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Abstract Details
Associations Between Reproductive and Hormone-Related Factors and Risk of Nonalcoholic Fatty Liver Disease in a Multiethnic Population
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1258-1266.e1. doi: 10.1016/j.cgh.2020.08.012.Epub 2020 Aug 12.
Jun Wang1, Anna H Wu1, Frank Z Stanczyk2, Jacqueline Porcel3, Mazen Noureddin4, Norah A Terrault5, Lynne R Wilkens6, Veronica Wendy Setiawan7
Author information
1Department of Preventive Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
2Department of Preventive Medicine; Department of Obstetrics and Gynecology.
3Department of Preventive Medicine.
4Division of Gastroenterology and Hepatology, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California.
5Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine.
6Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii.
7Department of Preventive Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
Abstract
Background & aims: Despite apparent differences between men and women in the prevalence and incidence of nonalcoholic fatty liver disease (NAFLD), there are limited epidemiologic data regarding the associations of reproductive and hormone-related factors with NAFLD. We examined the associations of these factors and exogenous hormone use with NAFLD risk in African American, Japanese American, Latino, Native Hawaiian, and white women.
Methods: We conducted a nested case-control study (1861 cases and 17,664 controls) in the Multiethnic Cohort Study. NAFLD cases were identified using Medicare claims data; controls were selected among participants without liver disease and individually matched to cases by birth year, ethnicity, and length of Medicare enrollment. Reproductive and hormone-related factors and covariates were obtained from the baseline questionnaire. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs.
Results: Later age at menarche was associated inversely with NAFLD (Ptrend = .01). Parity, regardless of number of children or age at first birth, was associated with increased risk of NAFLD (OR, 1.25; 95% CI, 1.05-1.48). Oral contraceptive use also was linked to increased risk of NAFLD (OR, 1.14; 95% CI, 1.01-1.29; duration of use Ptrend = .04). Compared with women with natural menopause, those with oophorectomy (OR, 1.41; 95% CI, 1.18-1.68) or hysterectomy (OR, 1.33; 95% CI, 1.11-1.60) had an increased risk of NAFLD. A longer duration of menopause hormone therapy (only estrogen therapy) was linked with an increasing risk of NAFLD (OR per 5 years of use, 1.08, 95% CI, 1.01-1.15).
Conclusions: Findings from a large multiethnic study support the concept that menstrual and reproductive factors, as well as the use of exogenous hormones, are associated with the risk of NAFLD.