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Nonalcoholic Steatohepatitis and Nonalcoholic Fatty Liver Disease in Young Women with Polycystic Ovary Syndrome

Department of Medicine (T.L.S., L.L.S., K.C.P., A.M.D., A.J.B.), Division of Endocrinology (T.L.S., K.C.P., A.J.B.), and Division of Gastroenterology (A.M.D.), Duke University Medical Center, Durham, North Carolina 27710; and Duke University (N.D.H.), Durham, North Carolina 27710

Address all correspondence and requests for reprints to: Tracy L. Setji, M.D., Department of Medicine, Division of Endocrinology, Duke University Medical Center, Box 3611, Durham, North Carolina 27710. E-mail: setji001{at}mc.duke.edu.

Context: Nonalcoholic fatty liver disease and polycystic ovary syndrome (PCOS) are both associated with insulin resistance. Thus, women with PCOS may have an increased prevalence of nonalcoholic fatty liver disease, including nonalcoholic steatohepatitis (NASH).

Objective: The objective of the study was to determine the prevalence and characteristics of NASH and abnormal aminotransferase activity in women with PCOS.

Design: The study is a retrospective chart review.

Setting: The setting is an academic endocrinology clinic.

Patients: Patients were 200 women with PCOS, defined as irregular menses and hyperandrogenism.

Main Outcome Measures: Biopsy-documented NASH and aminotransferase levels were the main outcome measures.

Results: Fifteen percent (29 of 200) had aspartate aminotransferase and/or alanine aminotransferase more than 60 U/liter. Women with aminotransferase elevations had lower high-density lipoprotein (HDL) (41 vs. 50 mg/dl, P = 0.006), higher triglycerides (174 vs. 129 mg/dl, P = 0.024), and higher fasting insulin (21 vs. 12 µIU/ml, P = 0.036) compared with women with normal aminotransferases. Six women (mean age 29 yr) with persistent aminotransferase elevations underwent liver biopsy. All six had NASH with fibrosis. Compared with the 194 of 200 PCOS women who did not undergo biopsy, women with biopsy-documented NASH had lower HDL (median 34 vs. 50 mg/dl, P < 0.001), and higher triglycerides (245 vs. 132 mg/dl, P = 0.025), fasting insulin (26 vs. 13 µIU/ml, P = 0.038), aspartate aminotransferase (144 vs. 22 U/liter, P < 0.001), and alanine aminotransferase (143 vs. 28 U/liter, P < 0.001).

Conclusion: Abnormal aminotransferase activity is common in women with PCOS. Low HDL, high triglycerides, and high fasting insulin were associated with abnormal aminotransferase activity. Some women already had evidence of NASH with fibrosis. Further studies are needed to evaluate whether to screen PCOS women for liver disease at an earlier age than is currently recommended for the general population.

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