open access

Vol 74, No 5 (2023)
Original paper
Submitted: 2022-12-20
Accepted: 2023-02-25
Published online: 2023-09-27
Get Citation

Association between polycystic ovary syndrome and risk of non-alcoholic fatty liver disease: a meta-analysis

Kui Yao1, Heng Zheng1, Hongling Peng1
·
Pubmed: 37779372
·
Endokrynol Pol 2023;74(5):520-527.
Affiliations
  1. Department of Obstetrics and Gynaecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, Chin

open access

Vol 74, No 5 (2023)
Original Paper
Submitted: 2022-12-20
Accepted: 2023-02-25
Published online: 2023-09-27

Abstract

Introduction: There have been many studies assessing whether abnormal metabolic and hormone levels among women with polycystic ovary syndrome (PCOS) are associated with a greater risk of non-alcoholic fatty liver disease (NAFLD). However, previous studies repported no consistent outcomes. To provide a comprehensive evaluation regarding the role of PCOS in the risk of NAFLD, we updated the published literature and conducted this systemic review and meta-analysis.

Material and methods: Electronic databases (Web of Science and PubMed) were searched for literature up to October 2022. We used STATA 12.0 software to compute odds ratios (ORs) and 95% confidence intervals (CIs), to evaluate the association between PCOS and risk of NAFLD.

Results: The study indicated that PCOS was significantly related to an elevated risk of NAFLD (OR = 2.93, 95% CI 2.38 to 3.62, I2 = 83.7%, p < 0.001). Meta-regression analysis showed that age and body mass index (BMI) were not responsible for heterogeneity across the studies (age: p = 0.096; BMI: p = 0.418). Sensitivity analysis indicated no alteration in the direction of effect when any study was eliminated. Begg’s test, Egger’s test, Begg’s test, and funnel plot indicated a significant risk of publication bias (Egger’s test: p = 0.028; Begg’s test: p < 0.001).

Conclusion: This meta-analysis reported that PCOS was associated with an elevated risk of NAFLD. Early proper detection of NAFLD for PCOS women is essential. All patients with PCOS should undergo appropriate diagnostics for early detection of fatty liver and fibrosis.

Abstract

Introduction: There have been many studies assessing whether abnormal metabolic and hormone levels among women with polycystic ovary syndrome (PCOS) are associated with a greater risk of non-alcoholic fatty liver disease (NAFLD). However, previous studies repported no consistent outcomes. To provide a comprehensive evaluation regarding the role of PCOS in the risk of NAFLD, we updated the published literature and conducted this systemic review and meta-analysis.

Material and methods: Electronic databases (Web of Science and PubMed) were searched for literature up to October 2022. We used STATA 12.0 software to compute odds ratios (ORs) and 95% confidence intervals (CIs), to evaluate the association between PCOS and risk of NAFLD.

Results: The study indicated that PCOS was significantly related to an elevated risk of NAFLD (OR = 2.93, 95% CI 2.38 to 3.62, I2 = 83.7%, p < 0.001). Meta-regression analysis showed that age and body mass index (BMI) were not responsible for heterogeneity across the studies (age: p = 0.096; BMI: p = 0.418). Sensitivity analysis indicated no alteration in the direction of effect when any study was eliminated. Begg’s test, Egger’s test, Begg’s test, and funnel plot indicated a significant risk of publication bias (Egger’s test: p = 0.028; Begg’s test: p < 0.001).

Conclusion: This meta-analysis reported that PCOS was associated with an elevated risk of NAFLD. Early proper detection of NAFLD for PCOS women is essential. All patients with PCOS should undergo appropriate diagnostics for early detection of fatty liver and fibrosis.

Get Citation

Keywords

meta-analysis; non-alcoholic fatty liver disease; polycystic ovary syndrome

Supp./Additional Files (1)
Supplmentary File
Download
903KB
About this article
Title

Association between polycystic ovary syndrome and risk of non-alcoholic fatty liver disease: a meta-analysis

Journal

Endokrynologia Polska

Issue

Vol 74, No 5 (2023)

Article type

Original paper

Pages

520-527

Published online

2023-09-27

Page views

482

Article views/downloads

352

DOI

10.5603/ep.93291

Pubmed

37779372

Bibliographic record

Endokrynol Pol 2023;74(5):520-527.

