The Burden of Non-Alcoholic Fatty Liver Disease in Adolescents with Polycystic Ovary Syndrome: A Case-Control Study

Aikaterini Giannouli; Vasiliki Efthymiou; Marianna Konidari; Iliana Mani; Leon Aravantinos; Spyridon P Dourakis; Aristeidis Antoniou; Efthymios Deligeoroglou; Flora Bacopoulou

doi:10.3390/jcm12020557

The Burden of Non-Alcoholic Fatty Liver Disease in Adolescents with Polycystic Ovary Syndrome: A Case-Control Study

J Clin Med. 2023 Jan 10;12(2):557. doi: 10.3390/jcm12020557.

Authors

Aikaterini Giannouli¹, Vasiliki Efthymiou¹, Marianna Konidari², Iliana Mani³, Leon Aravantinos⁴, Spyridon P Dourakis³, Aristeidis Antoniou², Efthymios Deligeoroglou⁵, Flora Bacopoulou¹

Affiliations

¹ Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Str., 11527 Athens, Greece.
² First Department of Radiology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 76 Vassilisis Sofias Ave., 11528 Athens, Greece.
³ Research Laboratory, Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokratio Hospital, 11527 Athens, Greece.
⁴ Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 76 Vassilisis Sofias Ave., 11528 Athens, Greece.
⁵ Department of Pediatric & Adolescent Gynecology, Mitera Children's Hospital, Erythrou Stavrou, 15123 Athens, Greece.

Abstract

The aim of this case-control study was to assess the burden of non-alcoholic fatty liver disease (NAFLD) in adolescents with polycystic ovary syndrome (PCOS) and its associations with insulin resistance, hyperandrogenism, and other metabolic characteristics of the syndrome. A total of 87 Caucasian adolescent girls (47 with PCOS and 40 controls), aged 12.3-20.4 years, underwent blood sampling for glucose metabolism, hormonal and lipid profile, gynecological and liver ultrasound, and liver elastography. Indices of insulin resistance, liver steatosis, and liver fibrosis were calculated. NAFLD diagnosed by ultrasound was more prevalent in adolescents with PCOS than controls (22.7% vs. 6.1%, p = 0.046), and was also verified by liver steatosis indices. The latter was not apparent for hepatic fibrosis, as assessed by Fibroscan^® and calculated indices. The homeostatic model assessment for insulin resistance (HOMA-IR) was found to predict NAFLD diagnosis by the liver fat score (LFS) index (β = 0.709, p = 0.002). Adolescents with PCOS and high free androgen index (FAI) presented worse NAFLD than those adolescents with PCOS and lower FAI. In addition, adolescents with PCOS and concurrent NAFLD had worse insulin sensitivity indices (HOMA-IR, QUICKI, and glucose to insulin ratio) than adolescents with PCOS alone. Adolescent insulin resistance could be considered a confounder of the association between PCOS and NAFLD.

Keywords: MAFLD; NAFLD; PCOS; adolescent; fatty liver; insulin resistance; liver steatosis; non-alcoholic fatty liver disease; obesity; polycystic ovary syndrome.

Grants and funding

This research received no external funding.