Table 1.
Population-based studies: sex-differences in frequency of NAFLD, fatty liver, and NAFLD fibrosis
| Author, year (Ref) | Country | M (n)/ F (n) | Age, yrs | Consideration of Menopausal status | Ethnicity | Main findings |
|---|---|---|---|---|---|---|
| Prevalence and incidence of NAFLD in adults | ||||||
| Zelber-Sagi S et al., 2006(86) | Israel | 174/152 | 50.5 ± 10.3 | No | Not specified | Overall NAFLDUS prevalence higher in men than in women (38% vs 21%). Male gender and metabolic factors independently predicted NAFLD. |
| Park et al., 2006(11) | Korea | 3,530/3,118 | 48.0 ± 11.8 | 1273 post-menopausal women | Asian | Menopause was an independent risk factor for prevalent NAFLDUS (OR 1.71) among women. |
| Caballeria et al., 2010(87) | Spain | 323/443 | 53±14 | No | Not specified | NAFLDUS prevalence significantly higher in men (33%) than women (20%). Male sex, age, MetS, IR and alanine aminotransferase independently predicted NAFLD. |
| Wong VW et al., 2012(12) | Hong Kong | 389/533 | 48 ± 11 | Age 50 years cut-off | Asian | NAFLDMRS prevalence higher in men than in women (37% vs 23%) overall. It peaked at 40 years and remained constant after in men while it increased steadily after 50 years in women. |
| Eguchi Y et al., 2012(13) | Japan | 2,627/2,448 | 50.0 ± 9.5 | No | Asian | NAFLDUS prevalence higher in men than in women at all ages (overall: 41% vs 18%) and increases with age in women (31% after 60 years). |
| Lazo M et al., 2013(88) | USA | Total 12,454 | 20–74 | No | European descent | Computed NAFLDUS prevalence after adjustment for other confounders was higher in men (20.2%) than in women (15.8%). |
| Li Z et al., 2014(89) | China | 201,481/ 152,124 from 48 Chinese studies | Weighted average: 40.32 for men, 34.8 for women | No | Asian | This meta-analysis of Chinese studies found a higher prevalence of NAFLDUS in men (24.8%) than in women (13.2%). |
| Wang Z et al., 2014(14) | China | 15,551/9,481 | 44.1 ± 15.0 | Age 60 years cut-off | Asian | NAFLDUS prevalence was higher in men than women (32% vs 13%) but comparable in women > 60 years (27.6%). |
| van den Berg et al., 2017(90) | Netherlands | 14,226/23,270 | 44 (36–51)$ | No | European | Male sex was independently associated with NAFLD prevalence (FLI ≥ 60). |
| Long MT et al., 2018(15) | USA | 364/321 | 45.0 ± 6.2 | Yes (N not reported) | Largely European descent | Incidence of fatty liver CT was similar between postmenopausal women and men (19% vs 22%) and was lower in premenopausal women (9%). |
| Prevalence of fatty liver# in adults | ||||||
| Browning JD et al., 2004(91) | USA | 2240/1194 | 46 ± 9 | No | Whites 38%, Blacks 43%, Hispanics 17.5% | Fatty liver MRS prevalence was higher in men than in women (42% vs 24%) among whites, but not in other ethnic groups. |
| Zhou YJ et al., 2007(92) | China | 1311/2232 | 7– 70+ | No | Asian | Fatty liverUS prevalence significantly higher in men (13.8%) than women (7.1%) before 50 years; the opposite after 50 years. |
| Prevalence of NAFLD and fatty liver in children | ||||||
| Anderson et al., 2015(18) | Europe, America, Asia | Total 23,208 from 20 general populations and 23,892 from 56 obese clinical populations | 2−19 | - | European, American, Asian | This meta-analysis of children found NAFLD US, LBx, MRI prevalence higher in male than female adolescents both in general (9% vs 6%, based on 15 studies) and obese populations (30% vs 22%, based on 27 studies). |
| Prevalence of NAFLD fibrosis | ||||||
| Kim et al., 2013(93) | USA | 5,296/5,858 | 20−74 | No | Non-Hispanic white, non-Hispanic black, Mexican American | 4,083 of 11,154 had NAFLDUS, of them 173 (3.2%) had elevated NFS (>0.676) with no sex difference. |
| Hartleb et al., 2017(94) | Poland | 1405/1598 | 79.6±8.3 | No | European | NAFLD (FLI ≥ 60) with fibrosis was more prevalent in males when defined by Fib-4 (≥ 1.45) but not NFS (>0.676). |
| Caballeria et al., 2018(19) | Spain | 1289/1725 | 54±12 | No | European | Higher liver stiffness (TE) was independently associated with male sex. |
| Tanaka et al. 2018(20) | Japan | 3316/3611 | 50 (42−57) $ | No | Asian | Among 1935 patients with NAFLDUS, 0.9% men and 1.0% women had advanced fibrosis (FIB-4 ≥ 2.67). |
: more than minimal alcohol use and/or viral hepatitis infection were not excluded.
: median and interquartile range
NAFLD definition - US: ultrasonography; MRS: Magnetic resonance spectroscopy; CT: computerized tomography; MRI: Magnetic resonance imaging; LBx: liver biopsy
Abbreviations: ALP, alkaline phosphatase; AST, aspartate aminotransferases; AUC, area under the curve; FL, fatty liver; FLI: fatty liver index; HDL-C, high density lipoprotein cholesterol; IR,insulin resistance; hsCRP, high sensitivity C reactive protein; LDL-C, low density lipoprotein cholesterol; MetS, metabolic syndrome; MVA, multivariable analysis; NA, not assessed; NASH, nonalcoholic steatohepatitis; NFS: NAFLD fibrosis score; SUA, serum uric acid; T2D, type 2 diabetes; TC, total cholesterol; TE: transient elastography; USA, United States of America; VAT, visceral adipose tissue; VFA, visceral fat area; WC, waist circumference