Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance (IR), early diabetes, hypertension and dyslipidemia. Recent studies have demonstrated an association between PCOS and another metabolic complication: nonalcoholic fatty liver disease (NAFLD). NAFLD occurs as a result of abnormal lipid handling by the liver, which sensitizes the liver to injury and inflammation. It can progress to nonalcoholic steatohepatitis (NASH), which is characterized by hepatocyte injury and apoptosis. With time and further inflammation, NASH can progress to cirrhosis. Thus, given the young age at which NAFLD may occur in PCOS, these women may be at significant risk for progressive hepatic injury over the course of their lives. Many potential links between PCOS and NAFLD have been proposed, most notably IR and hyperandrogenemia. Further studies are needed to clarify the association between PCOS and NAFLD. In the interim, clinicians should be aware of this connection and consider screening for NAFLD in PCOS patients who have other metabolic risk factors. The optimal method of screening is unknown. However, measuring alanine aminotransferase and/or obtaining ultrasound on high-risk patients can be considered. First line treatment consists of lifestyle interventions and weight loss, with possible pharmacologic interventions in some cases.

Keywords: Polycystic ovary syndrome, Fatty liver, Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis

Core tip: Nonalcoholic fatty liver disease (NAFLD) is a relatively common condition that can progress to nonalcoholic steatohepatitis (NASH) and even cirrhosis. Polycystic ovary syndrome (PCOS) has recently been recognized as a potential risk factor for NAFLD/NASH. Although screening for NAFLD is problematic, clinicians need to be aware that some patients with PCOS may develop significant liver disease, and at a much younger age than is typical. Identifying PCOS patients at risk for NAFLD, and early intervention in these patients, is needed to help prevent long term and serious complications of fatty liver.