Prevalence of nonalcoholic fatty liver disease increased with type 2 diabetes mellitus in overweight/obese youth with polycystic ovary syndrome.

Nonalcoholic Fatty Liver Disease: Indian Perspective.

Background and Objectives: Nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) are two prevalent metabolic disorders characterized by insulin resistance. A bidirectional relationship exists between NAFLD and PCOS. NAFLD prevalence is significantly higher and more severe in women with PCOS. This study was conducted to generate data regarding the frequency of NAFLD among Bangladeshi women with PCOS. Materials and Methods: This cross-sectional study was conducted at the endocrinology and gynecology outpatient department of a tertiary hospital in Bangladesh from October 2020 to December 2021. All adult women diagnosed with PCOS by the revised Rotterdam criteria underwent ultrasonographic evaluation for hepatic steatosis. Relevant sociodemographic and clinical data were obtained from all; all underwent hormonal and metabolic assessment. Results: Among 120 women (age 33.67 ± 10.15 years) with PCOS studied, 32 (26.7%) had NAFLD. NAFLD frequency was higher in rural than urban areas. Clinical hyperandrogenism (HA) was less frequent in the NAFLD group than in the non-NAFLD group. Two groups did not vary in the frequencies of overweight, obesity, abdominal obesity, and hypertension. Hormonal parameters were indifferent in the two groups; both groups had a similar frequency of biochemical HA. Both groups had similar plasma glucose levels and glycemic status. NAFLD patients had lower high-density lipoprotein cholesterol and higher triglyceride than the non-NAFLD patients; total and low-density lipoprotein cholesterol were similar in the two groups. Although metabolic syndrome frequency was higher (43.8% vs. 33.0%) in the NAFLD group, the difference was insignificant (P = 0.290). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were more elevated in the NAFLD group; AST: ALT ratios were identical in the two groups. In binary logistic regression analysis, only clinical HA was associated with a lower risk of NAFLD among the study participants. Conclusion: More than one-fourth of women with PCOS have NAFLD in this study. A large-scale, multicenter study may better explain NAFLD's association and risk factors in women with PCOS.

Association between folate and non-alcoholic fatty liver disease among US adults: a nationwide cross-sectional analysis.

The aim of this study was to determine the frequency of the rs738409 polymorphism in the patatin-like phospholipase domain containing 3 (PNPLA3) gene in patients with polycystic ovary syndrome (PCOS) and its impact on nonalcoholic fatty liver disease (NAFLD) risk and severity. We also evaluated other risk factors associated with NAFLD and advanced fibrosis. This was a cross-sectional study involving 163 patients with PCOS at a tertiary center. Genotyping for the PNPLA3 polymorphism was undertaken using a TaqMan assay. The degree of fibrosis was defined by transient elastography. The prevalence of NAFLD was 72.4%, and the polymorphism was heterozygous in 41.7% and homozygous in 8% of patients. Homeostasis model assessment of insulin resistance ≥ 2.5 was the main factor associated with the risk of developing NAFLD (OR = 4.313, p = 0.022), and its effect was amplified by the polymorphism (OR = 12.198, p = 0.017). Age > 32 years also conferred a higher risk for NAFLD. HDL values ≥ 50 mg/dL conferred protection against the outcome. Metabolic syndrome (OR = 13.030, p = 0.020) and AST > 32 U/L (OR = 9.039, p = 0.009) were independent risk factors for advanced fibrosis. In women with PCOS, metabolic characteristics are more relevant than PNPLA3 polymorphism regarding the risk for NAFLD and its advanced forms, but these factors can act synergistically, increasing disease risk.

