Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

doi:10.3748/wjg.v26.i44.7046

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Nov 28, 2020; 26(44): 7046-7060
Published online Nov 28, 2020. doi: 10.3748/wjg.v26.i44.7046

Table 1 Demographic, clinical, biochemical, and pharmacological characteristics of the study population (n = 101) and univariate analyses by outcome status, that is presence of nonalcoholic fatty liver disease

Variable	Total cohort (n = 101)	NAFLD (n = 40)	No NAFLD (n = 61)
Age (yr)	36.3 (4.8)	36.1 (5.6)	36.4 (4.3)
PCOS duration (yr)	7.0 (4.1)	7.4 (4.4)	6.8 (3.9)
Regular physical exercise (%)	20 (19.8)	8 (20.0)	12 (19.7)
ASCVD risk (lifetime)	0.28 (0.12)	0.31 (0.11)^a	0.26 (0.13)^a
Metabolic factors
Diabetes (%)	18 (17.8)	12 (30.0)^a	6 (9.8)^a
Hypertension (%)	6 (5.9)	1 (2.5)	5 (8.2)
Waist circumference (cm)	101.1 (12.3)	107.8 (11.1)^b	96.7 (11.1)^b
BMI (Kg/m²)	27.6 (5.0)	30.6 (4.5)^b	25.7 (4.4)^b
Medications
Metformin (%)	32 (31.7)	20 (50.0)^a	12 (19.7)^a
Steroids contraceptive (%)	5 (4.9)	2 (5.0)	3 (4.9)
Statin (%)	5 (4.9)	5 (12.5)	0
Biochemical parameters
Platelet count (10⁹/L)	271.9 (59.5)	271.9 (54.7)	271.9 (62.9)
AST (IU/L)	18.6 (11.8)	23.5 (17.2)^b	15.3 (3.9)^b
ALT (IU/L)	21.7 (18.7)	30.9 (25.7)^b	15.7 (8.0)^b
GGT (IU/L)	21.4 (19.1)	24.8 (16.8)	19.3 (20.4)
Total bilirubin (µmol/L)	9 (2.9)	9.8 (3.6)^a	8.5 (2.2)^a
Albumin (mg/L)	43.0 (2.9)	42.9 (3.0)	43.0 (2.8)
HOMA-IR	3.2 (2.9)	4.5 (3.3)^b	2.4 (2.2)^b
HbA1c (%)	6.4 (1.8)	6.9 (2.1)^b	5.6 (0.6)^b
Total cholesterol (mmol/L)	4.5 (1.0)	4.5 (1.0)	4.5 (0.9)
HDL cholesterol (mmol/L)	1.1 (0.3)	1.1 (0.3)^a	1.2 (0.3)^a
LDL cholesterol (mmol/L)	2.7 (0.8)	2.6 (0.9)	2.7 (0.7)
Triglycerides (mmol/L)	1.5 (1.2)	1.8 (1.0)	1.4 (1.3)
Creatinine (mmol/L)	56.8 (10.1)	55.2 (8.9)	57.9 (10.8)
TSH	2.6 (2.7)	2.6 (2.5)	2.5 (2.8)
Total testosterone (nmol/L)	1.6 (0.7)	1.8 (0.8)	1.6 (0.6)
SHBG (nmol/L)	32.2 (20.6)	22.4 (9.7)^b	39.1 (23.3)^b
FAI	3.6 (3.7)	5.4 (4.6)^b	2.4 (2.1)^b
CRP (mg/L)	5.3 (4.9)	6.9 (6.2)^a	4.3 (3.5)^a
Non-invasive tests for NAFLD and liver fibrosis
CAP (dB/m)	266.9 (63.0)	326.9 (30.5)	227.5 (45.1)
LSM (kPa)	4.9 (1.9)	5.7 (2.2)^b	4.4 (1.4)^b
APRI	0.18 (0.15)	0.23 (0.21)^a	0.15 (0.07)^a
FIB-4	0.6 (0.2)	0.60 (0.3)	0.6 (0.2)
NAFLD Fibrosis Score	-2.9 (1.2)	-2.5 (1.3)^a	-3.1 (1.1)^a
HSI	38.3 (5.7)	40.8 (6.7)^b	36.6 (4.2)^b

Continuous variables are expressed as mean (standard deviation) and categorical variables as numbers (%).

