Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center

Taranto, Daniela Oliveira de Lima; Guimarães, Thais Cristine Moura; Couto, Cláudia Alves; Cândido, Alexandre Luna; Azevedo, Rosana Correa Silva; Mattos, Fernanda Souza; Elias, Maria Luiza Cândido; Reis, Fernando M.; Rocha, Ana Luiza Lunardi; Faria, Luciana Costa

doi:10.20945/2359-3997000000242

Cited by 11 publications

(5 citation statements)

References 33 publications

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“…Taranto et al 20 evaluated the association between NAFLD and PCOS demonstrating a high prevalence of steatosis in patients with PCOS (77%) when compared with patients with similar BMI but without PCOS (55%). Central adiposity (mean 103 cm) and serum triglyceride levels (mean 134 md/dL), two components of the MetS, were identified as important factors associated with steatosis, similar to the findings of this study.…”

Section: Discussionmentioning

confidence: 99%

Polycystic Ovary Syndrome and Metabolic Syndrome: Clinical and Laboratory Findings and Non-Alcoholic Fatty Liver Disease Assessed by Elastography

Lavor

Júnior

Medeiros

2022

Rev Bras Ginecol Obstet

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Objective To evaluate the association between polycystic ovary syndrome (PCOS) and metabolic syndrome (MetS), adding liver assessment through elastography and ultrasound, for correlation with non-alcoholic fatty liver disease (NAFLD). Metabolic syndrome occurs in ∼ 43% of women with PCOS, and NAFLD is the hepatic expression of MetS. Methods One hundred women, 50 with PCOS and 50 controls, matched by age (18–35 years) and body mass index (BMI) were included, restricted to patients with overweight and obesity grade 1, at the Assis Chateaubrian Maternity School, Universidade Federal do Ceará, Brazil. For the diagnosis of PCOS, we adopted the Rotterdam criteria, and for the diagnosis of MetS, the criteria of the National Cholesterol Education Program (NCEP/ATP III). Hepatic elastography and ultrasound were performed to assess liver stiffness and echotexture, respectively. Results The average ages were 29.1 (±5.3) and 30.54 (±4.39) years, for the PCOS and the control group, respectively. Patients with PCOS had a risk 4 times higher of having MetS, odds ratio (95% confidence interval) = 4.14, than those in the control group. Women with PCOS had higher average of abdominal circumference (100.9 ± 9.08 cm vs 94.96 ± 6.99 cm) and triglycerides (162 ± 54.63 mg/dL vs 137.54 ± 36.91 mg/dL) and lower average of HDL cholesterol (45.66 ± 6.88 mg/dL vs 49.78 ± 7.05 mg/dL), with statistically significant difference. Hepatic steatosis was observed on ultrasound in women with PCOS; however, with no statistically significant difference. There was no change to NAFLD at elastography in any group. Conclusion Women with PCOS had 4-fold higher frequency of MetS and more hepatic steatosis, with no statistically significant difference. There was no change in liver stiffness between the groups at elastography. The results can be extended only to populations of overweight and obesity grade 1, with PCOS or not. They cannot be generalized to other untested groups.

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Section: Discussionmentioning

confidence: 99%

Polycystic Ovary Syndrome and Metabolic Syndrome: Clinical and Laboratory Findings and Non-Alcoholic Fatty Liver Disease Assessed by Elastography

Lavor

Júnior

Medeiros

2022

Rev Bras Ginecol Obstet

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“…Most of the studies included in this systematic review measured NAFLD using ultrasonography despite acknowledging that it is inferior to liver biopsy. Although understandably, performing a liver biopsy on each participant in a study is unfeasible, perhaps another method exists which will not only diagnose but also stage and monitor the extent of liver disease , they found strong evidence for the correlation but were unable to find a strong correlation between PCOS and liver fibrosis [12]. Thus, it can be argued that TE may be a more favorable alternative for NAFLD measurement than ultrasonography; however, further study is still warranted.…”

Section: Extent Of Nafldmentioning

confidence: 99%

A Systematic Review of the Risk of Non-alcoholic Fatty Liver Disease in Women With Polycystic Ovary Syndrome

