Department of Preventive Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
Department of Preventive Medicine; Department of Obstetrics and Gynecology.
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1258-1266.e1. doi: 10.1016/j.cgh.2020.08.012. Epub 2020 Aug 12.
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.
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.
Later age at menarche was associated inversely with NAFLD (P = .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 P = .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).
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.
尽管非酒精性脂肪性肝病（NAFLD）在男性和女性中的患病率和发病率存在明显差异，但关于生殖和激素相关因素与 NAFLD 之间关联的流行病学数据有限。我们研究了这些因素以及外源性激素的使用与非裔美国人、日裔美国人、拉丁裔、夏威夷原住民和白人女性中 NAFLD 风险的关联。
我们在多民族队列研究中进行了一项嵌套病例对照研究（1861 例病例和 17664 例对照）。使用医疗保险索赔数据确定 NAFLD 病例；选择没有肝病的参与者作为对照，并按出生年份、种族和医疗保险登记年限与病例进行个体匹配。生殖和激素相关因素以及协变量是从基线问卷中获得的。多变量逻辑回归用于计算比值比（OR）和 95%置信区间（CI）。
初潮年龄较晚与 NAFLD 呈负相关（P=0.01）。无论生育子女数量或初育年龄如何，生育都会增加 NAFLD 的风险（OR，1.25；95%CI，1.05-1.48）。口服避孕药的使用也与 NAFLD 风险增加相关（OR，1.14；95%CI，1.01-1.29；使用持续时间 P=0.04）。与自然绝经的女性相比，卵巢切除术（OR，1.41；95%CI，1.18-1.68）或子宫切除术（OR，1.33；95%CI，1.11-1.60）的女性患 NAFLD 的风险增加。绝经激素治疗（仅雌激素治疗）持续时间较长与 NAFLD 风险增加相关（每使用 5 年的 OR，1.08，95%CI，1.01-1.15）。
这项大型多民族研究的结果支持这样一种观点，即月经和生殖因素以及外源性激素的使用与 NAFLD 的风险相关。