PurposeChronic plaque psoriasis is associated with the presence of non-alcoholic fatty liver disease (NAFLD), but the magnitude of this association remains currently uncertain. We aimed to investigate the magnitude of the association between psoriasis and the risk of prevalent and incident NAFLD, and to assess whether psoriasis severity and/or psoriatic arthritis are associated with a greater risk of NAFLD.MethodsA systematic review and meta-analysis of observational studies evaluating the association between psoriasis and NAFLD, as diagnosed by imaging or International Classification of Diseases codes was performed. Literature search on PubMed, Scopus and Web of Science on May 3, 2021 was undertaken. Studies using liver biopsy were not available. For the meta-analysis, the random-effects modelling was adopted.ResultsWe identified 15 observational (case–control and cross-sectional) studies for a total of 249,933 patients with psoriasis (49% with NAFLD) and 1,491,402 controls (36% with NAFLD). Psoriasis was associated with prevalent NAFLD (n = 11 studies; pooled random-effects odds ratio [OR] 1.96, 95% CI 1.70–2.26; I2 = 97%, p < 0.01). Psoriatic patients with NAFLD had a higher mean psoriasis area and severity index (PASI) than their counterparts without NAFLD (n = 8 studies, pooled weighted mean difference: 3.93, 95% CI 2.01–5.84; I2 = 88%, p < 0.01). The risk of NAFLD was marginally higher in patients with psoriatic arthritis than in those with psoriasis alone (n = 5 studies, pooled random-effects OR 1.83, 95% CI 0.98–3.43; I2 = 64%, p = 0.03). Sensitivity analyses did not alter these findings. Funnel plot did not show any significant publication bias. A major limitation of the study was the high degree of heterogeneity across studies.ConclusionPsoriasis is associated with prevalent NAFLD and this risk parallels the severity of psoriasis.

Abnormal aminotransferase activity in women with polycystic ovary syndrome

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.

To investigate the effect of obesity on nonalcoholic fatty liver disease (NAFLD) in women with polycystic ovary syndrome (PCOS). The patient data were acquired from 306 women with PCOS by Rotterdam consensus criteria and 286 women selected as controls. Basal endocrine, oral glucose tolerance test (OGTT), insulin release test, lipid profile, blood pressure and body mass index (BMI) were tested. The essays of liver chemistries, B-hepatitis and c-hepatitis were performed and alcoholic liver diseases excluded. Fatty liver was diagnosed by ultrasound. Patients with PCOS showed a higher prevalence of NAFLD than control group (30.7% vs 17.5%), including 56 mild cases (59.6%), 34 moderate cases (36.2%) and 4 severe cases (4.2%). The prevalence of NAFLD in PCOS increased with BMI, waist hip ratio, triglyceride and HOMA-IR. The prevalence of NAFLD in abdominal obese PCOS patients was significantly higher than those with normal waist. In addition to the prevalence of insulin resistance, metabolic syndrome in PCOS women significantly increased with BMI. These findings indicate that Chinese women with PCOS have a high prevalence of NAFLD, especially in abdominal and II obese PCOS patients. The prevalence and severity of NAFLD are positively correlated with BMI. It seems that insulin resistance and metabolic abnormalities are closely associated with NAFLD in PCOS. It is essential to give a high priority to the screening and treatment of NAFLD in obese PCOS patients.

To study the prevalence and predictors of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) in women with polycystic ovarian syndrome (PCOS). Seventy-eight PCOS patients and 78 age and body mass index (BMI)-matched controls were studied. PCOS was diagnosed by Rotterdam criteria. Clinical examination, biochemical, and hormonal investigations, and transabdominal sonography were done for all participants. Based on gray-scale sonography, NAFLD was graded as 0, 1, 2, and 3. MAFLD was diagnosed when imaging or serological evidence of fatty liver disease was present and one of the following three criteria was met: overweight/obesity, diabetes, or metabolic disorders. Women with PCOS had a higher prevalence of NAFLD (53.8% vs. 17.9%; p < 0.001), MAFLD (70.5% vs. 48.7%; p < 0.01), insulin resistance (HOMA-IR 2.8 ± 1.3 vs. 1.4 ±0.3; p < 0.001) and metabolic syndrome (51.3% vs. 10.3%; p < 0.001) and higher values of waist-hip ratio (0.88 ± 0.1 vs. 0.83 ± 0.1; p < 0.001), alaninetransferase (44.1 ± 19.7 vs. 30.3 ± 7.6; p < 0.001), and free androgen index (FAI; 7.8 ± 4.4 vs. 3.4 ± 1.7; p < 0.001) than controls. Twenty-three percent of PCOS patients with NAFLD and 18.4% with MAFLD had Grades 2and 3 disease. Among different PCOS phenotypes, phenotype A was maximally affected with NAFLD and MAFLD. Multiple regression analysis showed that PCOS status and FAI were the predicting factors for NAFLD. MAFLD was significantly associated with hepatic steatosis index (HSI). PCOS patients were at a higher risk for NAFLD and MAFLD than age- and BMI-matched controls. The prevalence of NAFLD and MAFLD was highest in phenotype A. Hyperandrogenism is a predictor of NAFLD in PCOS.

