Obesity and nonalcoholic fatty liver disease in women with PCOS

Posted February 2, 2021

A study conducted by INCT Hormona group of Universidade Federal de Minas Gerais (UFMG) investigated the association between obesity and prevalence of nonalcoholic fatty liver disease (NAFLD), as well as its consequences (liver cirrhosis and hepatocellular carcinoma), in patients with Polycystic Ovary Syndrome (PCOS) treated in the Hyperandrogenism Outpatient Clinic at Hospital das Clínicas of UFMG.

The study entitled “Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center” aimed to investigate the prevalence and risk factors associated with NAFLD in women with PCOS. The investigation also evaluated non-invasive methods to detect fibrosis in patients diagnosed with both diseases.

According to the professor and researcher Dr. Ana Lúcia Cândido, member of the group, the presence of liver fibrosis is one of the main prognostic factors, and its degree of severity is associated with the risk of developing cirrhosis and hepatocellular carcinoma. “Identifying patients with more advanced fibrosis is essential in the management of these patients, and the gold standard for its diagnosis is liver biopsy, but it is an invasive method, with technical difficulties and high cost”, she comments. “Therefore, non-invasive methods have been applied, such as FIB-4 and NAFLD fibrosis scores, which use data like blood platelet count, glucose dosage, liver enzymes, and albumin, in addition to age and body mass index”, she explains. “They are low cost non-invasive methods that are useful in clinical practice to rule out the presence of end-stage liver fibrosis in patients with nonalcoholic fatty liver disease”, the specialist states.

According to the research, the study was conducted after the observed a prevalence of obesity among the patients treated in the outpatient clinic (86.7%), although they were of reproductive age and were often referred to the clinic due to infertility.

Dr. Cândido told that the research was conducted with 87 patients with PCOS and other 40 without the syndrome (control) treated at the Outpatient Clinic. The collected data showed that nonalcoholic fatty liver disease was present in 77% of patients, and they had higher levels of body mass index (BMI), waist circumference, triglycerides, total cholesterol, aminotransferases, and γ-glutamyltransferase (GGT) compared with their NAFLD-free counterparts, as well as evidence of insulin resistance.

 “Insulin resistance diagnosed by lipid accumulation product (LAP) was associated with NAFLD in this study, which further strengthens the use of this index by our group,” the specialist explains. “The assessed non-invasive methods (FIB-4 index, NAFLD fibrosis scores and elastography/TE- FibroScan) suggest low rates of severe liver fibrosis in these patients,” she adds.

The study concluded that central obesity and triglyceride levels were identified as independent factors associated with liver steatosis. “Thus, patients diagnosed with PCOS presenting with central adiposity and increased triglyceride levels should be actively screened for NAFLD,” the researcher reaffirms. “These findings, especially those suggesting low incidence of liver fibrosis, further reinforce the need to conduct active interventions with these patients, in an early and preventive manner, focusing on health reeducation, psychotherapeutic support, and adoption of healthy lifestyle measures, especially sustained weight loss for most of the patients, associated with regular aerobic physical activity”, she concludes.