role of estrogens. Ann Hepatol 9(4):402–409

    Article  PubMed  Google Scholar 

  49. Moon SS (2013) Relationship between serum uric acid level and nonalcoholic fatty liver disease in pre- and postmenopausal women. Ann Nutr Metab 62(2):158–163

    Article  CAS  PubMed  Google Scholar 

  50. Ryu S et al (2015) Menopausal stages and non-alcoholic fatty liver disease in middle-aged women. Eur J Obstet Gynecol Reprod Biol 190:65–70

    Article  PubMed  Google Scholar 

  51. Volzke H et al (2007) Menopausal status and hepatic steatosis in a general female population. Gut 56(4):594–595

    Article  PubMed  PubMed Central  Google Scholar 

  52. Suzuki A et al (2010) Regional anthropometric measures and hepatic fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 8(12):1062–1069

    Article  PubMed  PubMed Central  Google Scholar 

  53. Greendale GA et al (2019) Changes in body composition and weight during the menopause transition. JCI Insight 4(5):e124865

    Article  PubMed Central  Google Scholar 

  54. Lambrinoudaki I et al (2018) The metabolic syndrome is associated with carotid atherosclerosis and arterial stiffness in asymptomatic, nondiabetic postmenopausal women. Gynecol Endocrinol 34(1):78–82

    Article  PubMed  Google Scholar 

  55. Davis SR et al (2012) Understanding weight gain at menopause. Climacteric 15(5):419–429

    Article  CAS  PubMed  Google Scholar 

  56. Tchernof A et al (1998) Menopause, central body fatness, and insulin resistance: effects of hormone-replacement therapy. Coron Artery Dis 9(8):503–511

    Article  CAS  PubMed  Google Scholar 

  57. Brochu M et al (2000) Visceral adipose tissue is an independent correlate of glucose disposal in older obese postmenopausal women. J Clin Endocrinol Metab 85(7):2378–2384

    CAS  PubMed  Google Scholar 

  58. Signorelli SS et al (2006) Behaviour of some indicators of oxidative stress in postmenopausal and fertile women. Maturitas 53(1):77–82

    Article  CAS  PubMed  Google Scholar 

  59. Bourgonje AR et al (2020) Systemic oxidative stress is increased in postmenopausal women and independently associates with homocysteine levels. Int J Mol Sci 21(1):314

    Article  CAS  PubMed Central  Google Scholar 

  60. Kara A et al (2014) Ultra-structural changes and apoptotic activity in cerebellum of post-menopausal-diabetic rats: a histochemical and ultra-structural study. Gynecol Endocrinol 30(3):226–231

    Article  CAS  PubMed  Google Scholar 

  61. Hamaguchi M et al (2012) Aging is a risk factor of nonalcoholic fatty liver disease in premenopausal women. World J Gastroenterol 18(3):237–243

    Article  PubMed  PubMed Central  Google Scholar 

  62. Veronese N et al (2018) Menopause does not affect fatty liver severity in women: a population study in a Mediterranean area. Endocr Metab Immune Disord Drug Targets 18(5):513–521

    Article  CAS  PubMed  Google Scholar 

  63. Zhou H et al (2019) Prevalence of cardiovascular risk factors in non-menopausal and postmenopausal inpatients with type 2 diabetes mellitus in China. BMC Endocr Disord 19(1):98

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  64. Klair JS et al (2016) A longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease. Hepatology 64(1):85–91

    Article  CAS  PubMed  Google Scholar 

  65. Yang JD et al (2014) Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis. Hepatology 59(4):1406–1414

    Article  CAS  PubMed  Google Scholar 

  66. Yoneda M et al (2014) The influence of menopause on the development of hepatic fibrosis in nonobese women with nonalcoholic fatty liver disease. Hepatology 60(5):1792

    Article  PubMed  Google Scholar 

  67. Lazo M et al (2015) Association Between Endogenous Sex Hormones and Liver Fat in a Multiethnic Study of Atherosclerosis. Clin Gastroenterol Hepatol 13(9):1686–1693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Polyzos SA et al (2013) Sex steroids and sex hormone-binding globulin in postmenopausal women with nonalcoholic fatty liver disease. Hormones (Athens) 12(3):405–416

    Article  Google Scholar 

  69. Wang N et al (2016) Combined association of vitamin d and sex hormone binding globulin with nonalcoholic fatty liver disease in men and postmenopausal women: a cross-sectional study. Medicine (Baltimore) 95(4):e2621

    Article  CAS  Google Scholar 

  70. Flechtner-Mors M et al (2014) Associations of fatty liver disease and other factors affecting serum SHBG concentrations: a population based study on 1657 subjects. Horm Metab Res 46(4):287–293

    CAS  PubMed  Google Scholar 

  71. Rosner W et al (2013) Challenges to the measurement of estradiol: an endocrine society position statement. J Clin Endocrinol Metab 98(4):1376–1387

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Chartampilas E (2018) Imaging of nonalcoholic fatty liver disease and its clinical utility. Hormones (Athens) 17(1):69–81

    Article  Google Scholar 

  73. Wang X et al (2020) Serum SHBG is associated with the development and regression of nonalcoholic fatty liver disease: a prospective study. J Clin Endocrinol Metab 105(3):dgz244

    Article  PubMed  Google Scholar 

  74. Venetsanaki V, Polyzos SA (2019) Menopause and non-alcoholic fatty liver disease: a review focusing on therapeutic perspectives. Curr Vasc Pharmacol 17(6):546–555