Keywords

meta-analysis
non-alcoholic fatty liver disease
polycystic ovary syndrome

Authors

Kui Yao
Heng Zheng
Hongling Peng

References (62)
  1. Bozdag G, Mumusoglu S, Zengin D, et al. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016; 31(12): 2841–2855.
  2. Joham AE, Palomba S, Hart R. Polycystic Ovary Syndrome, Obesity, and Pregnancy. Semin Reprod Med. 2016; 34(2): 93–101.
  3. Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020; 30(7): 399–404.
  4. Wekker V, van Dammen L, Koning A, et al. Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis. Hum Reprod Update. 2020; 26(6): 942–960.
  5. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013; 6: 1–13.
  6. Morgante G, Massaro MG, Di Sabatino A, et al. Therapeutic approach for metabolic disorders and infertility in women with PCOS. Gynecol Endocrinol. 2018; 34(1): 4–9.
  7. Zhou J, Zhou F, Wang W, et al. Epidemiological Features of NAFLD From 1999 to 2018 in China. Hepatology. 2020; 71(5): 1851–1864.
  8. Rinella ME, Sanyal AJ. Management of NAFLD: a stage-based approach. Nat Rev Gastroenterol Hepatol. 2016; 13(4): 196–205.
  9. Cobbina E, Akhlaghi F. Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters. Drug Metab Rev. 2017; 49(2): 197–211.
  10. Eslam M, Valenti L, Romeo S. Genetics and epigenetics of NAFLD and NASH: Clinical impact. J Hepatol. 2018; 68(2): 268–279.
  11. DiStefano JK. NAFLD and NASH in Postmenopausal Women: Implications for Diagnosis and Treatment. Endocrinology. 2020; 161(10).
  12. Younossi Z, Anstee QM, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018; 15(1): 11–20.
  13. Friedman SL, Neuschwander-Tetri BA, Rinella M, et al. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018; 24(7): 908–922.
  14. Chakraborty S, Ganie MA, Masoodi I, et al. Shalimar. Fibroscan as a non-invasive predictor of hepatic steatosis in women with polycystic ovary syndrome. Indian J Med Res. 2020; 151(4): 333–341.
  15. Salva-Pastor N, López-Sánchez GN, Chávez-Tapia NC, et al. Polycystic ovary syndrome with feasible equivalence to overweight as a risk factor for non-alcoholic fatty liver disease development and severity in Mexican population. Ann Hepatol. 2020; 19(3): 251–257.
  16. Taranto DO, Guimarães TC, Couto CA, et al. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center. Arch Endocrinol Metab. 2020; 64(3): 235–242.
  17. Tantanavipas S, Vallibhakara O, Sobhonslidsuk A, et al. Abdominal Obesity as a Predictive Factor of Nonalcoholic Fatty Liver Disease Assessed by Ultrasonography and Transient Elastography in Polycystic Ovary Syndrome and Healthy Women. Biomed Res Int. 2019; 2019: 9047324.
  18. Sedgwick P. Meta-analyses: tests of heterogeneity. BMJ. 2012; 344(jun13 2): e3971–e3971.
  19. Cerda C, Pérez-Ayuso RM, Riquelme A, et al. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. J Hepatol. 2007; 47(3): 412–417.
  20. Serpoi G. Fatty Liver Amplifies Testosterone Levels in Patients with Polycystic Ovary Syndrome. Acta Endocrinologica (Bucharest). 2007; 3(3): 277–290.
  21. Gutierrez-Grobe Y, Ponciano-Rodríguez G, Ramos MH, et al. Prevalence of non alcoholic fatty liver disease in premenopausal, posmenopausal and polycystic ovary syndrome women. The role of estrogens. Ann Hepatol. 2010; 9(4): 402–409.
  22. Vassilatou E, Lafoyianni S, Vryonidou A, et al. Increased androgen bioavailability is associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome. Hum Reprod. 2010; 25(1): 212–220.
  23. Hossain N, Stepanova M, Afendy A, et al. Non-alcoholic steatohepatitis (NASH) in patients with polycystic ovarian syndrome (PCOS). Scand J Gastroenterol. 2011; 46(4): 479–484.
  24. Lerchbaum E, Gruber HJ, Schwetz V, et al. Fatty liver index in polycystic ovary syndrome. Eur J Endocrinol. 2011; 165(6): 935–943.
