Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: systematic review and meta-analysis

Rocha, Ana Luiza Lunardi; Faria, Luciana Costa; Guimarães, Thais Cristine Moura; Moreira, Geane; Cândido, Alexandre Luna; Couto, Cláudia Alves; Reis, Fernando M.

doi:10.1007/s40618-017-0708-9

Cited by 125 publications

(89 citation statements)

References 55 publications

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“…Hyperandrogenism measured by FAI was also an independent predictor of NAFLD. Our nding con rms previous data that high FAI correlates with liver disease markers and is a PCOS-speci c feature that further increases the risk of NAFLD (13). Elevated ALT was also an independent predictor of NAFLD on multivariable analysis.…”

Section: Discussionsupporting

confidence: 90%

“…These gures are higher than those reported for the general population, where the prevalence of NAFLD is 25.24% (1,28). Previous estimates of NAFLD prevalence among PCOS patients ranged widely, between 5.5% and 73.3% across studies (13). In the present study, we have included a homogeneous population of South Asian women, as both PCOS and NAFLD prevalence vary across ethnicities (29).…”

Section: Discussionmentioning

confidence: 99%

“…In the context of PCOS, a more complex pathogenesis may account for a relationship between the two diseases, particularly hyperandrogenism (12). Despite these considerations, the prevalence of NAFLD in PCOS varies largely between 5.5% and 73.3% across studies (13). This discrepancy may be attributed to retrospective study design leading to selection bias and to varying diagnostic methods and de nitions adopted for NAFLD.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Shengir

Krishnamurthy

Ghali

et al. 2020

Preprint

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Abstract Background & Aims: Polycystic ovary disease (PCOS) may be a risk factor for nonalcoholic fatty liver disease (NAFLD) due to common pathogenetic pathways, including insulin resistance and obesity. Both PCOS and NAFLD are more severe in South Asian women. Data on NAFLD in South Asian women with PCOS are lacking.Methods: We investigated prevalence and predictors of NAFLD and liver fibrosis by transient elastography (TE) with associated controlled attenuation parameter (CAP) in PCOS patients from South Asia, through a routine screening program. NAFLD was defined as CAP >288 dB/m. Significant liver fibrosis (stage 2 and higher out of 4) was defined as TE measurement >8.0 kPa. Elevated ALT was defined as ALT >24 IU/L, as per upper limit of normal reported in South Asian women. Hyperandrogenism was defined as free androgen index >5. Predictors of NAFLD were determined by logistic regression analysis.Results: 101 PCOS patients (mean age 36.3 years) with no significant alcohol intake or viral hepatitis were included. Prevalence of NAFLD and significant liver fibrosis was 39.6% and 6.9%, respectively. Elevated ALT was observed in 40.0% and 11.5% of patients with and without NAFLD, respectively. After adjusting for duration of PCOS and insulin resistance measured by HOMA-IR, independent predictors of NAFLD were higher BMI (adjusted odds ratio [aOR] 1.30, 95% CI 1.13-1.52), hyperandrogenism (aOR 5.32, 95% CI 1.56-18.17) and elevated ALT (aOR 3.54, 95% CI 1.10-11.47). Lifetime cardiovascular risk was higher in patients with NAFLD compared to those without NAFLD (0.31+0.11 vs. 0.26+0.13).Conclusions: Despite their young age, NAFLD diagnosed by TE with CAP is a frequent comorbidity in South Asian women with PCOS and is strongly associated with higher BMI and hyperandrogenism. Non-invasive screening strategies could help early diagnosis and initiation of interventions, including counselling on weight loss, cardiovascular risk stratification and linkage to hepatology care where appropriate.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Shengir

Krishnamurthy

Ghali

et al. 2020

Preprint

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“…These changes may explain the increased VTE risk that we observed, beyond high BMI, smoking, and hormone use. Moreover, women with PCOS have also been found to have a higher prevalence of non‐alcoholic fatty liver disease than women without the syndrome . Non‐alcoholic fatty liver disease is associated with increased procoagulant levels, which may also contribute to an increased VTE risk …”

