Long‐term metformin treatment is able to reduce the prevalence of metabolic syndrome and its hepatic involvement in young hyperinsulinaemic overweight patients with polycystic ovarian syndrome

Gangalè, Maria Francesca; Miele, Luca; Lanzone, Antonio; Sagnella, Francesca; Martínez, Daniela; Tropea, Anna; Moro, Francesca; Morciano, Andrea; Ciardulli, Andrea; Palla, Carola; Pompili, Maurizio; Cefalo, Consuelo; Grieco, Antonio; Apa, Rosanna

doi:10.1111/j.1365-2265.2011.04093.x

Cited by 47 publications

(33 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Treating patients with PCOS and NAFLD with metformin improves both insulin sensitivity and liver enzymes. These improvements are associated with a reduction in measures of IR and in the free androgen index (41). Importantly, weight loss through lifestyle modification, which often forms the mainstay of current treatment approaches, results in liver biopsy-proven improvements in NASH in patients with PCOS (42).…”

Section: Polycystic Ovarian Syndromementioning

confidence: 99%

Mechanisms in endocrinology: Non-alcoholic fatty liver disease in common endocrine disorders

Hazlehurst

Tomlinson

2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease spanning from simple benign steatosis to steatohepatitis with fibrosis and scarring that can eventually lead to cirrhosis. Its prevalence is rising rapidly and is developing into the leading indication for liver transplantation worldwide. Abnormalities in endocrine axes have been associated with NALFD, including hypogonadism, hypothyroidism, GH deficiency and hypercortisolaemia. In some instances, correction of the endocrine defects has been shown to have a beneficial impact. While in patients with type 2 diabetes the association with NAFLD is well established and recognised, there is a more limited appreciation of the condition among common endocrine diseases presenting with hormonal excess or deficiency. In this review, we examine the published data that have suggested a mechanistic link between endocrine abnormalities and NAFLD and summarise the clinical data endorsing these observations.

show abstract

Section: Polycystic Ovarian Syndromementioning

confidence: 99%

Mechanisms in endocrinology: Non-alcoholic fatty liver disease in common endocrine disorders

Hazlehurst

Tomlinson

2013

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…There is only one case-study in addition to small case-series studies that shows histology improvement in response to diet (149), or normalization of aminotransferase levels in response to diet and exercise alone, or in combination with metformin in PCOS women with biopsy-documented NASH (119). In relation to the effect of metformin on NAFLD in obese PCOS patients, there are two longitudinal studies of up to 12 months in duration R152 Review D Macut and others PCOS and NAFLD www.eje-online.org that showed a significant reduction of liver enzyme levels accompanied with the reduction of IR and androgen levels (66,150). The rat model of T2DM showed that metformin intervention affected the expression of insulin receptors and genes associated with lipid metabolism.…”

Section: Therapeutic Options For Nafldmentioning

confidence: 99%

“…However, there are usually no significant differences in circulating total androgens between PCOS with NAFLD and without it (65,66,67), but a lower SHBG independent of obesity, as well as a consequently higher free androgen index (FAI) in the former indicates a higher tissue exposure to biologically active free androgens (57, 58, 68). SHBG might be a possible mediator between IR and NAFLD, being a hormone carrier and an indicator of the metabolic and nutritional status (69) whose hepatic production is regulated by insulin.…”

Section: Molecular Basis Including Endocrine Disruptorsmentioning

confidence: 99%

“…It was shown that metformin and thiazolidinediones (TZDs) could ameliorate the adverse metabolic profile and restore ovulation in women with PCOS who were treated (6). Although the data on the effects of metformin in lean women with PCOS are missing, it was shown that 6-8 months of treatment with metformin could reduce transaminase levels in overweight or obese women with this syndrome (66,150). As concerns over the cardiovascular safety of pioglitazone bring into question the clinical use of this class of insulin sensitizers, metformin could be the drug of choice for treating PCOS patients with NAFLD when pharmacologic therapy is taken into consideration.…”

Section: Therapeutic Options For Nafldmentioning

confidence: 99%

“…NAFLD is assumed to be directly responsible for the development of local hepatic IR (64, 131) and could aggravate IR in PCOS associated with chronic anovulation, hyperandrogenemia, atherogenic dyslipidemia and subclinical inflammation (132,133). Accordingly, the favorable action of metformin on NAFLD can be explained by its effect on hepatic IR (66,134). Insulin-resistant visceral adipose tissue, like the one in women with PCOS, induces lipolysis and an increased flow of free fatty acids to the liver, causing hepatic fat accumulation (135).…”

