Prevalence of Nonalcoholic Fatty Liver Disease in the Female Population

Abstract

There is a paucity of recent data about the epidemiology and long‐term outcomes of nonalcoholic fatty liver disease (NAFLD) in the female population. Our aim was to assess the prevalence, risk factors, and mortality of NAFLD in female adults of the United States. Data from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999‐2014 were used. NAFLD status was determined by the U.S. Fatty Liver Index (US‐FLI) in the absence of other liver diseases and excessive alcohol consumption. The prevalence rates, risk factors, and 5‐year all‐cause and cardiovascular mortality were determined in women with NAFLD. The most recent prevalence of NAFLD among female adults (2007‐2014) in the United States was 24.4% (95% confidence interval [CI], 22.48‐26.33). Prevalence was higher among women >44 years of age and those with body mass index ≥30 kg/m2. In addition, the average age of the female population with NAFLD has decreased over time. The fully adjusted odds ratios in women with NAFLD compared to those without NAFLD were 1.48 (95% CI, 1.20‐1.82) for cardiovascular disease (CVD), 1.89 (95% CI, 1.42‐2.52) for atherosclerotic cardiovascular disease (ASCVD) score ≥7.5%, and 1.76 (95% CI, 1.37‐2.25) for either CVD or ASCVD ≥7.5%. The 5‐year mortality for female adults with NAFLD was significantly higher than for those without NAFLD (adjusted hazard ratio, 1.48; 95% CI, 1.07‐2.05). Among women with NAFLD, those with ASCVD ≥7.5% had significantly higher 5‐year all‐cause mortality and CVD mortality. Conclusion: The prevalence of NAFLD in female NHANES participants from the United States has continued over recent years. In the female population with NAFLD, ASCVD ≥7.5% is an independent predictor of overall and cardiac‐specific mortality.

Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

“…Such a finding confirms another report that also found the mortality rate is increasing among women with NAFLD . However, our study furthers this knowledge and notes that women encounter more deaths from cirrhosis when compared with men, suggestive that many women may have NASH rather than just NAFLD . Furthermore, our work highlights that there is possibly a sex bias when diagnosing NAFLD and that attention should be directed toward educating the public and health care workers that women are at risk for NAFLD and its negative outcomes, including patient‐reported outcomes and NAFLD‐related mortality.…”

“…Also of importance is that the death rate for adults with NAFLD is increasing significantly more in women than men . Such a finding confirms another report that also found the mortality rate is increasing among women with NAFLD . However, our study furthers this knowledge and notes that women encounter more deaths from cirrhosis when compared with men, suggestive that many women may have NASH rather than just NAFLD .…”

Attributable Fractions of Nonalcoholic Fatty Liver Disease for Mortality in the United States: Results From the Third National Health and Nutrition Examination Survey With 27 Years of Follow‐up

“…(9) Similarly, a study using NHANES III and NHANES 1999-2014 data found that risk of 5-year mortality was higher among women with NAFLD compared to women without NAFLD. (34) Although NAFLD is more common among men, risk and progression from simple steatosis to NASH has been suggested to increase among women after menopause. (35)(36)(37)(38)(39) In the current study, however, prevalence of NASH among women aged ≥55 years (3.3%) was similar to that of women aged <55 years (3.4%).…”

Dysregulation of bile acids increases the risk for preterm birth in pregnant women

“…Among the liver disorders, NAFLD is considered the most common disease [49][50][51] . Indeed, NAFLD is the commonest cause for liver dysfunction in our study cohort, with 4.2% of the pregnant women being diagnosed with NAFLD.…”