Sex/Gender Differences in Liver Diseases

Understanding the impact of sex and gender differences on health and diseases is crucial for individualized health management and patient information for those with chronic liver disease. The impact of sex and gender on chronic liver disease varies depending on the etiology of the disease. Although the prevalence of nonalcoholic fatty liver disease is lower in women than in men, postmenopausal women have a higher prevalence of advanced liver fibrosis due to hormonal causes. Women are at a higher risk of autoimmune hepatitis and primary biliary cholangitis, while men are at a higher risk of viral hepatitis, primary sclerosing cholangitis, cirrhosis, and hepatocellular carcinoma. Alcohol-related liver disease is more common in men, but the minimum amount of alcohol that induces alcohol-related liver disease in women is approximately half that in men. These differences are partly due to the effect of biological sex differences on ethanol metabolism, resulting in a higher concentration of alcohol in women’s blood than in men’s blood, even if they consume the same amount of alcohol. The insufficient knowledge of liver health in women highlights the need for studies on the etiological causes of chronic liver disease and therapeutic measures based on sex/gender differences to address the inequality of knowledge according to sex. In other words, additional studies are needed to investigate the expression, prevention, diagnosis, and treatment of chronic liver disease affected by sex/gender differences to maintain the health of both men and women.