Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1457-1472
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1457
Nonalcoholic fatty liver disease shows significant sex dimorphism
Xing-Yu Chen, Cong Wang, Yi-Zhou Huang, Li-Li Zhang
Xing-Yu Chen, Cong Wang, Yi-Zhou Huang, Li-Li Zhang, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 404100, China
Author contributions: Chen XY was the main author of the review, and completed the collection and analysis of relevant literature and the writing of the first draft of the paper; Wang C and Huang YZ participated in the analysis and collation of literature materials; Zhang LL is the principal of the project, supervising the thesis writing; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest associated with this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Li Zhang, MD, PhD, Associate Professor, Doctor, Postdoc, Research Fellow, The Second Affiliated Hospital, Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing 404100, China. zhanglili.jl@foxmail.com
Received: October 5, 2021
Peer-review started: October 5, 2021
First decision: November 15, 2021
Revised: December 2, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: February 16, 2022
Processing time: 129 Days and 1.1 Hours
Abstract

Nonalcoholic fatty liver disease (NAFLD), which has been renamed metabolic dysfunction-associated fatty liver disease, is a growing global medical problem. The incidence of NAFLD and its associated end-stage liver disease is increasing each year, and many research advancements have been achieved to date. This review focuses on the current knowledge of the sex differences in NAFLD and does not elaborate on areas without differences. Studies have revealed significant sex differences in the prevalence, influencing factors, pathophysiology, complications and therapies of NAFLD. Men have a higher incidence than women. Compared with women, men exhibit increased visceral fat deposition, are more susceptible to leptin resistance, lack estrogen receptors, and tend to synthesize fatty acids into fat storage. Male patients will experience more severe hepatic fibrosis and a higher incidence of liver cancer. However, once NAFLD occurs, women show a faster progression of liver fibrosis, higher levels of liver cell damage and inflammation and are less likely to undergo liver transplantation than men. In general, men have more risk factors and more severe pathophysiological reactions than women, whereas the development of NAFLD is faster in women, and the treatments for women are more limited than those for men. Thus, whether sex differences should be considered in the individualized prevention and treatment of NAFLD in the future is worth considering.

Keywords: Nonalcoholic fatty liver disease; Metabolic dysfunction-associated fatty liver disease; Sex differences; Estrogen; Steatosis; Cirrhosis

Core Tip: Nonalcoholic fatty liver disease (NAFLD) is a sexual dimorphic disease, and its prevalence worldwide is increasing each year. However, our understanding of sex differences in NAFLD remains insufficient. The incidence in males is significantly higher than that in females, and studies have also revealed significant sex differences in influencing factors, pathophysiology, complications and therapies. This review summarizes the current research progress on sex differences in NAFLD and indicates that whether sex differences in NAFLD can be considered in future research, treatment and prevention is worth exploring.