THU642 Progression To Cirrhosis And All-cause Mortality Are Increased In Postmenopausal Women With NAFLD
Authors: Izzi-Engbeaya Chioma , Eng Pei Chia , Dunin-Borkowska Aleksandra , Forlano Roberta , Mullish Benjamin H , Sigon Giordano , Lin Vicky , Tan Tricia , Yee Michael , Manousou Pinelopi , Dhillo Waljit Singh 
Published: October 2023

Disclosure: C. Izzi-Engbeaya: None. P. Eng: None. A. Dunin-Borkowska: None. R. Forlano: None. B.H. Mullish: None. G. Sigon: None. V. Lin: None. T. Tan: None. M. Yee: None. P. Manousou: None. W.S. Dhillo: None.

Background: Up to 30% of adults worldwide are estimated to have Non-alcoholic Liver Disease (NAFLD), ranging from hepatic steatosis alone to steatohepatitis and cirrhosis. Due to underlying metabolic and hepatic pathology, patients with NAFLD require specialist input from Endocrinologists and Hepatologists. Worryingly, postmenopausal women with NAFLD are more likely to progress to advanced fibrosis and experience more frequent liver decompensation events than men, but the causes of these disparate outcomes are incompletely understood. Methodology: We performed a retrospective cohort study utilising a database of consecutive patients managed in the multidisciplinary Metabolic Endocrinology and Hepatology Clinic at Imperial College Healthcare NHS Trust (London, UK) who had their first clinic review between January 2009 and December 2020. NAFLD was diagnosed clinically or histologically. Clinical, biochemical and histological data were collected up to December 2022. Postmenopausal women were defined as women aged ≥55 years at their initial clinic visit. Cirrhosis was diagnosed based on a combination of clinical and radiological features or based on histology, when available. Multivariate logistic regression was performed to identify variables independently associated with cirrhosis. Statistical significance was set at p&lt;0.05. Results: 739 patients were included in this study (n=286 female, n=244 White, median (IQR) age: 52 (42-60) years), with a median follow-up of 6 (3-8) years. All-cause mortality was highest amongst postmenopausal women (proportion who died during follow-up: men &lt;55y 2% vs men ≥55y 9% vs women &lt;55y 0.8% vs women ≥55y 14%, p&lt;0.0001). Postmenopausal women (n=153) had increased risks of cirrhosis when compared to age-matched men (cirrhosis: OR 2.8 (95%CI 1.1-7.2), p&lt;0.05). Postmenopausal women had lower ALT levels at initial clinic review (median (IQR) ALT IU/L: women ≥55y 48 (30-73) vs men ≥55y 54 (41-77), p &lt;0.05), and lower alcohol intake than age-matched men (p&lt;0.0001). Similar proportions of postmenopausal women and age-matched men had a baseline fibrosis stage ≥2 (82% vs 78% respectively, p=0.55). Initial prevalence of obesity (p=0.63), type 2 diabetes (p=0.15), cardiovascular disease (p=0.21), as well as use of GLP-1 receptor agonists (p=0.17) and SGLT2 inhibitors (p&gt;0.99) were similar between these two groups. There were insufficient data on reproductive hormone use for this variable to be included in the analyses. Conclusions: Despite presenting to a specialised secondary care clinic with similar co-morbidities, liver fibrosis stage, and receiving similar treatments, being a postmenopausal woman in our diverse cohort is associated with worse outcomes than being a man aged ≥55years. Therefore, tailored and/or personalised management strategies may be required to improve outcomes in postmenopausal women with NAFLD.

Presentation: Thursday, June 15, 2023