^aP < 0.05.

^bP < 0.001.

The P values refer to t test or χ² test between patients with the outcome (nonalcoholic fatty liver disease or significant liver fibrosis) and those without the outcome. ALT: Alanine aminotransferase; APRI: Aspartate aminotransferase-to-platelet ratio index; ASCVD: Atherosclerotic cardiovascular disease; AST: Aspartate aminotransferase; BMI: Body mass index; dB/m: Decibels per meter; CAP: Controlled association parameter; CRP: C-reactive protein; FAI: Free androgen index; FIB-4: Fibrosis-4 score; GGT: Gamma-glutamyl transpeptidase; HbA1c: Glycosylated hemoglobin; HDL: High-density lipoprotein; HOMA-IR: Homeostasis model for assessment of insulin resistance; HSI: Hepatic steatosis index; IU: International unit; LDL: Low-density lipoprotein; LSM: Liver stiffness measurement; NAFLD: Nonalcoholic fatty liver disease; TSH: Thyroid-stimulating hormone.

Table 2 Demographic, clinical and biochemical characteristics of patients with significant liver fibrosis (n = 7)

	PCOS duration (yr)	HOMA-IR	BMI (Kg/m²)	ALT (IU/L)	Triglycerides (mmol/L)	FAI	CAP (dB/m)
Patient 1	10	3.2	31.8	62	0.93	3.1	317
Patient 2	4	1.4	26.2	12	0.91	3.0	186
Patient 3	6	10.9	30.1	88	1.36	5.9	372
Patient 4	13	2.8	28.2	20	0.91	6.3	298
Patient 5	6	5.9	31.2	78	1.66	8.0	346
Patient 6	8	7.9	36.4	101	1.37	3.1	386
Patient 7	13	5.6	20.2	31	2.4	13.9	325

ALT: Alanine aminotransferase; BMI: Body mass index; dB/m: Decibels per meter; CAP: Controlled association parameter; FAI: Free androgen index; HOMA-IR: Homeostasis model for assessment of insulin resistance; PCOS: Polycystic ovary syndrome.

Table 3 Multivariate analysis of factors associated with nonalcoholic fatty liver disease

CAP cut-off 288 dB/m
Variable	Unadjusted OR	aOR
PCOS duration (per yr)	1.03 (0.94-1.14)	1.04 (0.92-1.17)
BMI (per Kg/m²)	1.31 (1.16-1.48)^b	1.31 (1.13-1.52)^b
HOMA-IR (per unit)	1.42 (1.14-1.78)^a	1.13 (0.90-1.41)
Hyperandrogenism (yes vs no)	3.68 (1.37-9.83)^a	5.32 (1.56-18.17)^a
Elevated ALT (yes vs no)	5.14 (1.87-14.12)^a	3.54 (1.10-11.47)^a
CAP cut-off 302 dB/m
Variable	Unadjusted OR	aOR
PCOS duration (per yr)	0.81 (0.33-2.00)	0.94 (0.83-1.07)
BMI (per Kg/m²)	1.12 (1.06-1.18)^b	1.33 (1.14-1.55)^b
HOMA-IR (per unit)	1.39 (1.14-1.70)^a	1.18 (0.95-1.46)
Hyperandrogenism (yes vs no)	1.28 (1.10-1.48)^a	3.54 (1.00-12.57)^a
Elevated ALT (yes vs no)	1.93 (1.32-2.84)^a	2.55 (0.80-8.14)

Odds ratios and 95% confidence intervals are shown for each variable analyzed in univariate and multivariate logistic regression analysis.

^aP < 0.05.

^bP < 0.001.

CAP: Controlled attenuation parameter; FAI: Free androgen index; HOMA-IR: Homeostasis model for assessment of insulin resistance; IU: International unit; aOR: Adjusted odds ratio; NAFLD: Nonalcoholic fatty liver disease; PCOS: Polycystic ovary syndrome.

Citation: Shengir M, Krishnamurthy S, Ghali P, Deschenes M, Wong P, Chen T, Sebastiani G. Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome. World J Gastroenterol 2020; 26(44): 7046-7060
URL: https://www.wjgnet.com/1007-9327/full/v26/i44/7046.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i44.7046