title: A longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease.
abstract: Postmenopausal women with nonalcoholic steatohepatitis are at an increased risk of hepatic fibrosis compared with premenopausal women. Whether duration of estrogen deficiency in postmenopausal state dictates an individual's fibrosis risk remains uninvestigated. We assessed the associations of age at menopause and time from menopause with fibrosis severity in postmenopausal women with nonalcoholic fatty liver disease. Data from 488 postmenopausal women with (1) histologic diagnosis of nonalcoholic fatty liver disease and (2) self-reported information on age at menopause were analyzed. The associations of premature menopause (age at menopause of <40 years) and time from menopause (age at study enrollment - age at menopause, years) with fibrosis severity (stage 0-4) were assessed using multiple ordinal logistic regression models with and without adjusting for clinical confounders. Among the participants (age at menopause 43.7 ± 8.6 years), women with premature menopause (29.3%) were younger at enrollment (P < 0.001) and used hormone replacement therapy more often (P < 0.003). After adjusting for age at enrollment, race, waist circumference standardized by body mass index, current smoking, current alcohol use, hypertension, diabetes/impaired fasting glucose, homeostatic model assessment of insulin resistance, and hormone replacement therapy, premature menopause was associated with an increased likelihood of having more severe fibrosis (adjusted cumulative odds ratio = 1.9, 95% confidence interval 1.3-2.7, P = 0.001), while time from menopause was directly associated with an increased likelihood of having more severe fibrosis (adjusted cumulative odds ratio for 5-year unit = 1.2, 95% confidence interval 1.1-1.3, P = 0.002).
  
  
  
  Duration of estrogen deficiency in postmenopausal state confers fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease. (Hepatology 2016;64:85-91).
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Jagpal Singh
authors.initials: JS
authors.lastname: Klair
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Ju Dong
authors.initials: JD
authors.lastname: Yang
authors.affiliation: Gastroenterology and Hepatology, Duke University, Durham, NC.
authors.forename: Manal F
authors.initials: MF
authors.lastname: Abdelmalek
authors.affiliation: Department of Pathology, Duke University, Durham, NC.
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Guy
authors.affiliation: Department of Pathology, University of California San Francisco, San Francisco, CA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Gill
authors.affiliation: Nonalcoholic Steatohepatitis Clinical Research Network Data Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Katherine
authors.initials: K
authors.lastname: Yates
authors.affiliation: Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.affiliation: Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Gastroenterology and Hepatology, Duke University, Durham, NC.
authors.forename: Anna Mae
authors.initials: AM
authors.lastname: Diehl
authors.affiliation: Gastroenterology and Hepatology, Duke University, Durham, NC.|Gastroenterology, Central Arkansas Veterans Healthcare System.|Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Ayako
authors.initials: A
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004967:Estrogens / Q000172:deficiency*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008594:Menopause, Premature; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000378:metabolism / Q000473:pathology*; D017698:Postmenopause
chemical_list: D004967:Estrogens