Objective To compare the prevalence of non-alcoholic fatty liver disease (NAFLD) in women with or without polycystic ovary syndrome (PCOS), and to evaluate association between PCOS and NAFLD. Methods A cross-sectional study was performed including 122 PCOS patients (PCOS group) and 107 age, and body mass index (BMI)-matched women (control group). Anthropometric parameters, liver enzyme, lipid profile, glucose and insulin levels, sex hormones and hepatic ultrasonography were measured in all subjects. The clinical features, laboratory parameters and prevalence of NAFLD were compared between PCOS group and control group. The related factors were evaluated between PCOS and NAFLD, finally the role of insulin resistance (IR) and hyperandrogenism (HA) was analysed. Results Women with PCOS had a significantly higher prevalence of NAFLD than those without PCOS (62.6% vs. 76.2%, P=0.025). Logistic regression found that HOMA-IR and FAI were associated with NAFLD in PCOS women (OR=1.686, 95% CI=1.279-2.223; OR=1.167, 95% CI=1.039-1.311), however, there was no significant correlation between FAI and NAFLD after adjustment for HOMA-IR (P>0.05). Conclusion NAFLD is more prevalent in women with PCOS than in those without. Insulin resistance and HA drive risk of NAFLD in young female with PCOS. IR may be an independent risk factor for NAFLD, and the association between HA and NAFLD is not independent but is mediated by IR. Key words: Polycystic ovary syndrome; Non-alcoholic fatty liver disease; Insulin resistance; Hyperandrogenism

BackgroundFasting plasma glucose (FPG) is an easily quantifiable and inexpensive metabolic marker, which is often used to assess cardiovascular disease and diabetes. However, there have been limited studies on the association between FPG and nonalcoholic fatty liver disease (NAFLD) risk in nonobese people, especially in Chinese individuals. The purpose of this study was to investigate the association between FPG and NAFLD in nonobese Chinese people with normal blood lipid levels.MethodsIn this prospective cohort study, 9767 nonobese participants with normal blood lipid levels without NAFLD were recruited and prospectively followed for 5 years. The Cox proportional hazard model was used to evaluate the risk factors of NAFLD. Moreover, a Cox model with cubic spline functions and smooth curve fitting (the cubic spline smoothing) were used to identify the nonlinear association between FPG and NAFLD.ResultsDuring the 5-year follow-up, 841 (8.61%) participants were diagnosed with NAFLD. The good functional results (without NAFLD) estimated by the Kaplan-Meier method for 1 year, 2 years, 3 years, 4 years, and 5 years were 98.84, 95.35, 91.67%, 87.57 and 74.86%, respectively. Additionally, through the Cox proportional hazard model, after adjusting for other covariates, there was an independent positive correlation between FPG and increased NAFLD risk (HR:1.21, 95% CI:1.15–1.28, P < 0.0001), and the NAFLD risk was incrementally higher with the rising FPG quartile. The nonlinear association between FPG and NAFLD was visualized by cubic spline smoothing technique. It was calculated that the inflection point of FPG was 5.54. When FPG ≤ 5.54, there was a positive correlation between FPG and the risk of NAFLD (HR:2.20, 95% CI:1.78–2.73, P < 0.0001). When FPG > 5.54, the risk of NAFLD increased by 50% (HR:1.10, 95% CI:1.02–1.18, P = 0.0159) compared with the left side of the inflection point and gradually leveled off.ConclusionsIn a nonobese Chinese population with normal lipid levels, there is an independent nonlinear association between FPG and NAFLD, and the increase in FPG may indicate an increased risk of NAFLD. Additionally, this independent association is more obvious in the short stature population.

