Prevalence of nonalcoholic fatty liver disease increased with type 2 diabetes mellitus in overweight/obese youth with polycystic ovary syndrome

Namrata Patel-Sanchez; Emily Perito; Patrika Tsai; Marissa Raymond-Flesch; Maya Lodish; Monika Sarkar

doi:10.1515/jpem-2022-0527

Article

Prevalence of nonalcoholic fatty liver disease increased with type 2 diabetes mellitus in overweight/obese youth with polycystic ovary syndrome

Namrata Patel-Sanchez , Emily Perito , Patrika Tsai , Marissa Raymond-Flesch , Maya Lodish and Monika Sarkar

Published/Copyright: April 17, 2023

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 5

Abstract

Objectives

Polycystic ovary syndrome (PCOS) increases non-alcoholic fatty liver disease (NAFLD) risk and severity in adults, but data in adolescents with diverse backgrounds are limited. We evaluated NAFLD prevalence and characterized NAFLD risk factors in overweight/obese adolescents by PCOS status.

Methods

Retrospective study of overweight (n=52)/obese (n=271) female adolescents (12–18 years old), evaluated clinically 2012–2020, was conducted comparing PCOS patients to age-matched non-PCOS controls. NAFLD was defined as ALT≥44U/L x2 and/or ≥80U/L x1, hepatic steatosis on imaging, or NAFLD on biopsy, in absence of other liver disease. Metabolic comorbidities were captured. Log-binomial regression models estimated prevalence risk ratios (PR).

Results

NAFLD prevalence was 19.1 % in adolescents with PCOS (n=161), similar to those without (n=162) (16.8 %, p=0.6). Adolescents with PCOS were more likely to have insulin resistance, hypercholesterolemia, and higher triglycerides (p<0.05). Those with PCOS and concomitant type 2 diabetes (T2DM) did have increased NAFLD risk (PR 2.5, p=0.04), but those with PCOS without T2DM did not (PR 0.9, p=0.8). Adolescents with PCOS and NAFLD, compared to those with PCOS without NAFLD, had a higher prevalence of metabolic comorbidities including hypercholesterolemia (77 vs. 48 %), T2DM (29 vs. 8 %), and hypertriglyceridemia (65 vs. 37 %) (p<0.01).

Conclusions

Almost 1 in 5 overweight/obese female adolescents had NAFLD, but PCOS did not increase NAFLD risk in this diverse cohort. Among young women with PCOS, concomitant T2DM did increase the risk for NAFLD. Closer monitoring of obesity comorbidities in adolescents with PCOS is essential for optimizing health and merits updating current guidelines.

Keywords: NAFLD; non-alcoholic fatty liver disease; PCOS; pediatric NAFLD; polycystic ovary syndrome; type 2 diabetes

Corresponding author: Namrata Patel-Sanchez, MD, MPH, Department of Gastroenterology, University of California, San Francisco, Benioff Children’s Hospital- Oakland, 744 52nd St Suite 5701, Oakland, CA 94609, USA; and 550 16th St San Francisco, CA 94109, USA, Phone: (510) 428-3058, (630) 292-6700, Fax: (510) 450-5813, E-mail: Namrata.Patel-Sanchez@ucsf.edu

Funding source: National Institute for Health Research

Award Identifier / Grant number: T32 DK007762

Research funding: This work was supported in part by NIH grantT32DK007762.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Institutional Review Board approval was obtained.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpem-2022-0527).

Received: 2022-10-14

Accepted: 2023-03-20

Published Online: 2023-04-17

Published in Print: 2023-05-25

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Keywords for this article

NAFLD; non-alcoholic fatty liver disease; PCOS; pediatric NAFLD; polycystic ovary syndrome; type 2 diabetes