Non-alcoholic fatty liver disease in polycystic ovary syndrome women

Seok Kyo Seo,Byung Seok Lee,Young Bin Won,Young Sik Choi,Bo Hyon Yun,Sihyun Cho

doi:10.1038/s41598-021-86697-y

Seok Kyo Seo, Byung Seok Lee + Show 4 more

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https://doi.org/10.1038/s41598-021-86697-y

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Abstract

To evaluate risk factors leading to non-alcoholic fatty liver disease (NAFLD) occurrence in polycystic ovarian syndrome (PCOS) women. A retrospective cohort study of a total of 586 women diagnosed with PCOS aged 13–35 years at the gynecology department at a university hospital was done to evaluate PCOS phenotype, metabolic syndrome (MetS) diagnosis, body composition, insulin sensitivity, sex hormones, lipid profile, liver function, and transient elastography (TE). In PCOS women with NAFLD compared to those without, MetS diagnosis (Hazard ratio [HR] 5.6, 95% Confidence interval [CI] 2.2–14.4, p < 0.01) and hyperandrogenism (HA) (HR 4.4, 95% CI 1.4–13.4, p = 0.01) were risk factors significantly associated with subsequent NAFLD occurrence, whereas 2-h insulin level in 75 g glucose tolerance test (GTT) (HR 1.2, 95% CI 0.5–2.5, p = 0.70) and body mass index (BMI) > 25 kg/m2 (HR 2.2, 95% CI 0.6–8.0, p = 0.24) was not. Among NAFLD patients who underwent TE, a higher number of MetS components indicated a worse degree of fibrosis and steatosis. MetS diagnosis and HA at PCOS diagnosis were risk factors associated with NAFLD, while 2-h insulin level in 75 g GTT and obesity were not. Although elevated aspartate aminotransferase levels were significant for NAFLD risk, liver enzyme elevations may not be present until late liver damage. Further prospective studies of PCOS women with MetS or HA are warranted to determine whether patients without liver enzyme elevations should undergo preemptive liver examinations.

Highlights

To evaluate risk factors leading to non-alcoholic fatty liver disease (NAFLD) occurrence in polycystic ovarian syndrome (PCOS) women
Metabolic disturbances such as diabetes mellitus (DM) and obesity threaten the health of PCOS women and preventing this at an early stage is crucial from a public healthcare standpoint
Our study suggests that metabolic disturbances are intimately related to the pathophysiology and development of liver disease in women with PCOS

Summary

Introduction

To evaluate risk factors leading to non-alcoholic fatty liver disease (NAFLD) occurrence in polycystic ovarian syndrome (PCOS) women. Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive age women and is characterized by irregular menstruation, clinical or biochemical hyperandrogenism (HA), and polycystic ovarian morphology on ultrasonography1–3 It is an endocrine disorder whose association with metabolic problems is notable. The increase in insulin resistance promotes androgen production in ovarian theca cells leading to aggravation of H A6,7 Metabolic disturbances such as DM and obesity threaten the health of PCOS women and preventing this at an early stage is crucial from a public healthcare standpoint. Non-alcoholic fatty liver disease (NAFLD) encompasses an extensive range of liver diseases, including liver steatosis, non-alcoholic steatohepatitis, liver fibrosis, and liver cirrhosis, which may develop into liver failure and even hepatocellular c arcinoma9 Androgens such as testosterone, dihydrotestosterone, and dehydroepiandrosterone (DHEA) are recognized as pro-apoptotic agents that act on peripheral cells such as hepatocytes. This study was conducted to evaluate risk factors associated with NAFLD occurrence to determine better identifiers in screening for metabolic abnormalities at the time of PCOS diagnosis and consider its underlying cause

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