icon-folder.gif   Conference Reports for NATAP  
  The Liver Meeting
Digital Experience
November 13 - 16 - 2020
Back grey_arrow_rt.gif
Breastfeeding Linked to Lower Chance of Severe Fibrosis in US Women With NAFLD
  AASLD The Liver Meeting Digital Experience, November 13-16, 2020
Mark Mascolini
Analysis of 429 US women with nonalcoholic fatty liver disease (NAFLD) linked breastfeeding for more than 3 months in their lifetime to lower odds of severe fibrosis [1]. The study from Duke University also tied breastfeeding to reduced chances of portal inflammation, while linking a live birth to lower body mass index (BMI). These associations did not remain significant for women older than 50 years, a proxy for menopause.
Duke University researchers who conducted this study noted that breastfeeding has metabolic effects and appears to protect both mothers and children from NAFLD. Some work links breastfeeding for longer than 6 months to lower BMI, a lower rate of metabolic disorder, and a lower risk of new-onset NAFLD. Because research has not clarified whether breastfeeding affects NAFLD severity, the Duke team conducted this study to address that question. They also aimed to explore whether a live birth affects metabolic features and histologic severity of NAFLD in women with that condition.
This cross-sectional analysis drew on the Duke NAFLD Clinical Database, a prospective project launched in 2007. Participants complete standardized questionnaires at liver biopsy and are enrolled in the Duke Liver Clinic or Duke Bariatric Surgery. For this analysis the researchers focused on women with histologically confirmed NAFLD who answered questions about pregnancy and breastfeeding on the standardized questionnaire.
The investigators used standard statistical tools including unadjusted and adjusted regression analyses to identify associations between study outcomes (BMI, diabetes, hyperlipidemia, hypertension, various NAFLD histologic features including portal hypertension and fibrosis) and study predictors (live birth, cumulative lifetime breastfeeding at least 3 months or at least 6 months).
The study population of 429 women included 275 from the liver clinic and 134 from the bariatric clinic. The group averaged 51 years in age, 82% were white, 23% had advanced (stage 3-4) fibrosis, 47% had type 2 diabetes, 71% had hypertension, and 65% had hyperlipidemia. BMI averaged 40 kg/m2, well above the obese threshold of 30 kg/m2.
Three quarters of these women (78%) had a live birth (median 2). Of these 329 women, 51% breastfed, 42% breastfed more than 3 months, and 35% breastfeed more than 6 months.
Having a live birth was associated with a lower BMI (beta = -2.7, P = 0.003), and that effect dwindled after age 50 (beta = -2.2, P = 0.09). Live birth was not associated with type 2 diabetes, hypertension, or hyperlipidemia. Among women with a live birth, breastfeeding more than 3 months or more than 6 months was not significantly associated with BMI regardless of age.
Adjusted analysis determined lower odds of severe fibrosis with breastfeeding more than 3 months (adjusted odds ratio [aOR] 0.65, 95% confidence interval 0.43 to 0.99, P = 0.043). That association remained significant in women 50 or younger (aOR 0.41, 95% CI 0.21 to 0.80, P < 0.009) but not in older women (aOR 0.83, 95% CI 0.48 to 1.4, P = 0.50). Breastfeeding more than 6 months tended to lower chances of severe fibrosis, but the association stopped short of statistical significance (for all women aOR 0.71, 95% CI 0.46 to 1.10, P = 0.13; for women 50 or younger aOR 0.53, 95% CI 0.27 to 1.0, P = 0.059).
Breastfeeding more than 6 months predicted lower odds of portal inflammation (aOR 0.58, 95% CI 0.35 to 0.93, P = 0.03), and that association remained significant only in the 50-or-younger group (aOR 0.31, 95% CI 0.14 to 0.69, P = 0.004). For women 50 or younger (but not older women) breastfeeding more than 3 months predicted lower odds of portal inflammation (aOR 0.36, 95% CI 0.17 to 0.77, P = 0.008). Regression analyses saw no association of breastfeeding with steatosis, lobular inflammation, or hepatocyte ballooning.
The researchers concluded that live births are associated with lower BMI, while breastfeeding lowers odds of severe fibrosis and portal inflammation. The Duke researchers stressed the need for prospective study to confirm the possible beneficial effects of live births and breastfeeding on NAFLD progression. They urged that reproductive history and reproductive health information should be considered more in future research.
1. Suzuki A, Wang Y, Coviello AD, et al. History of breastfeeding is associated with a decreased risk of hepatic fibrosis among young women with NAFLD. AASLD The Liver Meeting Digital Experience, November 13-16, 2020. Abstract 87.