Fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent disease (25-30% of the global adult general population) with no approved treatment to-date, although its treatment is attractive for the researchers and the pharmaceutical industry. The cessation of ovarian function (natural or iatrogenic menopause, premature ovarian insufficiency) is associated with increased abdominal adipose tissue and changes in carbohydrate and lipid metabolism. These changes lead to a dysmetabolic milieu, characterized by unfavorable lipid profile and the development of NAFLD, which may contribute to the increase in cardiovascular risk observed after menopause. Not only the prevalence of NAFLD seems to be higher in postmenopausal compared with premenopausal women, but also the rates of advanced types of the disease, i.e., nonalcoholic steatohepatitis and hepatic fibrosis, the latter regarded as the main histological prognostic factor of advanced liver disease and a difficult-to-reverse target. These observations may render menopausal hormone therapy (MHT) an appealing way to retard or even restore NAFLD after menopause. Although there are some experimental data favoring this consideration, there are only a few interventional clinical studies evaluating the effect of MHT on NAFLD, which have provided conflicting results. Some of them showed encouraging effects of MHT on liver function tests and/or lower rates of NAFLD in women receiving as compared with those not receiving MHT. However, other studies showed that MHT may adversely affect NAFLD. Regarding the route of administration of MHT, there are currently not comparative data between per os and transdermal use on NAFLD. Until waiting for the publication of relevant studies, based on the favorable effect of transdermal MHT on triglyceride concentrations and the fact that high triglyceride and low high-density lipoprotein-cholesterol concentrations are associated with the severity of NAFLD, the use of transdermal MHT may be preferred in women with NAFLD after the cessation of ovarian function. Of course, MHT could not be recommended as standard treatment of NAFLD in women, because MHT may be used for a certain time frame in a woman’s life. However, given that NAFLD seems to be common after the pause of ovarian function, any potential effect of MHT on NAFLD may be considered before treatment initiation and during the follow-up of these women.