  25. Faisal A, Nasser A, Zyiton AZ, et al. Liver Affection in Polycystic Ovary Syndrome (PCOS). Med J Cairo Univ. 2012; 80(2): 117–122.
  26. Zueff LFN, Martins WP, Vieira CS, et al. Ultrasonographic and laboratory markers of metabolic and cardiovascular disease risk in obese women with polycystic ovary syndrome. Ultrasound Obstet Gynecol. 2012; 39(3): 341–347.
  27. Karoli R, Fatima J, Chandra A, et al. Prevalence of hepatic steatosis in women with polycystic ovary syndrome. J Hum Reprod Sci. 2013; 6(1): 9–14.
  28. Qu Z, Zhu Y, Jiang J, et al. The clinical characteristics and etiological study of nonalcoholic fatty liver disease in Chinese women with PCOS. Iran J Reprod Med. 2013; 11(9): 725–732.
  29. Tarantino G, Valentino R, Di Somma C, et al. Bisphenol A in polycystic ovary syndrome and its association with liver-spleen axis. Clin Endocrinol (Oxf). 2013; 78(3): 447–453.
  30. Kahal H, Abouda G, Rigby AS, et al. Glucagon-like peptide-1 analogue, liraglutide, improves liver fibrosis markers in obese women with polycystic ovary syndrome and nonalcoholic fatty liver disease. Clin Endocrinol (Oxf). 2014; 81(4): 523–528.
  31. Bohdanowicz-Pawlak A, Lenarcik-Kabza A, Brona A, et al. Non-alcoholic fatty liver disease in women with polycystic ovary syndrome - clinical and metabolic aspects and lipoprotein lipase gene polymorphism. Endokrynol Pol. 2014; 65(6): 416–421.
  32. Kuliczkowska Plaksej J, Laczmanski L, Milewicz A, et al. Cannabinoid receptor 1 gene polymorphisms and nonalcoholic Fatty liver disease in women with polycystic ovary syndrome and in healthy controls. Int J Endocrinol. 2014; 2014: 232975.
  33. H SR, V BB, Kudva N, et al. Incidence of non-alkoholic hepatic fatty infiltration in women with polycystic ovary syndrome. J Evid Based Med Healthcare. 2014; 1(8): 867–875.
  34. Çağlar G, Kiseli M, Seker R, et al. Atherogenic dyslipidemia, subclinical atherosclerosis, non-alcoholic fatty liver disease and insulin resistance in polycystic ovarian syndrome. Turk J Biochem. 2015; 40(1): 24–30.
  35. Romanowski MD, Parolin MB, Freitas ACT, et al. Prevalence of non-alcoholic fatty liver disease in women with polycystic ovary syndrome and its correlation with metabolic syndrome. Arq Gastroenterol. 2015; 52(2): 117–123.
  36. Ayonrinde OT, Adams LA, Doherty DA, et al. Adverse metabolic phenotype of adolescent girls with non-alcoholic fatty liver disease plus polycystic ovary syndrome compared with other girls and boys. J Gastroenterol Hepatol. 2016; 31(5): 980–987.
  37. Macut D, Tziomalos K, Božić-Antić I, et al. Non-alcoholic fatty liver disease is associated with insulin resistance and lipid accumulation product in women with polycystic ovary syndrome. Hum Reprod. 2016; 31(6): 1347–1353.
  38. Cai J, Wu CH, Zhang Y, et al. High-free androgen index is associated with increased risk of non-alcoholic fatty liver disease in women with polycystic ovary syndrome, independent of obesity and insulin resistance. Int J Obes (Lond). 2017; 41(9): 1341–1347.
  39. Kim JJ, Kim D, Yim JY, et al. Polycystic ovary syndrome with hyperandrogenism as a risk factor for non-obese non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2017; 45(11): 1403–1412.
  40. Mehrabian F, Jahanmardi R. Nonalcoholic Fatty Liver Disease in a Sample of Iranian Women with Polycystic Ovary Syndrome. Int J Prev Med. 2017; 8: 79.
  41. Petta S, Ciresi A, Bianco J, et al. Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS. PLoS One. 2017; 12(11): e0186136.
  42. Zhang J, Hu J, Zhang C, et al. Analyses of risk factors for polycystic ovary syndrome complicated with non-alcoholic fatty liver disease. Exp Ther Med. 2018; 15(5): 4259–4264.
