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Conference Paper: Gender and Menopause Impact Severity of Fibrosis among Patients with Nonalcoholic Steatohepatitis

TitleGender and Menopause Impact Severity of Fibrosis among Patients with Nonalcoholic Steatohepatitis
Authors
Issue Date2012
PublisherSaunders.
Citation
The 63rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): The Liver Meeting 2012, Boston, MA., 9-13 November 2012. In Hepatology, 2012, v. 56 n. 4 suppl., p. 888A-889A, abstract no. 1483 How to Cite?
AbstractBACKGROUND/AIM: Estrogens inhibit stellate cell activation and fibrogenesis. Thus, gender/menopause may influence the degree of fibrosis in patients with nonalcoholic steatohepatitis (NASH). We assessed whether gender/menopause is associated with severity of fibrosis (FIB) in adult patients with NASH after taking account of degrees of hepatocyte ballooning (BAL) and portal inflammation (PORT), two significant histologic features well correlated with FIB. METHODS: We analyzed 550 adult patients enrolled at two clinical sites [referral liver clinic (N=344) and bariatric surgery center (N=206)] who had histologic diagnosis of NASH with no co-existing liver conditions or excess alcohol use. Menopausal state was classified based on self-reported reproductive information, history of oophorectomy, and age relative to the average US age at menopause (50 years old). Liver histology was scored for BAL, PORT, and FIB according to the NASH CRN scoring system. Two different modeling approaches, classification and regression tree model (CART) and multiple ordinal logistic regression model (MOLR), were used to assess the association between the gender/menopause and FIB, taking into consideration age, race, BMI, diabetes mellitus (DM) and hypertension (HTN). RESULTS: Overall, men, pre-menopausal and post-menopausal women composed 35.1%, 28.4%, and 36.5% of the population, respectively. Mean (SD) age and BMI were 48±11 years and 40±10 kg/m2, 51% had DM/pre-DM, 71% had HTN, and 22% had advanced fibrosis. There was no significant siteinteraction between FIB and the gender/menopause categories; thus the association was assessed in the total population adjusting for the sites. The non-parametric CART model identified pre-menopausal women as one of the important factors in the classification of FIB severity, which was associated with lower stages of FIB vs. others. In the MOLR model adjusting for BAL, PORT, and the sites, men and post-menopausal women had a higher likelihood of greater FIB severity vs. premenopausal women: adjusted cumulative odds ratio (ACOR) and 95% confident interval (CI) = 1.6[1.0, 2.4], p<0.04 for post-menopausal women and 1.7[1.1, 2.6], p<0.02 for men. After adjusting for other confounders, ACOR and 95% CI was 1.4[0.9, 2.1], p=0.17 for post-menopausal women and 1.5 [1.0, 2.4], p<0.06 for men. CONCLUSION: Before menopause, men are at a higher risk of having more advanced fibrosis vs. women, at any given grade of hepatocyte ballooning and portal inflammation, while post-menopausal women have a similar risk for fibrosis as men. These findings may be explained by the protective effects of estrogen on fibrogenesis.
Descriptionpp. 191A-1144A of this free journal suppl. entitled: AASLD Abstracts
Persistent Identifierhttp://hdl.handle.net/10722/195792
ISSN
2015 Impact Factor: 11.711
2015 SCImago Journal Rankings: 4.752

 

DC FieldValueLanguage
dc.contributor.authorSuzuki, Aen_US
dc.contributor.authorPang, HMHen_US
dc.contributor.authorGuy, CDen_US
dc.contributor.authorSmith, ADen_US
dc.contributor.authorDiehl, AMen_US
dc.contributor.authorAbdelmalek, MFen_US
dc.date.accessioned2014-03-10T04:53:31Z-
dc.date.available2014-03-10T04:53:31Z-
dc.date.issued2012en_US
dc.identifier.citationThe 63rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): The Liver Meeting 2012, Boston, MA., 9-13 November 2012. In Hepatology, 2012, v. 56 n. 4 suppl., p. 888A-889A, abstract no. 1483en_US
dc.identifier.issn0270-9139en_US
dc.identifier.urihttp://hdl.handle.net/10722/195792-
dc.descriptionpp. 191A-1144A of this free journal suppl. entitled: AASLD Abstracts-
dc.description.abstractBACKGROUND/AIM: Estrogens inhibit stellate cell activation and fibrogenesis. Thus, gender/menopause may influence the degree of fibrosis in patients with nonalcoholic steatohepatitis (NASH). We assessed whether gender/menopause is associated with severity of fibrosis (FIB) in adult patients with NASH after taking account of degrees of hepatocyte ballooning (BAL) and portal inflammation (PORT), two significant histologic features well correlated with FIB. METHODS: We analyzed 550 adult patients enrolled at two clinical sites [referral liver clinic (N=344) and bariatric surgery center (N=206)] who had histologic diagnosis of NASH with no co-existing liver conditions or excess alcohol use. Menopausal state was classified based on self-reported reproductive information, history of oophorectomy, and age relative to the average US age at menopause (50 years old). Liver histology was scored for BAL, PORT, and FIB according to the NASH CRN scoring system. Two different modeling approaches, classification and regression tree model (CART) and multiple ordinal logistic regression model (MOLR), were used to assess the association between the gender/menopause and FIB, taking into consideration age, race, BMI, diabetes mellitus (DM) and hypertension (HTN). RESULTS: Overall, men, pre-menopausal and post-menopausal women composed 35.1%, 28.4%, and 36.5% of the population, respectively. Mean (SD) age and BMI were 48±11 years and 40±10 kg/m2, 51% had DM/pre-DM, 71% had HTN, and 22% had advanced fibrosis. There was no significant siteinteraction between FIB and the gender/menopause categories; thus the association was assessed in the total population adjusting for the sites. The non-parametric CART model identified pre-menopausal women as one of the important factors in the classification of FIB severity, which was associated with lower stages of FIB vs. others. In the MOLR model adjusting for BAL, PORT, and the sites, men and post-menopausal women had a higher likelihood of greater FIB severity vs. premenopausal women: adjusted cumulative odds ratio (ACOR) and 95% confident interval (CI) = 1.6[1.0, 2.4], p<0.04 for post-menopausal women and 1.7[1.1, 2.6], p<0.02 for men. After adjusting for other confounders, ACOR and 95% CI was 1.4[0.9, 2.1], p=0.17 for post-menopausal women and 1.5 [1.0, 2.4], p<0.06 for men. CONCLUSION: Before menopause, men are at a higher risk of having more advanced fibrosis vs. women, at any given grade of hepatocyte ballooning and portal inflammation, while post-menopausal women have a similar risk for fibrosis as men. These findings may be explained by the protective effects of estrogen on fibrogenesis.-
dc.languageengen_US
dc.publisherSaunders.en_US
dc.relation.ispartofHepatologyen_US
dc.titleGender and Menopause Impact Severity of Fibrosis among Patients with Nonalcoholic Steatohepatitisen_US
dc.typeConference_Paperen_US
dc.identifier.emailPang, HMH: herbpang@hku.hken_US
dc.identifier.authorityPang, HMH=rp01857en_US
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1002/hep.26040-
dc.identifier.volume56en_US
dc.identifier.issue4 suppl.-
dc.identifier.spage888A, abstract no. 1483en_US
dc.identifier.epage889Aen_US
dc.publisher.placeUnited Statesen_US

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