Relationship between nonalcoholic fatty liver disease and hyperandrogenemia in adolescents with polycystic ovary syndrome

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is common in adults with polycystic ovary syndrome (PCOS), and several studies on adults have investigated its influencing factors. However, factors associated with NAFLD in adolescents with PCOS remain unknown.Purpose: This study aimed to investigate the presence of NAFLD in adolescents with PCOS using the noninvasive methods of vibration-controlled transient elastography (VCTE) and ultrasonography (USG), along with assessing NAFLD-related metabolic and hormonal risk factors.Methods: This study included patients aged 12–18 years who were diagnosed with PCOS according to the Rotterdam criteria. The control group included young women with similar age and body mass index (BMI) z scores, who had menstruated regularly for more than 2 years. Patients with PCOS were divided into hyperandrogenemia and nonhyperandrogenemia groups based on serum androgen level. USG was performed on all patients to evaluate the presence of hepatic steatosis. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed using VCTE (Fibroscan). Clinical, laboratory, and radiological data were compared between groups.Results: This study included 124 adolescent girls aged 12–18 years (61 with PCOS, 63 controls). BMI z scores were similar between groups. Waist circumference and total cholesterol, triglyceride, and alanine aminotransferase levels were higher in the PCOS versus the control group. The presence of hepatic steatosis on USG was similar between groups. However, the rate of hepatic steatosis on USG was higher in patients with hyperandrogenic PCOS (P=0.01). LSM and CAP measurements were similar between groups.Conclusion: No increase in prevalence of NAFLD was observed among adolescents with PCOS. However, hyperandrogenemia is a risk factor for NAFLD. Therefore, adolescents with PCOS and elevated androgen level should be screened for NAFLD.

Visceral Adipose Tissue, Epicardial Fat, and Hepatic Steatosis in Polycystic Ovary Syndrome: A Study of Ectopic Fat Stores and Metabolic Dysfunction

“…PCOS and NAFLD share similar clinical presentations, including central obesity and metabolic abnormality [39,40], and a well-known association between NAFLD and IR in PCOS has been described by numerous authors [9,10,41]. Nevertheless, consistent with our ndings, Tantanavipas et al [42], after multivariate logistic regression, reported that the association between NAFLD and IR in PCOS did not persist and suggested that hyperandrogenism, rather than IR, plays a pivotal role in the onset of hepatic fat deposition in PCOS, as previously reported by other studies [10,37,43]. Such an association between NAFLD and androgens was corroborated by a meta-analysis of 17 studies, which revealed that only hyperandrogenic PCOS patients had a signi cantly higher risk of NAFLD than the controls (OR = 3.31, 95% CI = 2.58-4.24), leading to the conclusion that NAFLD screening should be warranted for PCOS patients only in the presence of hyperandrogenism [44].…”

“…Supported by some studies on PCOS, we found a higher prevalence of hepatic steatosis in the PCOS group [36,37] and a positive association between TE-CAP values and triglyceride levels [36, 38], although such a correlation was borderline in our study. PCOS and NAFLD share similar clinical presentations, including central obesity and metabolic abnormality [39,40], and a well-known association between NAFLD and IR in PCOS has been described by numerous authors [9,10,41].…”

Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort

“…The prevalence of NAFLD has been reported to be either not different or higher in prevalence in adolescent and adult individuals with PCOS, and it has been associated with higher rates of obesity, insulin-resistance, hypertriglyceridemia, and hyperandrogenemia indices. 103 , 104 , 105 , 106 , 107 NAFLD also is associated with an increased transition and incidence of type 2 diabetes in the general population and in those with PCOS. 108 The 4.27% prevalence of NAFLD in those with PCOS in our results is very low compared to findings in other population cohort studies, which show a 40%-50% prevalence in those with PCOS.…”