Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. A meta-analysis has confirmed decreased serum 25-hydroxyvitamin D levels in NAFLD patients. This intervention study investigates whether vitamin D correction ameliorates hepatic steatosis. Methods: We prospectively recruited 40 patients from an outpatient liver clinic with vitamin D deficiency (serum 25-hydroxyvitamin D < 20 ng/ml). Controlled attenuation parameter (CAP) during transient elastography quantified hepatic steatosis. Patients with significant liver fat accumulation were included, which was defined by a CAP value ≥ 280 dB/m. Patients received 20,000 IU vitamin D/week for six months, while vitamin D status, liver function tests (LFTs), CAP and body composition were monitored. Results: The cohort comprised 47.5% women (age 54.9 ± 12.1 years; BMI 29.5 ± 3.0 kg/m2). Mean serum vitamin D level was 11.8 ± 4.8 ng/ml. CAP decreased significantly from baseline (330 ± 32 vs. 307 ± 41 dB/m) during supplementation (P = 0.007). A mean CAP reduction relative to baseline was demonstrated at four weeks and three and six months: -5.3 ± 13.8%; -6.0 ± 14.6% and -6.4 ± 13.0%, respectively. During these time points, restoration of serum vitamin D levels was observed (34.6 ± 12.9, 36.3 ± 10.2, 34.8 ± 9.8 ng/ml; P < 0.0001). Liver function tests and body composition remained unchanged. Conclusions: Hepatic steatosis, as assessed by CAP, significantly improves after only 4 weeks of vitamin D correction. Hepatic steatosis is a dynamic process, that can be monitored in the short-term using such non-invasive methods. Abbreviations: ALT: alanine aminotransferase; ANOVA: analysis of variance; AP: alkaline phosphatase; AST: aspartate aminotransferase; CAP: controlled attenuation parameter; CRP: C-reactive protein; FFA: free fatty acids; γ-GT: gamma-glutamyl transpeptidase; ITT: intention-to-treat; LFT: liver function test; LSM: liver stiffness measurement; NAFLD: non-alcoholic fatty liver disease; PPAR-γ: peroxisome proliferator-activated receptor gamma; PP: per protocol; PTH: parathyroid hormone; VDR: vitamin D receptor

Background & Aims: Fatty liver disease (FLD) is common in women with polycystic ovary syndrome (PCOS). Here, we use non-invasive tests to quantify liver injury in women with PCOS and analyse whether FLD-associated genetic variants contribute to liver phenotypes in PCOS.Methods: Prospectively, we recruited women with PCOS and controls at two university centres in Germany and Poland. Alcohol abuse was regarded as an exclusion criterion. Genotyping of variants associated with FLD was performed using TaqMan How to cite this article: Smyk W, Papapostoli I, Żorniak M, et al. Liver phenotypes in PCOS: Analysis of exogenous and inherited risk factors for liver injury in two European cohorts.

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