title: Patient Sex, Reproductive Status, and Synthetic Hormone Use Associate With Histologic Severity of Nonalcoholic Steatohepatitis.
abstract: Sex and sex hormones can affect responses of patients with nonalcoholic fatty liver disease (NAFLD) to metabolic stress and development of hepatocyte injury and inflammation.
  
  
  
  We collected data from 3 large U.S. studies of patients with NAFLD (between October 2004 and June 2013) to assess the association between histologic severity and sex, menopause status, synthetic hormone use, and menstrual abnormalities in 1112 patients with a histologic diagnosis of NAFLD. We performed logistic or ordinal logistic regression models, adjusting for covariates relevant to an increase of hepatic metabolic stress.
  
  
  
  Premenopausal women were at an increased risk of lobular inflammation, hepatocyte ballooning, and Mallory-Denk bodies than men and also at an increased risk of lobular inflammation and Mallory-Denk bodies than postmenopausal women (P < .01). Use of oral contraceptives was associated with an increased risk of lobular inflammation and Mallory-Denk bodies in premenopausal women, whereas hormone replacement therapy was associated with an increased risk of lobular inflammation in postmenopausal women (P < .05).
  
  
  
  Being a premenopausal woman or a female user of synthetic hormones is associated with increased histologic severity of hepatocyte injury and inflammation among patients with NAFLD at given levels of hepatic metabolic stress.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Ju Dong
authors: JD
authors: Yang
authors: Gastroenterology and Hepatology, Duke University, Durham, North Carolina.
authors: Manal F
authors: MF
authors: Abdelmalek
authors: Department of Pathology, Duke University, Durham, North Carolina.
authors: Cynthia D
authors: CD
authors: Guy
authors: Department of Pathology, University of California San Francisco, San Francisco, California.
authors: Ryan M
authors: RM
authors: Gill
authors: Department of Pediatrics, Columbia University, New York, New York.
authors: Joel E
authors: JE
authors: Lavine
authors: Nonalcoholic Steatohepatitis Clinical Research Network Data Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors: Katherine
authors: K
authors: Yates
authors: Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors: Jagpal
authors: J
authors: Klair
authors: Division of Gastroenterology, University of California San Francisco, San Francisco, California.
authors: Norah A
authors: NA
authors: Terrault
authors: Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, Maryland.
authors: Jeanne M
authors: JM
authors: Clark
authors: Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors: Aynur
authors: A
authors: Unalp-Arida
authors: Gastroenterology and Hepatology, Duke University, Durham, North Carolina.
authors: Anna Mae
authors: AM
authors: Diehl
authors: Gastroenterology and Hepatology, Duke University, Durham, North Carolina; Gastroenterology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: ayako.suzuki@va.gov.
authors: Ayako
authors: A
authors: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006651:Histocytochemistry; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008593:Menopause; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000473:pathology*; D012098:Reproduction; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006728:Hormones
keywords: Fibrosis; Gender Differences; Risk Factor Analysis