Section: Discussionmentioning

confidence: 99%

Endogenous sex hormones and risk of venous thromboembolism in young women

Scheres

Vlieg

Ballieux

et al. 2019

Journal of Thrombosis and Haemostasis

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| on behalf of the CREW consortiumThis is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: The risk of venous thromboembolism (VTE) in young women can predominantly be attributed to exogenous hormone use. The influence of (abnormalities in) endogenous sex hormones, as in polycystic ovary syndrome (PCOS) or primary ovarian insufficiency (POI), on VTE risk is uncertain.Objectives: Th assess the association between endogenous sex hormone levels and VTE risk.Methods: Women aged ≤45 years from the MEGA case-control study who provided a blood sample in the absence of exogenous hormone exposure or pregnancy were included. Sex hormone-binding globulin (SHBG), estradiol, follicle-stimulating hormone (FSH) and testosterone were measured. The free androgen index (FAI) and estradiol to testosterone ratio (E:T) were calculated. VTE risk was assessed according to quartiles (Qs) of levels and clinical cut-offs as proxies for PCOS (FAI > 4.5) and POI (FSH > 40 U/L). Logistic regression models were used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results:Six hundred and sixty-five women (369 cases; 296 controls) were eligible for the analyses. Testosterone and FSH levels, E:T and POI (FSH > 40 U/L vs FSH ≤ 40 U/L) were not associated with VTE risk. For estradiol, VTE risk was increased with levels in Q4 vs Q1 (OR 1.6; 95% CI 1.0-2.5). There was a dose-response relationship between SHBG levels and VTE risk, with the highest OR at Q4 vs Q1: 2.0 (95% CI 1.2-3.3). FAI > 4.5 (PCOS proxy) vs FAI ≤ 4.5 was associated with increased VTE risk (OR 3.3; 95% CI 0.9-11.8). Conclusions:Estradiol, SHBG and FAI were associated with VTE risk, suggesting a role for endogenous sex hormones in the pathophysiology of VTE in young women. K E Y W O R D Shormones, polycystic ovary syndrome, premature ovarian failure, venous thromboembolism, women

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“…88 A recent systematic review and meta-analysis of 17 studies has revealed that PCOS patients (n = 2,734) have increased prevalence of NAFLD (OR: 2.54, 95% CI 2.19-2.95) and the presence of NAFLD among them is associated with hyperandrogenism, in addition to IR and adiposity. 89 The prevalence of NAFLD among women with PCOS is estimated to vary from 15% to 55%, whereas amongst the reproductive-aged women with NAFLD, the prevalence of PCOS is as high as 71%. 90 OSA OSA is strongly associated with NAFLD independent of traditional risk factors.…”

Section: Pcosmentioning

confidence: 99%

Non-alcoholic Fatty Liver Disease: Growing Burden, Adverse Outcomes and Associations

Kumar¹,

Priyadarshi²,

Anand³

2019

Journal of Clinical and Translational Hepatology

106

112

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Nonalcoholic fatty liver disease (NAFLD) is a systemic disorder with a complex multifactorial pathogenesis and heterogenous clinical manifestations. NAFLD, once believed to be an innocuous condition, has now become the most common cause of chronic liver disease in many countries worldwide. NAFLD is already highly prevalent in the general population, and owing to a rising incidence of obesity and diabetes mellitus, the incidence of NAFLD and its impact on global healthcare are expected to increase in the future. A subset of patients with NAFLD develops progressive liver disease leading to cirrhosis, hepatocellular carcinoma, and liver failure. NAFLD has emerged as one of the leading causes of cirrhosis and hepatocellular carcinoma in recent years. Moreover, HCC can occur in NAFLD even in absence of cirrhosis. Compared with the general population, NAFLD increases the risk of liverrelated, cardiovascular and all-cause mortality. NAFLD is bidirectionally associated with metabolic syndrome. NAFLD increases the risk and contributes to aggravation of the pathophysiology of atherosclerosis, cardiovascular diseases, diabetes mellitus, and chronic kidney disease. In addition, NAFLD is linked to colorectal polyps, polycystic ovarian syndrome, osteoporosis, obstructive sleep apnea, stroke, and various extrahepatic malignancies. Extended resection of steatotic liver is associated with increased risk of liver failure and mortality. There is an increasing trend of NAFLDrelated cirrhosis requiring liver transplantation, and the recurrence of NAFLD in such patients is almost universal. This review discusses the growing burden of NAFLD, its outcomes, and adverse associations with various diseases. Citation of this article: Kumar R, Priyadarshi RN, Anand U. Non-alcoholic fatty liver disease: Growing burden, adverse outcomes and associations. Global burden and rising prevalenceAccording to current estimate, the global prevalence of NAFLD among the general population may be as high as one billion. 2 In a recent meta-analysis of 86 studies, 76

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Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: systematic review and meta-analysis

Abstract: The prevalence of NAFLD is increased in women with PCOS and the presence of NAFLD is associated with high serum androgen levels, in addition to obesity and insulin resistance.

Cited by 125 publications

References 55 publications

Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Endogenous sex hormones and risk of venous thromboembolism in young women

Non-alcoholic Fatty Liver Disease: Growing Burden, Adverse Outcomes and Associations

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