Hum. Reprod. Advance Access published online on November 3, 2009
Human Reproduction, doi:10.1093/humrep/dep380
Increased androgen bioavailability is associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome
1 Department of Endocrinology, Diabetes and Metabolism, ‘Amalia Fleming’ General Hospital, 14, 25th Martiou Street, Melissia, Athens 15127, Greece 2 Department of Radiology, ‘Amalia Fleming’ General Hospital, Athens 15127, Greece 3 Department of Endocrinology, Diabetes and Metabolism ‘Red Cross Hospital’, Athens, Greece 4 Department of Gastroenterology, ‘Amalia Fleming’ General Hospital, Athens 15127, Greece
5 Correspondence address. Fax: +30-210-8047656; E-mail: niadas{at}hol.gr
BACKGROUND: Increased prevalence of abnormal aminotransferase levels and/or ultrasonographic evidence of hepatic steatosis (HS) have been found in women with polycystic ovary syndrome (PCOS). However, factors associated with non-alcoholic fatty liver disease (NAFLD) in PCOS are still under investigation. The aim of this case–control study was to investigate the presence of NAFLD and to assess factors associated with this condition in PCOS patients.
METHODS: A prospective study of 57 premenopausal PCOS patients and 60 age- and weight-matched control women, with a history of no or minimal alcohol consumption was conducted. Anthropometric variables, biochemical and hormonal parameters were determined and NAFLD was evaluated by abdominal ultrasonography and biochemical testing, after excluding causes of secondary liver disease. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and free androgen index (FAI) was calculated.
RESULTS: PCOS patients had an increased prevalence of HS [21/57 patients (36.8%) versus 12/60 controls (20.0%), P < 0.05] and abnormal (
40 IU/l) serum aminotransferase levels [13/57 patients (22.8%) versus 2/60 controls (3.3%), P < 0.01] than controls. All patients and controls with metabolic syndrome had HS. Factors associated with HS were PCOS diagnosis, older age, increased BMI, waist circumference (WC), HOMA-IR and FAI values and decreased high-density lipid cholesterol and sex hormone binding globulin levels. PCOS patients had an OR of 3.55 (95% CI: 1.02–5.35) for HS versus controls, after adjustment for age, BMI and WC.
CONCLUSIONS: NAFLD is common in PCOS patients and increased androgen bioavailability may be implicated, in combination with metabolic abnormalities. Liver evaluation is proposed in PCOS patients, especially in those with metabolic syndrome.
Key words: non-alcoholic fatty liver disease/polycystic ovary syndrome/hyperandrogenism/FAI/SHBG
Submitted on July 13, 2009; resubmitted on October 5, 2009; accepted on October 6, 2009.