Shahbaz¹,

Almatooq²,

Foucambert³

et al. 2022

Cureus

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Polycystic ovary syndrome (PCOS) is a complex hormonal disorder associated with complications throughout various body organs. Previous studies have shown evidence of liver disease in some women with PCOS. In this study, we attempted to explore the risk of non-alcoholic fatty liver disease (NAFLD) in PCOS women and the specific factors involved in its development. We searched PubMed, PubMed Central, Medline, and ScienceDirect for articles related to the topic, screened those articles according to our inclusion/exclusion criteria, and conducted a thorough quality check using various quality appraisal tools to select articles relevant to our research. The process was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Checklist 2020.We selected 11 high-quality observational studies for our review. Studies from various countries were included, and all studies demonstrated an increased prevalence of NAFLD in PCOS patients compared to healthy controls. Although insulin resistance, obesity, and increased androgens contribute to the increase in the risk of NAFLD in these patients, hyperandrogenism was the most influential risk factor in four of these studies. Two studies explored the degree of NAFLD in these patients using transient elastography (TE). They concluded that PCOS was significantly associated with hepatic steatosis (HS) rather than hepatic fibrosis in most patients. PCOS patients have an increased risk of developing NAFLD, particularly HS, and hyperandrogenism seems to be the main determinant. Therefore, effort should be put into screening and monitoring these patients to manage the disease. TE may be a useful method for monitoring the natural history of NAFLD in these patients, which requires further exploration.

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“…PCOS is now perceived as both a reproductive syndrome, presenting clinically with hyperandrogenism, ovulatory dysfunction (including oligo-amenorrhea), polycystic ovaries, and infertility (1), and a metabolic disorder (2). Most women with PCOS have obesity and insulin resistance (IR) (3,4) that further increases the risk for type 2 diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), and metabolic syndrome (5)(6)(7). All of the aforementioned and associated with PCOS conditions are considered chronic low-grade inflammatory disorders (8) where visceral adipose tissue is thought to play a central role (9).…”

Section: Introductionmentioning

confidence: 99%

Elevated levels of interleukin-18 are associated with several indices of general and visceral adiposity and insulin resistance in women with polycystic ovary syndrome

Kabakchieva¹,

Gateva²,

Velikova

et al. 2022

Archives of Endocrinology and Metabolism

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Objective: Our aim was to analyze levels of proinflammatory biomarker interleukin-18 (IL-18) in healthy controls and patients with polycystic ovary syndrome (PCOS) focusing on its association with obesity, clinical, hormonal, and metabolic characteristics. Subjects and methods: Fifty-eight patients with PCOS were enrolled in the study fulfilling the Rotterdam criteria and were matched for age, body mass index (BMI), and ethnicity with 30 healthy controls. Detailed anthropometric measurements, clinical investigations, hormonal and biochemical tests were obtained between the 3 rd and 5 th day of a menstrual cycle. A subanalysis of the PCOS group was performed separating patients into several groups according to a waist-to-height ratio (WHtR), insulin resistance (IR), and free androgen index (FAI). Serum IL-18 levels were measured using the ELISA method. Results: Levels of IL-18 were similar between PCOS patients and controls. IL-18 was higher in overweight/obese women compared to normal-weight women when analyzing all participants together and separately PCOS or controls group (p < 0.001, p < 0.001, p = 0.01, respectively). Additionally, IL-18 levels were higher in high-WHtR and IR subgroups compared to low-WHtR (p < 0.001) and non-IR PCOS women (p < 0.001). PCOS women with high FAI had greater serum IL-18 levels than normal-FAI patients (p = 0.002). Levels of IL-18 correlated positively with most of the anthropometric and metabolic parameters. In multiple linear regression, age, waist circumference, and fasting insulin were independently related factors with IL-18. Conclusion: Elevated levels of IL-18 were related to several indices of general and visceral adiposity and insulin resistance in PCOS.

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Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center

Cited by 11 publications

References 33 publications

Polycystic Ovary Syndrome and Metabolic Syndrome: Clinical and Laboratory Findings and Non-Alcoholic Fatty Liver Disease Assessed by Elastography

Polycystic Ovary Syndrome and Metabolic Syndrome: Clinical and Laboratory Findings and Non-Alcoholic Fatty Liver Disease Assessed by Elastography

A Systematic Review of the Risk of Non-alcoholic Fatty Liver Disease in Women With Polycystic Ovary Syndrome

Elevated levels of interleukin-18 are associated with several indices of general and visceral adiposity and insulin resistance in women with polycystic ovary syndrome

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