Yang Chenlu, Chen Shuohua, Feng Baoyu, Lu Ying, Wang Yanhong, Liao Wei, Wu Shouling, Wang Li
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, 5 Dong Dan San Tiao, Beijing 100005, China.
Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd, Tangshan, Hebei Province 063000, China.
Maturitas. 2025 Jan;192:108148. doi: 10.1016/j.maturitas.2024.108148. Epub 2024 Nov 13.
The association between menopause, changes in body composition, and nonalcoholic fatty liver disease is not clear, and there is a lack of weight management strategies for perimenopausal women from the perspective of preventing nonalcoholic fatty liver disease.
A total of 1316 postmenopausal and 3049 premenopausal women in the Kailuan cohort in China between 2006 and 2017 were enrolled and followed up till 2021. Cox regression models, including the causal mediation analyses, were used to estimate the association between menopause and nonalcoholic fatty liver disease and the potential mediation effect of changes in body composition. We also explored the impact of weight changes on the correlation between menopause and nonalcoholic fatty liver disease.
Women who experienced menopause had a higher risk of nonalcoholic fatty liver disease than premenopausal women (9-year cumulative incidence: 56.87 % vs. 48.80 %, adjusted hazard ratio = 1.219, 95 % confidence interval: 1.088-1.365). The nine-year cumulative incidence of nonalcoholic fatty liver disease was higher among overweight/obese postmenopausal women (67.24 % vs. 45.74 %, P < 0.001) and those with abdominal obesity (63.36 % vs. 49.69 %, P < 0.001); however, the hazard ratio of menopause for nonalcoholic fatty liver disease was more evident in women with a body mass index under 23.0 kg/m (hazard ratio = 1.434, 95 % confidence interval: 1.168-1.759) and those with normal waist circumference (hazard ratio = 1.362, 95 % confidence interval: 1.129-1.643), which could partially be explained by the visceral fat index (7.09 % and 7.35 % mediation, respectively). Weight loss of 3 % or more or reduction in waist circumference by 5 % or more was associated with a 31.1 % reduction (95 % confidence interval, 20.8 %-40.0 %) or a 14.2 % reduction (95 % confidence interval, 1.1 %-25.6 %) in the risk of nonalcoholic fatty liver disease among the premenopausal women. For postmenopausal women, weight gain of 3 % or more was associated with an increased risk of nonalcoholic fatty liver disease, especially in individuals with a body mass index under 23.0 kg/m.
Menopause was associated with a higher risk of nonalcoholic fatty liver disease, partially by increasing visceral fat. Controlling weight in perimenopausal women may reduce the risk.
绝经、身体成分变化与非酒精性脂肪性肝病之间的关联尚不清楚，且从预防非酒精性脂肪性肝病的角度来看，围绝经期女性缺乏体重管理策略。
纳入2006年至2017年间中国开滦队列中的1316名绝经后女性和3049名绝经前女性，并随访至2021年。使用Cox回归模型，包括因果中介分析，来估计绝经与非酒精性脂肪性肝病之间的关联以及身体成分变化的潜在中介作用。我们还探讨了体重变化对绝经与非酒精性脂肪性肝病之间相关性的影响。
经历绝经的女性患非酒精性脂肪性肝病的风险高于绝经前女性（9年累积发病率：56.87%对48.80%，调整后风险比=1.219，95%置信区间：1.088 - 1.365）。超重/肥胖的绝经后女性（67.24%对45.74%，P<0.001）和腹型肥胖女性（63.36%对49.69%，P<0.001）的非酒精性脂肪性肝病9年累积发病率更高；然而，绝经对非酒精性脂肪性肝病的风险比在体重指数低于23.0kg/m²的女性（风险比=1.434，95%置信区间：1.168 - 1.759）和腰围正常的女性（风险比=1.362，95%置信区间：1.129 - 1.643）中更为明显，这部分可由内脏脂肪指数解释（分别为7.09%和7.35%的中介作用）。绝经前女性体重减轻3%或更多或腰围减少5%或更多与非酒精性脂肪性肝病风险降低31.1%（95%置信区间，20.8% - 40.0%）或14.2%（95%置信区间，1.1% - 25.6%）相关。对于绝经后女性，体重增加3%或更多与非酒精性脂肪性肝病风险增加相关，尤其是在体重指数低于23.0kg/m²的个体中。
绝经与非酒精性脂肪性肝病风险较高相关，部分原因是内脏脂肪增加。控制围绝经期女性的体重可能会降低风险。
