Menopausal Stages and Non-alcoholic Fatty Liver Disease in Middle-aged Women

Objectives: There is no established evidence regarding the influence of the menopausal transition period on non-alcoholic fatty liver disease (NAFLD). The goal of this study was to examine the association between menopausal stages and the prevalence of NAFLD in middle-aged Korean women.

Methods: This study was a cross-sectional analysis of 1559 women aged 44-56 years, who underwent a comprehensive health screening examination in the Kangbuk Samsung Hospital Total Healthcare Centers during 2012 and 2013. Information regarding menopause status was collected using a standardized, self-administered questionnaire. The presence of fatty liver was determined using ultrasonography. Menopausal stages were defined according to the criteria of the Stages of Reproductive Aging Workshop (STRAW+10) as follows: early menopausal transition was defined as a persistent difference in consecutive menstrual cycle length of seven or more days; late menopausal transition was defined as having an interval of amenorrhea of 60 days or more; post-menopause was defined as the absence of menstrual periods for 12 or more months since the last period; pre-menopause was defined as having a regular menstrual cycle and not meeting the above criteria. Odds ratios and 95% confidence intervals for NAFLD were estimated by menopausal stages.

Results: Of the 1559 women, 334 had NAFLD. A higher prevalence of NAFLD was observed across menopausal stages (p for trend <0.05). After adjusting for age, center, BMI, smoking status, alcohol intake, physical activity, educational level, parity and age at menarche, the odds ratios (95% CIs) for NAFLD comparing early transition, late transition, and post-menopause to pre-menopause were 1.07 (0.68-1.67), 1.87 (1.23-2.85), and 1.67 (1.01-2.78), respectively.

Conclusions: This study performed in middle-aged Korean women suggests that there is an increased prevalence of NAFLD in the late menopausal transition as well as post-menopausal stages, independent of a variety of potential confounders. The findings of this study suggest that early intervention strategies implemented before women begin to experience the menopausal transition are needed to reduce the risk of NAFLD.