Sex Differences in Alcohol Consumption and Alcohol-Associated Liver Disease

Abstract

Alcohol-associated liver disease is becoming increasingly prevalent throughout the United States. Previously alcohol-associated liver disease was known to affect men more often than women; however, this gap between the sexes is narrowing. Studies show that women develop liver disease with lesser alcohol exposure and suffer worse disease as compared with men. This review article explores the increasing prevalence of alcohol-associated liver disease in women, reasons for changing patterns in alcohol consumption and liver disease development including obesity and bariatric surgery, proposed mechanisms of sex-specific differences in alcohol metabolism that may account for this discrepancy between men and women, and sex differences in treatment enrollment and response. Studies were identified by performing a literature search of PubMed and Google Scholar and through review of the references in retrieved articles. Search terms included alcohol-associated liver disease, alcoholic hepatitis, alcoholic cirrhosis, sex, gender, female, epidemiology, bariatric surgery, obesity, treatment. Due to the paucity of literature on some of the relevant subject matter and inclusion of landmark studies, no date range was selected. Studies were included if their methods were sufficiently robust and they made a comparison between the sexes that is clinically relevant. Understanding of the changing epidemiology and mechanisms of liver disease development unique to women are paramount in creating appropriate and effective interventions for women who represent a rapidly growing subset of patients with alcohol-associated liver disease.

Alcohol-associated Liver Disease Is Now the Most Common Indication for Liver Transplant Waitlisting Among Young American Adults

“…First, although historically men were more likely than women to participate in harmful alcohol consumption, this gender gap has narrowed with young men and women consuming alcohol at similar rates. 18 Second, it is well established that harmful effects of alcohol occur at lower levels of exposure in women compared to men. 19 Furthermore, women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to engage in treatment compared to men.…”

Genetic and environmental factors underlying parallel changes in body mass index and alcohol consumption: a 36-year longitudinal study of adult twins

“…That is, they were free to correlate without influencing each other during the model-fitting phase (Figure 2). This modeling was sex-specific to correct for structural differences in alcohol consumption between the sexes that are well-established in most populations (16,(18)(19)(20).…”

“…Alcohol use is widely known to have a genetic component (16)(17) and substantial interindividual differences, such as sex differences (18)(19)(20). Large epidemiological studies have also found differences and inconsistencies between men and women in the association between drinking at baseline and weight gain (21)(22)(23)(24).…”

Liver-specific drug delivery platforms: Applications for the treatment of alcohol-associated liver disease

“…Additionally, in pre-clinical ALD research, it is important to consider sex differences, since men and women consume and metabolize alcohol differently, have different risk factors contributing to ALD, and ultimately, have different susceptibility to developing the disease[ 100 ]. Even in mice, there are sex differences in susceptibility to ALD when controlling for alcohol intake, diet, and other factors[ 101 ].…”