USCAP 2022 Abstracts: Liver Pathology (1018-1075)

Background: Men and post-menopausal women are at increased risk of developing non-alcoholic steatohepatitis (NASH) compared to pre-menopausal women.However, the impact of age and gender on NASH progression remains controversial.We sought to investigate whether age and gender were associated with severity of nonalcoholic steatohepatitis (NASH).Design: From a cohort of adult patients with biopsy-proven NASH from 2012-2019, we conducted a cross-sectional study with patients stratified by age and gender (men 18-50 years, women 18-50 years, men >50 years, women >50 years).Twenty-five patients were randomly selected into each group.Patients with a prior liver transplant or alternative etiologies were excluded, including autoimmune and viral hepatitis, alcoholic liver disease, and genetic and other metabolic disorders.Baseline anthropometric data at the time of the index liver biopsy date were obtained.Each patient's liver biopsy was evaluated for a variety of histologic factors, including steatosis, fibrosis (NASH-CRN criteria) and nonalcoholic fatty liver disease activity score (NAS).ANOVA tests were performed to calculate differences between age and gender groups for various clinical and histologic parameters.Results: A summary of descriptive results for the various age and gender groups is show in Table 1.Baseline mean age was similar among corresponding age groups, and BMI was similar across all groups.Among histologic features, there was a significant difference among age and gender groups for NAS (p=0.02) and fibrosis (p<0.001).The degree of steatosis (mean 2.3, SD 0.8) and NAS (mean 4.5, SD 0.9) were highest in 18-50 year-old women compared to >50 year-old women and men of all ages.Fibrosis scores were higher in men compared to women for all age groups, and was highest in >50 year-old men (mean 2.8, SD 1.2).Men, 18-50 years Mean (SD) Female, 18-50 years Mean (SD) Male, >50 years Mean (SD)Conclusions: An association between age and gender with severity of NASH was observed.Women have higher steatosis and NAS compared to men.However, liver fibrosis tends to be more severe in men, and tends to increase with age irrespective of gender.Estrogen-related sex hormones may play a protective role against fibrosis in young pre-menopausal women.This phenomenon may have therapeutic implications and needs further evaluation.