Section: Nafld and Metabolic Syndrome In Pcosmentioning

confidence: 99%

See 2 more Smart Citations

MANAGEMENT OF ENDOCRINE DISEASE: Polycystic ovary syndrome and nonalcoholic fatty liver disease

Macut

Božić-Antić

Bjekić-Macut

et al. 2017

European Journal of Endocrinology

View full text Add to dashboard Cite

Polycystic ovary syndrome (PCOS) is a frequent endocrine disease in women, with a number of metabolic and reproductive consequences. Obesity, insulin resistance (IR) and type 2 diabetes are prominent metabolic characteristics of PCOS and common factors affecting liver function and generating nonalcoholic fatty liver disease (NAFLD). Multiple genes involved in the synthesis of androgens, cytokines and IR, as well as acquired factors, such as endocrine disruptors, could associate the etiopathogenesis of PCOS and NAFLD. Besides the high prevalence of PCOS in general population, NAFLD was shown to be a frequent condition in transition periods, such as adolescence and menopause. Although liver biopsy is considered to be the gold standard for diagnosing liver damage, its routine use in such a prevalent condition as PCOS can be related to a higher rate of complications. Therefore, it is necessary to be able to diagnose NAFLD using simple and reliable surrogate markers. Recently, fatty liver index and NAFLD fatty liver score analyzed in large cohorts of PCOS women have been shown as accurate markers of liver damage in this metabolically vulnerable population. Lifestyle changes are still the mainstay of the management of NAFLD in PCOS, although prospective randomized controlled clinical studies remain a priority in the field. With regard to medications, metformin may be the drug of choice for treating PCOS patients with NAFLD when pharmacologic therapy is considered. Liraglutide use in obese PCOS has shown favorable effects on the predictors of liver fibrosis. In this review, we aim to summarize the influence of the common risk factors and to discuss the diagnostic approaches and management options for NAFLD in patients with PCOS.

show abstract

Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis?

2015

View full text Add to dashboard Cite

Increasing evidence suggests that non-alcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) are associated with obesity, insulin resistance, metabolic syndrome, cardiovascular disease, cirrhosis, and liver tumors. On these grounds, we have hypothesized that NAFLD and PCOS occur more frequently than expected by chance alone. We have tested this hypothesis by reviewing the clinical and biological evidence that supports a significant association between NAFLD and PCOS. PubMed was extensively searched for articles published through March 2015 using the keywords "nonalcoholic fatty liver disease" or "fatty liver" combined with "PCOS." Several cross-sectional and case-control studies have consistently demonstrated that the prevalence of NAFLD is remarkably increased in young women with PCOS, independent of overweight/obesity and other coexisting metabolic syndrome features, and that these women are more likely to have the more severe forms of NAFLD (non-alcoholic steatohepatitis, advanced fibrosis, and cirrhosis). Accumulating evidence suggests that NAFLD, especially its necro-inflammatory form, may exacerbate hepatic and systemic insulin resistance and releases multiple pro-inflammatory, pro-coagulant, and pro-fibrogenic mediators that may play important roles in the pathophysiology of PCOS. These findings call for more active and systematic search for NAFLD among women with PCOS. Conversely, gastroenterologists/hepatologists need to be aware of the presence of PCOS among female patients with NAFLD and compatible clinical features. Finally, all these patients should undergo regular follow-up not only for liver-related complications but also for cardio-metabolic diseases.

show abstract

Long‐term metformin treatment is able to reduce the prevalence of metabolic syndrome and its hepatic involvement in young hyperinsulinaemic overweight patients with polycystic ovarian syndrome

Abstract: Treatment with metformin is indicated in all hyperinsulinaemic overweight patients with PCOS, especially in those with NAFLD. These data appear even more interesting considering their increased risk to develop metabolic and hepatic complications.

Cited by 47 publications

References 31 publications

Mechanisms in endocrinology: Non-alcoholic fatty liver disease in common endocrine disorders

Mechanisms in endocrinology: Non-alcoholic fatty liver disease in common endocrine disorders

MANAGEMENT OF ENDOCRINE DISEASE: Polycystic ovary syndrome and nonalcoholic fatty liver disease

Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis?

Contact Info

Product

Resources

About