title: Oral contraceptive pill use is associated with reduced odds of nonalcoholic fatty liver disease in menstruating women: results from NHANES III.
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.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA.
authors.forename: Su-Hsun
authors.initials: SH
authors.lastname: Liu
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.forename: Ayman
authors.initials: A
authors.lastname: Koteish
authors.forename: W H Linda
authors.initials: WH
authors.lastname: Kao
authors.forename: Ming-Hsiung
authors.initials: MH
authors.lastname: Shih
authors.forename: Susanne
authors.initials: S
authors.lastname: Bonekamp
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernaez
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
mesh_terms: D000328:Adult; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008598:Menstruation; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D012307:Risk Factors; D014463:Ultrasonography; D014481:United States; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral