Nonalcoholic Fatty Liver Disease in a Sample of Iranian Women with Polycystic Ovary Syndrome

Abnormal aminotransferase activity in women with polycystic ovary syndrome

Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome

Rosiglitazone treatment alleviates inflammation and improves liver function in overweight women with polycystic ovary syndrome: a randomized placebo-controlled study

The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study

Variation in metabolic and cardiovascular risk in women with different polycystic ovary syndrome phenotypes

Polycystic ovary syndrome (PCOS) is a highly complex reproductive metabolic disorder and women with PCOS have high prevalence of non-alcoholic fatty liver disease (NAFLD). Despite both hyperandrogenism and insulin resistance are common pathophysiologies in NAFLD and PCOS, this association is still controversial. Therefore, the aim of this study is to evaluate the relationship between hyperandrogenism and NAFLD in females diagnosed with PCOS. We recruited 667 women diagnosed with PCOS and 289 women with regular menstrual cycles as control. The PCOS diagnosis was made using National Institute of Child Health and Human Disease criteria. Total and free testosterone levels (TT and TF, respectively), and free androgen index (FAI) were used as measures of hyperandrogenism. Fatty liver index and liver fat score (FLI and LFS, respectively), and hepatic steatosis index (HSI) were used to assess NAFLD. The prevalence of NAFLD in PCOS women evaluated by LFS, FLI, and HIS were 19.9, 10.3, and 32.2%, respectively. In the control group, the incidence was 2.1, 0.7, and 4.2%, respectively. Both FT and FAI levels showed significant association with increased NAFLD-related indices, after adjusting for insulin resistance and other factors (LFS (OR 3.18 (95% CI 1.53–6.63) in FT; 1.12 (1.04–1.22) in FAI), FLI (OR 2.68 (95% CI 1.43–5.03) in FT; 1.13 (1.06–1.20) in FAI), and HSI (OR 3.29 (95% CI 2.08–5.21) in FT; 1.5 (1.09–1.21) in FAI). TT did not exhibit association with any NAFLD index. In women with PCOS, significantly higher rate of NAFLD was observed compared to the control women. The FT and FAI were independently associated with NAFLD in women with PCOS. The findings suggest the possibility of hyperandrogenism contributing to the progression and/or development of NAFLD in PCOS.

Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m 2 ). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. Arch Endocrinol Metab. 2020;64(3):235-42.

IL-22 and its interaction with amino acid and glycolipid metabolite in polycystic ovary syndrome (PCOS) patients

An appraisal of serum preptin levels in PCOS

Lower serum apelin levels in women with polycystic ovary syndrome

Periodontal disease in polycystic ovary syndrome

Nonalcoholic fatty liver disease in women with polycystic ovary syndrome

Objective To explore the incidence of insulin resistance (IR) in patients with obese polycystic ovary syndrome (PCOS) and its relationship with body composition including body fat (BF) and visceral fat area (VFA). Methods In the period from April 2013 to December 2014, in Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, 62 patients with obese PCOS who were in the weight loss program in the Department of Clinical Nutrition were selected, and 19 obesity subjects without PCOS, matching with the obsess PCOS group in age and body mass index (BMI), were selected as controls. In the cases and controls, we used Biospace Inbody720 body composition analyzer to determine their body composition, measured serum lipid profile, conducted 75 g oral glucose tolerance test and insulin release test, and calculated homeostasis model assessment of insulin resistance (HOMA-IR). Results Blood lipids, insulin level, and HOMA-IR were not significantly different between the obese PCOS and the control groups (all P>0.05). Both groups showed IR (defined as HOMA-IR≥2.69), and HOMA-IR in the obese PCOS group was higher than that in the control group, but with no significant difference(6.17 ± 3.15 vs. 5.00±2.18, t= 1.515, P= 0.134). The mean alanine aminotransferase (ALT) level in the obese PCOS group was higher than normal, and the ALT values and the proportion of patients with ALT> 40 U/L were higher than those in the control group, but with no significant difference (P= 0.106 and P= 0.134). Those with nonalcoholic fatty liver disease (NAFLD) accounted for 27/62 in the obese PCOS group, also higher than the 6/19 in the control group(χ2 = 0.863, P= 0.353). BF in the obese PCOS group was lower than that in the control group [(36.28±6.16)kg vs. (39.56±6.13)kg, t=-2.032, P=0.046], so was VFA after adjusting for waist-to-hip ratio [(150.39±22.86)cm2vs. (161.74±20.77)cm2,OR=0.963, P=0.040]. Linear regression analysis showed that HOMA-IR was not correlated with BF, VFA or other body composition indexes in the obese PCOS patients (all P>0.05). Conclusions Obesity PCOS patients have significant IR, but HOMA-IR seems to be not correlated with BF, VFA, and other body composition indexes in this population. Studies with larger sample size and exploring relevant mechanisms are still needed. Key words: Obesity; Polycystic ovary syndrome; Insulin resistance index; Inbody720 body composition analyzer; Visceral fat area

Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance

Non-alcoholic fatty liver disease (NAFLD) is known to be associated with polycystic ovary syndrome (PCOS). However, most studies investigated the prevalence of NAFLD in obese PCOS patients. To compare the prevalence of non-obese NAFLD in women with or without PCOS, and to assess an independent association between PCOS and NAFLD in a non-obese Asian cohort. This was a case-control study using a prospective PCOS cohort. After subjects with other potential causes of chronic liver disease were excluded, 275 non-obese women with PCOS and 892 non-obese controls were enrolled. NAFLD was determined by hepatic ultrasonography. Main outcomes were the prevalence of NAFLD on hepatic ultrasonography between non-obese women with or without PCOS, and an independent association between non-obese NAFLD and PCOS. Non-obese women with PCOS had a significantly higher prevalence of NAFLD than those without PCOS (5.5% vs. 2.8%, P=0.027). PCOS was associated with non-obese NAFLD (odds ratio: 2.62, 95% confidence intervals: 1.25-5.48) after adjustment for age and body mass index (BMI). In women with PCOS, the level of androgenicity represented by free testosterone or free androgen index was associated with NAFLD after adjustment for age, BMI, lipid profile, insulin resistance or glycaemic status. Non-obese NAFLD is more prevalent in women with polycystic ovary syndrome than in those without. In non-obese patients with polycystic ovary syndrome, hyperandrogenemia may be an independent risk factor for non-obese NAFLD.