Background:Our objective was to determine the overall prevalence of nonalcoholic fatty liver disease (NAFLD) in women with polycystic ovarian syndrome (PCOS) in our sample population. The second aim was to evaluate the predictive value of body mass index (BMI), waist circumference (WC), and visceral fat for the onset of NAFLD in these patients.Materials and Methods:This cross-sectional study was performed on 71 women with PCOS who were referred to Arash Women's Hospital in Tehran. Demographic and clinical information and anthropometric and biomedical indices were collected by a trained nurse. Liver ultrasonography was performed for all participants by a radiologist.Results:NAFLD was identified in 53.5% (n = 38) of subjects and the frequency of mild, moderate, and severe grades were 65.8%, 31.6%, and 2.6%, respectively. BMI and visceral fat of patients with NAFLD were significantly higher than non-NAFLD (P < 0.001). Receiving operating characteristic (ROC) curve analysis revealed that BMI was the best indicator of predicting NAFLD (cutoff = 25.5 kg/m2, sensitivity 75%, and specificity 75%), whereas visceral fat (cutoff = 5.5%, sensitivity 79%, and specificity 67%) and WC (cutoff = 89.5 cm, sensitivity 73%, and specificity 64%) were inferior for predicting NAFLD in PCOS patients.Conclusion:The prevalence of NAFLD in the study population is high. Our findings supported the use of BMI as a simple and practical predictive factor for the NAFLD onset, with a cutoff level of 25.5. The use of this cutoff level will enable physicians to identify PCOS patients at risk for NAFLD.

Do women with PCOS have a unique predisposition to obesity?

Association between Helicobacter pylori infection and risk of nonalcoholic fatty liver disease: An updated meta-analysis

Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized comorbidity in Crohn's disease (CD), but the mechanisms are poorly understood. Autophagy is a highly conserved process regulating innate immunity that contributes to CD susceptibility. Emerging data suggest that variants in the autophagy-governing IRGM gene may contribute to the accumulation of visceral adipose tissue (VAT) and hepatic fat. Our objective was to characterize the relationship between VAT, IRGM gene variants, and NAFLD risk in patients with CD. We included all CD patients in the Prospective Registry in Inflammatory Bowel Disease Study at Massachusetts General Hospital (PRISM) without history of alcohol abuse or liver disease. Hepatic fat was quantified by liver attenuation (LA) on computed tomography, with NAFLD defined by the validated liver:spleen (L:S) ratio. NAFLD severity was estimated by the FIB-4 Index and alanine aminotransferase (ALT). Using logistic regression modeling, we examined the relationship between VAT, autophagy gene variants, and NAFLD risk. Among 462 patients, 52% had NAFLD. Increasing VAT quartile was associated with reduced LA (mean change, -7.43; 95% confidence interval [CI], -10.05 to -4.81; Ptrend < 0.0001). In the fully adjusted model, patients in the highest VAT quartile had a 2.2-fold increased NAFLD risk (95% CI, 1.21 to 4.14; Ptrend = 0.032) and a 4.2-fold increased risk of ALT>upper limit of normal (ULN) (95% CI, 1.19 to 14.76; Ptrend = 0.017). The relationship between VAT and NAFLD was modified by IRGM variants rs4958847 and rs13361189 (Pinteraction = 0.005 and Pinteraction < 0.001, respectively). In a large CD cohort, VAT was directly associated with prevalent NAFLD, and this relationship was augmented by functionally annotated IRGM variants associated with impaired autophagy.