  43. Vassilatou E, Lafoyianni S, Vassiliadi DA, et al. Visceral adiposity index for the diagnosis of nonalcoholic fatty liver disease in premenopausal women with and without polycystic ovary syndrome. Maturitas. 2018; 116: 1–7.
  44. Asfari MM, Sarmini MT, Baidoun F, et al. Association of non-alcoholic fatty liver disease and polycystic ovarian syndrome. BMJ Open Gastroenterol. 2020; 7(1).
  45. Sarkar M, Terrault N, Chan W, et al. Polycystic ovary syndrome (PCOS) is associated with NASH severity and advanced fibrosis. Liver Int. 2020; 40(2): 355–359.
  46. Kumarendran B, O'Reilly MW, Manolopoulos KN, et al. Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database. PLoS Med. 2018; 15(3): e1002542.
  47. Ramezani-Binabaj M, Motalebi M, Karimi-Sari H, et al. Are women with polycystic ovarian syndrome at a high risk of non-alcoholic Fatty liver disease; a meta-analysis. Hepat Mon. 2014; 14(11): e23235.
  48. Rocha ALL, Faria LC, Guimarães TCM, et al. Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: systematic review and meta-analysis. J Endocrinol Invest. 2017; 40(12): 1279–1288.
  49. Shengir M, Chen T, Guadagno E, et al. Non-alcoholic fatty liver disease in premenopausal women with polycystic ovary syndrome: A systematic review and meta-analysis. JGH Open. 2021; 5(4): 434–445.
  50. Shengir M, Chen T, Guadagno E, et al. Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome. World J Gastroenterol. 2020; 26(44): 7046–7060.
  51. Rosato V, Masarone M, Dallio M, et al. NAFLD and Extra-Hepatic Comorbidities: Current Evidence on a Multi-Organ Metabolic Syndrome. Int J Environ Res Public Health. 2019; 16(18).
  52. Chen MJ, Ho HN. Hepatic manifestations of women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2016; 37: 119–128.
  53. Harsha Varma S, Tirupati S, Pradeep TVS, et al. Insulin resistance and hyperandrogenemia independently predict nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Diabetes Metab Syndr. 2019; 13(2): 1065–1069.
  54. Randeva HS, Tan BK, Weickert MO, et al. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev. 2012; 33(5): 812–841.
  55. Watt MJ, Miotto PM, De Nardo W, et al. The Liver as an Endocrine Organ-Linking NAFLD and Insulin Resistance. Endocr Rev. 2019; 40(5): 1367–1393.
  56. Polyzos SA, Goulis DG, Kountouras J, et al. Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: assessment of non-invasive indices predicting hepatic steatosis and fibrosis. Hormones (Athens). 2014; 13(4): 519–531.
  57. Dai W, Ye L, Liu A, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis. Medicine (Baltimore). 2017; 96(39): e8179.
  58. Tanase DM, Gosav EM, Costea CF, et al. The Intricate Relationship between Type 2 Diabetes Mellitus (T2DM), Insulin Resistance (IR), and Nonalcoholic Fatty Liver Disease (NAFLD). J Diabetes Res. 2020; 2020: 3920196.
  59. Kelley CE, Brown AJ, Diehl AM, et al. Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. World J Gastroenterol. 2014; 20(39): 14172–14184.
  60. Jones H, Sprung VS, Pugh CJA, et al. Polycystic ovary syndrome with hyperandrogenism is characterized by an increased risk of hepatic steatosis compared to nonhyperandrogenic PCOS phenotypes and healthy controls, independent of obesity and insulin resistance. J Clin Endocrinol Metab. 2012; 97(10): 3709–3716.
  61. Marino L, Jornayvaz FR. Endocrine causes of nonalcoholic fatty liver disease. World J Gastroenterol. 2015; 21(39): 11053–11076.
  62. Brunt EM, Wong VWS, Nobili V, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primers. 2015; 1: 15080.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaWydawcą jest  VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl