Original article
Prevalence of Nonalcoholic Fatty Liver Disease in Women With Polycystic Ovary Syndrome

Presented in part at the Annual Meeting of the Endocrine Society ENDO 2005, San Diego, CA, June 5, 2005 (abstract P2-365).
https://doi.org/10.1016/j.cgh.2006.10.010Get rights and content

Background & Aims: Insulin resistance has been implicated in the pathogenesis of both nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS). We hypothesized that NAFLD would be common in both obese and nonobese women with PCOS. The aim of this study was to estimate the prevalence of and identify associated factors for hepatic steatosis in women with PCOS. Methods: This is a retrospective study of 88 consecutive premenopausal women with PCOS. Clinical history, height, weight, and laboratory values were obtained. Fasting measurements of serum glucose and insulin were used to calculate homeostasis model assessment of insulin resistance (HOMA-IR). Abdominal ultrasonography was used to determine the presence and severity of hepatic steatosis. Results: Of the 88 women (median age, 31.4 years), 48 (55%) had steatosis; 15 (39%) of them were lean women. The presence of steatosis was associated with a greater body mass index (BMI) (P = .005) and HOMA-IR (P = .033), a lower fasting high-density lipoprotein (P = .003), and a greater prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus (P = .013). Only 7 (15%) subjects with hepatic steatosis had abnormal liver chemistries. Conclusions: Fatty liver was identified in 55% of subjects with PCOS, nearly 40% of whom were lean women. High BMI and insulin resistance appeared to be important associated factors. Early recognition of NAFLD in this group of young patients is warranted, and further investigation including liver biopsy might be indicated.

Section snippets

Methods

Medical records of reproductive-age women consecutively seen between April and November 2004 in a single endocrinology practice in New York City with expertise in the evaluation and management of PCOS were retrospectively reviewed. Women were included in the study population if they were 18 years of age or older at the time of the initial evaluation and met the consensus diagnostic criteria for PCOS from the 1990 National Institutes of Health conference in Bethesda, Maryland25: (1) menstrual

Results

Eighty-eight women were identified who fit our inclusion criteria. Demographic and clinical data of the study population are reported in Table 1. Forty-three percent of the study population was found to be lean, 15% overweight, and 42% obese by BMI criteria. The overall prevalence of hepatic steatosis (mild, moderate, or severe) as assessed by abdominal ultrasonography was 55% (48/88 subjects). The presence of steatosis was associated with a greater median BMI (31.1 vs 24.3 kg/m2, P = .009).

Discussion

NAFLD describes a clinicopathologic condition that is characterized by significant lipid deposition in the hepatocytes of the liver parenchyma in patients with no history of excessive alcohol consumption. The pathologic features of NAFLD range from simple hepatic steatosis (fatty liver) at the most clinically benign end of the spectrum to cirrhosis at the opposite extreme.

NASH is believed to be an intermediate stage of liver damage and is characterized by hepatic steatosis plus liver cell

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