TOPLINE:

Women had a lower overall prevalence of clinically significant liver fibrosis than men. However, having two or more cardiometabolic risk factors, a large waist circumference, or glucose intolerance was associated with markedly larger increases in odds of the condition in women than in men.

METHODOLOGY:

• The occurrence of advanced liver fibrosis is increasing globally, and women tend to have faster progression despite lower prevalence. However, whether individual cardiometabolic risk factors are differentially associated with liver fibrosis risk in women and men remains unclear.
• Researchers conducted a cross-sectional analysis using US survey data (2017-2020) from adults aged 20 years or older to evaluate sex differences in the associations between common cardiometabolic risk factors and clinically significant liver fibrosis.
• Cardiometabolic risk factors included high waist circumference (> 102 cm in men or > 88 cm in women), glucose intolerance, hypertension, hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol, and obesity.
• The primary outcome was clinically significant fibrosis, defined as liver stiffness ≥ 8.0 kPa measured by transient elastography.

TAKEAWAY:

• The analysis included 5981 US adults (mean age, 49 years; 50.2% women). Clinically significant liver fibrosis was present in 6.9% of women and 10.7% of men.
• Women with two or more cardiometabolic risk factors had a substantially higher likelihood of clinically significant liver fibrosis than those with 0-1 factors (adjusted odds ratio [aOR], 10.22). The corresponding increase in the likelihood of the condition was smaller in men (aOR, 2.87; P for interaction = .002).
• Stronger associations with liver fibrosis were observed in women than in men for high waist circumference (aOR, 13.45 vs 4.44; P for interaction = .01) and glucose intolerance (aOR, 2.94 vs 1.51; P for interaction = .045).
• A high body roundness index was associated with a greater likelihood of liver fibrosis in women than in men (P for interaction = .006), whereas the effects of obesity, hypertension, hypertriglyceridemia, and low HDL cholesterol levels did not significantly differ by sex.

IN PRACTICE:

“From a clinical perspective, this supports expanding beyond approaches that focus on BMI, which did not achieve statistical significance when comparing the association by sex in this study. This is particularly true for women, who may not meet traditional obesity thresholds but are metabolically at high risk,” the authors of the study wrote.

SOURCE:

This study was led by Somaya Albhaisi, MBBCh, MPH, University of Southern California, Los Angeles. It was published online in JAMA Network Open.

LIMITATIONS:

With a cross-sectional design, the study could not prove cause-and-effect links between metabolic risk factors and liver fibrosis. Researchers determined fibrosis by transient elastography rather than biopsy. Other potential risk factors for liver disease, such as dietary intake, toxins, and medication use, were not assessed.

DISCLOSURES:

One author reported receiving support from a National Institutes of Health T32 Translational Research Training in Hepatology grant. Another author disclosed receiving grants, royalties, and educational materials from multiple pharmaceutical, healthcare, and publishing companies, and a national institute. One author reported receiving grant support from the National Institutes of Health.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.