Clinical impact of sexual dimorphism in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)

Liver Int. 2021 Aug;41(8):1713-1733. doi: 10.1111/liv.14943. Epub 2021 Jun 8.


NAFLD/NASH is a sex-dimorphic disease, with a general higher prevalence in men. Women are at reduced risk of NAFLD compared to men in fertile age, whereas after menopause women have a comparable prevalence of NAFLD as men. Indeed, sexual category, sex hormones and gender habits interact with numerous NAFLD factors including cytokines, stress and environmental factors and alter the risk profiles and phenotypes of NAFLD. In the present review, we summarized the last findings about the influence of sex on epidemiology, pathogenesis, progression in cirrhosis, indication for liver transplantation and alternative therapies, including lifestyle modification and pharmacological strategies. We are confident that an appropriate consideration of sex, age, hormonal status and sociocultural gender differences will lead to a better understanding of sex differences in NAFLD risk, therapeutic targets and treatment responses and will aid in achieving sex-specific personalized therapies.

Keywords: HCC; NAFLD/NASH; acute-on-chronic liver failure; chronic kidney disease; liver disease; liver transplantation; sex dimorphism.

Publication types

  • Review

MeSH terms

  • Female
  • Humans
  • Liver / pathology
  • Liver Cirrhosis / pathology
  • Male
  • Non-alcoholic Fatty Liver Disease* / epidemiology
  • Non-alcoholic Fatty Liver Disease* / pathology
  • Non-alcoholic Fatty Liver Disease* / therapy
  • Sex Characteristics
  • Sex Factors