Liver disease is becoming a growing health concern around the world. One condition that doctors are watching closely is liver fibrosis. Liver fibrosis happens when scar tissue slowly builds up in the liver after long periods of inflammation or damage.
Over time, this scar tissue can make it harder for the liver to work properly. If the damage continues, liver fibrosis can eventually lead to severe diseases such as cirrhosis, liver failure, or even liver cancer.
Scientists have known for many years that certain health problems increase the risk of liver disease. These problems are often called cardiometabolic risk factors. They include conditions such as type 2 diabetes, high blood pressure, excess body fat around the waist, abnormal cholesterol levels, and high triglycerides.
These conditions are already known to increase the risk of heart disease and stroke, but researchers are now discovering that they also play an important role in liver health.
A new study from researchers at the Keck School of Medicine of the University of Southern California has found that these cardiometabolic risk factors may affect women and men differently when it comes to liver fibrosis. The findings were published in the medical journal JAMA Network Open.
The researchers wanted to understand whether the same risk factors lead to different outcomes for men and women.
While previous research has shown that men tend to develop liver fibrosis more often, doctors have recently noticed that severe cases among women appear to be increasing. This raised an important question: once liver disease begins, do women face a different level of risk than men?
To explore this issue, the research team analyzed data from a large national health study in the United States. The data came from the National Health and Nutrition Examination Survey, a major program run by the U.S. Centers for Disease Control and Prevention.
This survey collects detailed information about the health and lifestyle of Americans, including diet, exercise, alcohol consumption, blood tests, and medical imaging results.
For this analysis, the researchers included information from 5,981 adults in the United States. The average age of the participants was about 47 years old, and the data were collected between 2017 and 2020.
The study used laboratory tests and ultrasound imaging to examine the liver. This allowed the researchers to measure both liver fibrosis and liver fat, also known as steatosis, with greater accuracy than studies that rely only on medical records or self-reported health information.
The scientists then looked at several cardiometabolic risk factors. These included waist circumference, high blood pressure, diabetes or prediabetes, high triglycerides, low levels of HDL cholesterol (often called “good cholesterol”), and the presence of multiple risk factors at the same time.
To ensure that the results were as accurate as possible, the researchers also accounted for other factors that might influence liver disease. These included age, race, ethnicity, smoking habits, and alcohol consumption.
At first glance, the results seemed to confirm what earlier studies had shown. Overall, men still had higher rates of liver fibrosis compared with women. However, when the researchers looked more closely at people who had cardiometabolic risk factors, a different pattern appeared.
Among individuals with these risk factors, women’s risk of liver fibrosis increased much more sharply than men’s.
For example, women with a high waist circumference showed a dramatic increase in fibrosis risk. In women, the rate rose from about 0.8 percent to 9.2 percent. This represents roughly an eleven-fold increase. In men, the increase was smaller, rising from about 4.4 percent to 17 percent, which is about a four-fold increase.
A similar pattern appeared with diabetes and prediabetes. Women with these conditions had about a 2.8 times higher risk of liver fibrosis, while men showed about a 1.4 times increase.
The researchers also looked at people who had two or more cardiometabolic risk factors at the same time. In these cases, the risk of fibrosis increased by about 8.4 times for women, compared with about 2.6 times for men.
These findings suggest that women may start with a lower overall risk of liver fibrosis, but once certain metabolic problems appear, their risk may rise more quickly than it does in men.
One possible explanation may involve hormones. Scientists believe that the hormone estrogen may provide some protection against liver disease earlier in life. However, as women age and estrogen levels fall, especially after menopause, this protection may weaken.
The researchers note that their current study did not include enough information to fully explore the role of menopause. However, they plan to investigate this question in future research. They are particularly interested in whether hormone replacement therapy might influence liver disease risk.
The research team also hopes to conduct future studies that follow participants over longer periods of time. By tracking individuals for several years, scientists may better understand how cardiometabolic risk factors contribute to the development of liver fibrosis.
The study also highlights another growing concern in liver health. A condition known as metabolic dysfunction–associated steatotic liver disease, which is not caused by heavy alcohol use, is becoming more common worldwide. This condition is strongly linked to obesity, diabetes, and other metabolic disorders.
Analyzing the findings, the study offers important insights into how metabolic health affects the liver and why men and women may experience different disease patterns. The results suggest that healthcare providers should pay close attention to metabolic risk factors in women, even if their baseline risk of liver disease appears lower.
However, the study also has some limitations. Because it used data collected at one point in time, it cannot prove that the risk factors directly caused liver fibrosis. Larger studies that follow participants over many years will be needed to confirm these findings and better understand the biological reasons behind the sex differences.
Even with these limitations, the research adds to growing evidence that metabolic health plays a major role in liver disease. Managing conditions such as diabetes, high blood pressure, and abdominal obesity may not only protect the heart but also reduce the risk of serious liver damage.
The findings also remind doctors and the public that liver disease prevention should be part of broader efforts to improve metabolic and cardiovascular health.
If you care about liver health, please read studies that refined fiber is link to liver cancer, and the best and worst foods for liver health.
For more health information, please see recent studies about how to boost your liver naturally, and simple ways to detox your liver.
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