More women are developing cirrhosis driven largely by alcohol-related liver disease (ALD) in young women and nonalcoholic fatty liver disease (NAFLD) in older women, according to a study from Canada. "Public-health education should be specifically directed to women regarding the risk factors for both non-alcoholic fatty liver disease and alcohol-related liver disease," Dr. Jennifer Flemming of Queen's University in Kingston, Ontario, said in a pre-recorded presentation at a press briefing November 16 at The Liver Meeting, held by the American Association for the Study of Liver Diseases (AASLD). Using universally collected healthcare data from the province of Ontario, she and her colleagues identified more than 65,000 women diagnosed with cirrhosis from 2000 to 2017. The median age at diagnosis was 57 years. The most common causes of cirrhosis were NAFLD (63%) and ALD (16%), followed by hepatitis C (10%), autoimmune liver disease (6%), hepatitis B (5%) and "other" (1%). Between 2000 and 2017, new cases of cirrhosis increased by 33%. The highest increases were noted in women with NAFLD-related cirrhosis who were postmenopausal. Their rate increased by almost 9% per year, Dr. Flemming told the briefing. "An also worrisome trend" was noted in young women born after 1980 in whom ALD increased by more than 12% per year, she noted. The researchers used the data to project new cases and causes of cirrhosis to the year 2040 in women in Ontario. "This suggested that over the next 20 years, new cases of NAFLD-related cirrhosis will increase by almost 250% in postmenopausal women, and new cases of alcohol-related cirrhosis will increase by 350% in women born after 1980," Dr. Flemming told the briefing. The researchers also calculated rates of hepatocellular carcinoma in an exclusively female population and showed that the highest risk was in women with underlying hepatitis C and autoimmune liver disease. "We also showed that the risk of non-malignant hepatic decompensation and death were highest in women with underlying alcohol-related liver disease and these risks were almost two fold greater than in any other etiology of cirrhosis," Dr. Flemming reported. The findings, she concluded, suggest that "consideration for screening for NAFLD at the primary care level could be targeted to perimenopausal women during routine care to identify women most at risk for progressing to cirrhosis." "Interventions to identify and treat young women with alcohol-use disorder and alcohol-related liver disease may have the greatest impact on the development of cirrhosis, decompensation and mortality in the future," she added. —Megan Brooks Source
