Nonalcoholic fatty liver disease and polycystic ovary syndrome

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world comprising a spectrum of liver damage from fatty liver infiltration to end-stage liver disease, in patients without significant alcohol consumption. Increased prevalence of NAFLD has been reported in patients with polycystic ovary syndrome (PCOS), one of the most common endocrinopathies in premenopausal women, which has been redefined as a reproductive and metabolic disorder after the recognition of the important role of insulin resistance in the pathophysiology of the syndrome. Obesity, in particular central adiposity and insulin resistance are considered as the main factors related to NAFLD in PCOS. Moreover, existing data support that androgen excess, which is the main feature of PCOS and is interrelated to insulin resistance, may be an additional contributing factor to the development of NAFLD. Although the natural history of NAFLD remains unclear and hepatic steatosis seems to be a relatively benign condition in most patients, limited data imply that advanced stage of liver disease is possibly more frequent in obese PCOS patients with NAFLD. PCOS patients, particularly obese patients with features of the metabolic syndrome, should be submitted to screening for NAFLD comprising assessment of serum aminotransferase levels and of hepatic steatosis by abdominal ultrasound. Lifestyle modifications including diet, weight loss and exercise are the most appropriate initial therapeutic interventions for PCOS patients with NAFLD. When pharmacologic therapy is considered, metformin may be used, although currently there is no medical therapy of proven benefit for NAFLD. Long-term follow up studies are needed to clarify clinical implications and guide appropriate diagnostic evaluation, follow-up protocol and optimal treatment for PCOS patients with NAFLD.

Prenatal hyperandrogenism induces alterations that affect liver lipid metabolism

“…The liver is involved in lipid synthesis, transportation and storage, as well as in glucose and insulin metabolism (Paschos & Paletas 2009), all key factors in PCOS pathogenesis (den Boer et al 2004, Paschos & Paletas 2009, Baranova et al 2011, Vassilatou 2014. One of the most frequent hepatic affections, related to metabolic abnormalities, is nonalcoholic fatty liver disease (NAFLD), which affects 20-30% of the general population (Vassilatou 2014).…”

Increased prevalence of polycystic ovary syndrome in premenopausal women with nonalcoholic fatty liver disease

“…Regarding premenopausal women, NAFLD has been mostly studied in patients with polycystic ovary syndrome (PCOS), and it has been shown that it is more prevalent in these patients (13). PCOS is characterised by hyperandrogenism and ovulatory dysfunction and is one of the most common endocrinopathies in premenopausal women, affecting 6-19% of this population depending on the used diagnostic criteria (14).…”

PCOS and diabetes mellitus: from insulin resistance to altered beta pancreatic function, a link in evolution

“…In clinical practice, obese women with PCOS may develop a chronic inflammatory hepatic condition, also known as non-alcoholic steatohepatitis (NASH), which may vary from 30 to 86% in many case studies. NASH reaches 100% occurrence in those case studies which use both ultrasound screening and laboratory exams as well [4]. The only presence of adipose liver, associated to enlarged waist measurement, identifies these women as phenotypically thin but metabolically fat, even in absence of increased BMI (Table 2).…”