Menopause Does Not Affect Fatty Liver Severity In Women: A Population Study in a Mediterranean Area

Abstract

Background and objective: Estrogens could protect the liver from fatty degeneration, but there is little information about whether menopause is associated with the severity of alcoholic (AFL) and non-alcoholic fatty liver (NAFL). Our aim was to evaluate the distribution of fatty liver detected by ultrasound in pre- and post-menopausal women and the factors associated with these conditions.

Methods: In this cross-sectional study, the years from menopause were investigated through selfreported information. The degree of fatty liver was assessed through a standardized ultrasound examination (scores 0 to 6, higher values reflecting a greater severity). Liver steatosis was classified as NAFL or AFL based on a daily alcohol intake > 20g/d.

Results: The study included 752 women in menopause and 535 in pre-menopause. The years from menopause were not associated with the severity of liver steatosis in NAFL (p for trend=0.74; Spearman correlation=0.04; 95%CI: -0.09 to 0.17), whereas all the indexes of adiposity and the number of metabolic syndrome factors were associated with a higher liver steatosis score. Taking AFL liver steatosis as the outcome, the years since menopause were not significantly associated with liver steatosis in AFL (p for trend=0.50; Spearman correlation=0.09; 95%CI: -0.17 to 0.34), whilst the association between anthropometric parameters and liver steatosis severity resulted stronger in postmenopausal compared to pre- menopausal women.

Conclusion: the higher prevalence of fatty liver observed in post-menopausal women is probably not due to menopause per se, but to the adiposity (particularly abdominal) typical of this age and its consequences (such as metabolic syndrome).

Keywords: Fatty liver; epidemiology; mediterranean area; menopause; metabolic syndrome; ultrasound..