    Article  CAS  PubMed  Google Scholar 

  75. Simo R et al (2012) Potential role of tumor necrosis factor-alpha in downregulating sex hormone-binding globulin. Diabetes 61(2):372–382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Luo J et al (2018) Association of sex hormone-binding globulin with nonalcoholic fatty liver disease in Chinese adults. Nutr Metab (Lond) 15:79

    Article  CAS  Google Scholar 

  77. Polyzos SA, Kountouras J, Mantzoros CS (2017) Adipose tissue, obesity and non-alcoholic fatty liver disease. Minerva Endocrinol 42(2):92–108

    Article  PubMed  Google Scholar 

  78. Shen M, Shi H (2015) Sex hormones and their receptors regulate liver energy homeostasis. Int J Endocrinol 2015:294278

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  79. Larsson H, Ahren B (1996) Androgen activity as a risk factor for impaired glucose tolerance in postmenopausal women. Diabetes Care 19(12):1399–1403

    Article  CAS  PubMed  Google Scholar 

  80. Nikolaou N et al (2015) Regulation of lipogenesis in human hepatocytes by androgens, glucocorticoids, and 5[alpha]-reductase. Endocr Abstr. https://doi.org/10.1530/endoabs.37.GP.04.04

    Article  Google Scholar 

  81. Galmes-Pascual BM et al (2020) 17beta-estradiol ameliorates lipotoxicity-induced hepatic mitochondrial oxidative stress and insulin resistance. Free Radic Biol Med 150:148–160

    Article  CAS  PubMed  Google Scholar 

  82. Galmes-Pascual BM et al (2017) 17beta-estradiol improves hepatic mitochondrial biogenesis and function through PGC1B. J Endocrinol 232(2):297–308

    Article  CAS  PubMed  Google Scholar 

  83. Zhu L et al (2013) Estrogen treatment after ovariectomy protects against fatty liver and may improve pathway-selective insulin resistance. Diabetes 62(2):424–434

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Cortes E et al (2019) Tamoxifen mechanically deactivates hepatic stellate cells via the G protein-coupled estrogen receptor. Oncogene 38(16):2910–2922

    Article  CAS  PubMed  Google Scholar 

  85. Itagaki T et al (2005) Opposing effects of oestradiol and progesterone on intracellular pathways and activation processes in the oxidative stress induced activation of cultured rat hepatic stellate cells. Gut 54(12):1782–1789

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. McKenzie J et al (2006) Effects of HRT on liver enzyme levels in women with type 2 diabetes: a randomized placebo-controlled trial. Clin Endocrinol (Oxf) 65(1):40–44

    Article  CAS  Google Scholar 

  87. Florentino GS et al (2013) Nonalcoholic fatty liver disease in menopausal women. Arq Gastroenterol 50(3):180–185

    Article  PubMed  Google Scholar 

  88. Yang JD et al (2017) Patient sex, reproductive status, and synthetic hormone use associate with histologic severity of nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 15(1):127–131

    Article  CAS  PubMed  Google Scholar 

  89. Nishino M et al (2003) Effects of tamoxifen on hepatic fat content and the development of hepatic steatosis in patients with breast cancer: high frequency of involvement and rapid reversal after completion of tamoxifen therapy. AJR Am J Roentgenol 180(1):129–134

    Article  PubMed  Google Scholar 

  90. Bruno S et al (2005) Incidence and risk factors for non-alcoholic steatohepatitis: prospective study of 5408 women enrolled in Italian tamoxifen chemoprevention trial. BMJ 330(7497):932

    Article  PubMed  PubMed Central  Google Scholar 

  91. Yan M et al (2017) The relationship between tamoxifen-associated nonalcoholic fatty liver disease and the prognosis of patients with early-stage breast cancer. Clin Breast Cancer 17(3):195–203

    Article  CAS  PubMed  Google Scholar 

  92. Hong N et al (2017) Different patterns in the risk of newly developed fatty liver and lipid changes with tamoxifen versus aromatase inhibitors in postmenopausal women with early breast cancer: a propensity score-matched cohort study. Eur J Cancer 82:103–114

    Article  CAS  PubMed  Google Scholar 

  93. Lee JI et al (2019) Aromatase inhibitors and newly developed nonalcoholic fatty liver disease in postmenopausal patients with early breast cancer: a propensity score-matched cohort study. Oncologist 24(8):e653–e661

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Cartoons in Figure 1 were created with BioRender.com.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

    K. Pafili

  2. German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany

    K. Pafili

  3. Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece

    K. Pafili

  4. Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    S. A. Paschou

  5. Menopause Unit, 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    S. A. Paschou, E. Armeni & I. Lambrinoudaki

  6. First Laboratory of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloníki, Greece

    S. A. Polyzos

  7. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloníki, Greece

    D. G. Goulis

Authors
  1. K. Pafili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. A. Paschou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Armeni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. A. Polyzos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. G. Goulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I. Lambrinoudaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: IL, SAPa. Data investigation: KP, EA. Data interpretation: KP, EA, SAPo, SAPa, DG, IL. Draft preparation: KP. Revision: KP, EA, SAPo, SAPa, DG, IL. Approval of submission: KP, EA, SAPo, SAPa, DG, IL.

Corresponding author

Correspondence to I. Lambrinoudaki.

Ethics declarations

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethics approval

This study has been approved by the Ethics department of the Aretaieio Hospital, National and Kapodistrian University of Athens.

Informed consent

For this type of study, consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pafili, K., Paschou, S.A., Armeni, E. et al. Non-alcoholic fatty liver disease through the female lifespan: the role of sex hormones. J Endocrinol Invest 45, 1609–1623 (2022). https://doi.org/10.1007/s40618-022-01766-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-022-01766-x

Keywords

Search

Navigation