Abstract
BackgroundAndrogen excess is a defining feature of polycystic ovary syndrome (PCOS), which affects 10% of women and represents a lifelong metabolic disorder, with increased risk of type 2 diabetes, hypertension, and cardiovascular events. Previous studies have suggested an increased risk of nonalcoholic fatty liver disease (NAFLD) in individuals with PCOS and implicated androgen excess as a potential driver.Methods and findingsWe carried out a retrospective longitudinal cohort study utilizing a large primary care database in the United Kingdom, evaluating NAFLD rates in 63,120 women with PCOS and 121,064 age-, body mass index (BMI)-, and location-matched control women registered from January 2000 to May 2016. In 2 independent cohorts, we also determined the rate of NAFLD in women with a measurement of serum testosterone (n = 71,061) and sex hormone-binding globulin (SHBG; n = 49,625). We used multivariate Cox models to estimate the hazard ratio (HR) for NAFLD and found that women with PCOS had an increased rate of NAFLD (HR = 2.23, 95% CI 1.86–2.66, p < 0.001), also after adjusting for BMI or dysglycemia. Serum testosterone >3.0 nmol/L was associated with an increase in NAFLD (HR = 2.30, 95% CI 1.16–4.53, p = 0.017 for 3–3.49 nmol/L and HR = 2.40, 95% CI 1.24–4.66, p = 0.009 for >3.5 nmol/L). Mirroring this finding, SHBG <30 nmol/L was associated with increased NAFLD hazard (HR = 4.75, 95% CI 2.44–9.25, p < 0.001 for 20–29.99 nmol/L and HR = 4.98, 95% CI 2.45–10.11, p < 0.001 for <20 nmol/L). Limitations of this study include its retrospective nature, absence of detailed information on criteria used to diagnosis PCOS and NAFLD, and absence of data on laboratory assays used to measure serum androgens.ConclusionsWe found that women with PCOS have an increased rate of NAFLD. In addition to increased BMI and dysglycemia, androgen excess contributes to the development of NAFLD in women with PCOS. In women with PCOS-related androgen excess, systematic NAFLD screening should be considered.
Highlights
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting 6%–10% of women worldwide [1]
We carried out a retrospective longitudinal cohort study utilizing a large primary care database in the United Kingdom, evaluating nonalcoholic fatty liver disease (NAFLD) rates in 63,120 women with polycystic ovary syndrome (PCOS) and 121,064 age, body mass index (BMI), and location-matched control women registered from January 2000 to May 2016
We found that women with PCOS have an increased rate of NAFLD
Summary
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting 6%–10% of women worldwide [1]. Nonalcoholic fatty liver disease (NAFLD) is a hepatic complication of the metabolic syndrome, with global NAFLD prevalence rising to epidemic proportions in recent years [8]. It encompasses a continuous spectrum of morphological changes in the liver, from simple hepatic steatosis, continuing to the stage of nonalcoholic steatohepatitis (NASH), with prevailing inflammation, and eventually progressing to irreversible hepatic fibrosis and cirrhosis [9]. Previous studies have suggested an increased risk of nonalcoholic fatty liver disease (NAFLD) in individuals with PCOS and implicated androgen excess as a potential driver
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
