Women With Multiple Cardiometabolic Risk Factors Have Higher Risk of Liver Fibrosis: Study
USA: A cross-sectional study has found that women with multiple cardiometabolic risk factors have disproportionately higher odds of clinically significant liver fibrosis compared with men with similar risk profiles.
The association was strongest with central obesity, where a high waist circumference was linked to over 13-fold higher odds of fibrosis in women versus about 4-fold in men. Although overall fibrosis prevalence was lower in women, they may progress more rapidly to advanced liver disease once fibrosis develops. The findings were published in JAMA Network Open.
The study was conducted by Somaya Albhaisi and colleagues from the Division of Gastrointestinal and Liver Diseases at the Keck School of Medicine of USC. The researchers aimed to examine whether cardiometabolic risk factors are linked differently with liver fibrosis risk in women and men.
Advanced liver fibrosis is an increasingly common condition worldwide and can progress to severe complications such as Cirrhosis. Previous research has suggested that although women tend to have a lower overall prevalence of fibrosis, the disease may progress more rapidly once it develops.
For the analysis, investigators used data from the National Health and Nutrition Examination Survey collected between 2017 and 2020. The study included 5,981 adults aged 20 years or older who had valid liver stiffness measurements obtained through transient elastography, a noninvasive method used to assess liver fibrosis.
The study population comprised 2,992 women and 2,989 men with mean ages of 49 and 47 years, respectively. Researchers evaluated several cardiometabolic risk factors, including increased waist circumference, glucose intolerance, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol levels, and obesity. They also examined the presence of two or more cardiometabolic risk factors.
The researchers reported the following findings:
- Clinically significant liver fibrosis was defined as a liver stiffness measurement of 8.0 kPa or higher.
- The overall prevalence of significant fibrosis was 6.9% in women and 10.7% in men.
- Despite the lower overall prevalence in women, certain cardiometabolic risk factors were associated with a greater increase in fibrosis risk among women than men.
- Central adiposity (high waist circumference) showed the strongest association with fibrosis risk.
- Women with high waist circumference had substantially higher odds of significant fibrosis compared with men with the same risk factor.
- Glucose intolerance was also linked to a stronger increase in fibrosis risk in women than in men.
- The presence of two or more cardiometabolic risk factors was associated with a markedly greater rise in the odds of significant fibrosis among women compared with men.
The authors acknowledged several limitations. The cross-sectional design prevents establishing causality between cardiometabolic risk factors and liver fibrosis. Fibrosis was assessed using transient elastography rather than liver biopsy, which may lead to some misclassification. The study also did not evaluate the influence of menopausal status or hormone therapy.
Overall, the findings suggest that cardiometabolic risk factors—especially central obesity and glucose intolerance—may raise liver fibrosis risk more in women than in men, highlighting the need for sex-specific screening and early detection strategies.
Reference:
Albhaisi S, Kim S, Terrault N, Dodge JL. Sex-Specific Cardiometabolic Profiles and Severity of Liver Fibrosis. JAMA Netw Open. 2026;9(3):e260863. doi:10.1001/jamanetworkopen.2026.0863
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