SAN FRANCISCO – Nonalcoholic fatty liver disease is common in adolescent girls with polycystic ovaries, and its presence coincides with worse metabolic derangements, according to Australian researchers.
Because of that, it makes sense when doing an ultrasound study of women with polycystic ovary syndrome (PCOS) to check the liver, as well, for signs of nonalcoholic fatty liver disease (NAFLD), including increased echogenicity and bile duct or blood vessel blurring, said lead investigator Dr. Oyekoya Ayonrinde.
"If we see a girl or woman who has PCOS, we should look for the presence of fatty liver. It just adds maybe another 5 or 10 minutes to the [ultrasound] study," said Dr. Ayonrinde at the annual meeting of the American Association for the Study of Liver Diseases.
That’s important because PCOS, and perhaps even more so when combined with NAFLD, predisposes women to diabetes and cardiovascular disease, among other problems. The combination might also increase the risk of nonalcoholic steatohepatitis.
Dr. Ayonrinde, a clinical gastroenterology lecturer at the University of Western Australia in Perth, and his colleagues came to their conclusions after analyzing 244 girls aged 14-17 years in the Western Australian Pregnancy Cohort (Raine) Study, plus 578 girls and 592 boys, all 17 years old, in a separate NAFLD study. In all, 201 girls had both ovarian and liver ultrasounds, which were used to diagnose both PCOS and NAFLD.
In all, 43% of the girls with PCOS had concomitant NAFLD.
The researchers also found that suprailiac skinfold thickness (odds ratio, 1.16; 95% CI, 1.08-1.24; P less than .001) and the presence of PCOS (OR 3.87; 95% CI, 1.09-13.76; P = .04) were independent predictors of NAFLD in the Raine cohort; free testosterone levels were not predictors after obesity was controlled for.
Obesity in girls with PCOS coincided with a greater prevalence of NAFLD. Girls with both conditions had a mean suprailiac skin fold thickness of 29.6 mm; girls with PCOS alone had a mean thickness of 15.4 mm.
Girls with both conditions, compared to those with PCOS alone, also had higher serum leptin and triglyceride levels, lower serum adiponectin levels, higher body mass indexes, and more subcutaneous fat.
They "approach what we find in boys" with NAFLD, who tend to have more severe disease, Dr. Ayonrinde said.
Boys with NAFLD and girls with PCOS and NAFLD had similar body weights, waist circumferences, waist/hip ratios, body mass indexes, subcutaneous and visceral fat thicknesses, and glucose tolerance test results, as well as similar serum glucose, insulin, triglyceride, cholesterol, and adiponectin levels.
Dr. Ayonrinde said he has no disclosures. Coauthors disclosed research support from Hoffmann-La Roche and Merck – both of whom are developing NAFLD therapies – and other companies.