Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2020; 26(44): 7046-7060
Published online Nov 28, 2020. doi: 10.3748/wjg.v26.i44.7046
Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome
Mohamed Shengir, Srinivasan Krishnamurthy, Peter Ghali, Marc Deschenes, Philip Wong, Tianyan Chen, Giada Sebastiani
Mohamed Shengir, Department of Experimental Medicine, McGill University, Montreal H4A3J1, Canada
Srinivasan Krishnamurthy, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal H4A3J1, Canada
Peter Ghali, Marc Deschenes, Philip Wong, Tianyan Chen, Giada Sebastiani, Department of Medicine, McGill University Health Centre, Montreal H4A3J1, Canada
Author contributions: Shengir M contributed to conception, study design, data, interpretation of the data; Krishnamurthy S and Chen T contributed to study design, data, interpretation of the data; Ghali P, Deschenes M and Wong P contributed to data and interpretation of data; Sebastiani G contributed to conception, study design, data and interpretation of the data, statistical analysis and first draft of the manuscript; all approved the final manuscript.
Supported by Libyan Ministry of Higher Education and Scientific Research sponsored through Canadian Bureau for International Education, No. 2979.
Institutional review board statement: The study was approved by the Research Ethics Board of the Research Institute of the MUHC (study code 2019-4584).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Ghali P has acted as consultant for Merck and Gilead. Deschenes M has served as an advisory board member for Merck, Janssen, Gilead; Wong P has acted as consultant for BMS, Gilead, Merck, Novartis; Sebastiani G has acted as speaker for Merck, Gilead, Abbvie, Novonordisk, Novartis, Pfizer, served as an advisory board member for Merck, Intercept, Novartis, Gilead, Allergan and has received research funding from Merck and Theratec Inc. Shengir M, Krishnamurthy S and Chen T have no conflicts of interest to declare.
Data sharing statement: According to stipulations of the patient consent form signed by all study participants, ethical restrictions imposed by our Institutional Ethics review boards (Institutional Ethics Review Board Biomedical B Research Ethics Board of the McGill University Health Centre), and legal restrictions imposed by Canadian law regarding clinical trials, anonymized data are available upon reasonable request. Please send data access requests to Sheldon Levy, Biomedical B (BMB) Research Ethics Board (REB) Coordinator Centre for Applied Ethics, 5100, boul. de Maisonneuve Ouest, 5th floor, Office 576, Montréal, Québec, H4A 3T2, Canada.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giada Sebastiani, MD, Associate Professor, Department of Medicine, McGill University Health Centre, 1001 Blvd. Decarie, Montreal H4A3J1, Canada. giada.sebastiani@mcgill.ca
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: October 17, 2020
Revised: October 30, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: November 28, 2020
Processing time: 67 Days and 22.5 Hours
Abstract
BACKGROUND

Polycystic ovary disease (PCOS) may be a risk factor for nonalcoholic fatty liver disease (NAFLD) due to common pathogenetic pathways, including insulin resistance and obesity. Both PCOS and NAFLD are more severe in South Asian women. Data on NAFLD in South Asian women with PCOS are lacking.

AIM

To investigate prevalence and predictors of NAFLD and liver fibrosis in PCOS patients from South Asia.

METHODS

We conducted an observational routine screening program by means of transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD was defined as CAP ≥ 288 decibels per meter. Significant liver fibrosis (stage 2 and higher out of 4) was defined as TE measurement ≥ 8.0 kilopascals. Elevated alanine aminotransferase (ALT) was defined as ALT > 24 IU/L, as per upper limit of normal reported in South Asian women. Biochemical hyperandrogenism was defined as free androgen index > 5. Predictors of NAFLD were determined by logistic regression analysis.

RESULTS

101 PCOS patients (mean age 36.3 years) with no significant alcohol intake or viral hepatitis were included. Prevalence of NAFLD and significant liver fibrosis was 39.6% and 6.9%, respectively. Elevated ALT was observed in 40% and 11.5% of patients with and without NAFLD, respectively. After adjusting for duration of PCOS and insulin resistance measured by homeostasis model for assessment of insulin resistance, independent predictors of NAFLD were higher body mass index [adjusted odds ratio (aOR) 1.30, 95% confidence interval (CI): 1.13-1.52], hyperandrogenism (aOR: 5.32, 95%CI: 1.56-18.17) and elevated ALT (aOR: 3.54, 95%CI: 1.10-11.47). Lifetime cardiovascular risk was higher in patients with NAFLD compared to those without NAFLD (0.31 ± 0.11 vs 0.26 ± 0.13).

CONCLUSION

Despite their young age, NAFLD diagnosed by TE with CAP is a frequent comorbidity in South Asian women with PCOS and is strongly associated with higher body mass index and hyperandrogenism. Non-invasive screening strategies could help early diagnosis and initiation of interventions, including counselling on weight loss, cardiovascular risk stratification and linkage to hepatology care where appropriate.

Keywords: Body mass index; Transient elastography; Controlled attenuation parameter; Hyperadrogenism; Alanine aminotransferase; Lifetime cardiovascular risk

Core Tip: This is the first cohort study using transient elastography with controlled association parameter to investigate nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Despite their young age, South Asian women with polycystic ovary disease have high frequency of nonalcoholic fatty liver disease at 39.6%, which could also result in liver fibrosis. Non-invasive screening strategies could help early diagnosis and initiation of interventions, including weight loss, correction of dyslipidemia and cardiovascular risk stratification to initiate statin.