Abstract
Polycystic ovary syndrome (PCOS) and nonalcoholic fatty liver (NAFLD) share similar clinical presentations including obesity, insulin resistance (IR), and metabolic abnormality. The predictive factors of NAFLD in women with PCOS and specifically in Asian women are not well established. Associated factors for NAFLD assessed by ultrasound (US) among a group of PCOS and healthy women were determined and diagnostic accuracy between US and transient elastography (TE) for NAFLD was compared and correlated. Sixty-three women with ages ranging from 20 to 40 years participated in the present cross-sectional study. Forty-two women with PCOS as diagnosed by the Rotterdam criteria and 21 healthy women were recruited into the study. Women with underlying hepatic diseases and history of alcohol consumption >20 g/day were excluded. Biochemical and hormonal testing, anthropometrics, liver US, and TE were assessed. Waist circumference (WC) greater than 80 cm was the only predictive factor for NAFLD as assessed by US in the whole group (adjusted odds ratio [aOR] 5.49, 95% confidence interval [CI]: 1.85–16.26, p <0.001). The value of the TE-based controlled attenuation parameter (CAP) was significantly correlated with stage of steatosis as assessed by US (correlation coefficient = 0.696, p <0.001). The diagnostic accuracies of dichotomized CAP ≥236 dB/m assessed for NAFLD using US as the gold standard were 84% and 78% sensitivity and specificity, respectively, with the area under the curve at 0.81 (p <0.001). Abdominal obesity, rather than the presence of PCOS, was shown to be the independently associated factor for NAFLD. WC could be used as the primary screening tool before performing complicated intervention for detection of steatosis. TE is an alternative noninvasive detection tool in women with PCOS for NAFLD and hepatic fibrosis identification.
Highlights
Polycystic ovary syndrome (PCOS) is the most common gynecological endocrine disorder
Nonalcoholic fatty liver disease (NAFLD) is classified as nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), which consists of a more progressive and wider clinical spectrum including fibrosis, cirrhosis, and hepatocellular carcinoma [2]
The correlation and accuracy of transient elastography (TE)-based controlled attenuation parameter (CAP) for NAFLD detection were nearly equal to US, but TE provides an advantage over the US for concurrently identifying significant liver fibrosis during CAP assessment
Summary
Polycystic ovary syndrome (PCOS) is the most common gynecological endocrine disorder. Nonalcoholic fatty liver disease (NAFLD) or steatosis refers to an increase in and excessive hepatic fat accumulation. It is identified by the presence of fat >5% of hepatocyte and/or proton density fat fraction technique or >5.6% defined by magnetic resonance spectroscopy. NAFLD is classified as nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), which consists of a more progressive and wider clinical spectrum including fibrosis, cirrhosis, and hepatocellular carcinoma [2]. Liver biopsy is the gold standard for NAFLD diagnosis [5]. This technique is invasive, and it is burdensome to perform liver biopsies in all NAFLD patients. TE is a new and promising technique for liver fibrosis evaluation in order to avoid invasive liver biopsy
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