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

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

J Pediatr Endocrinol Metab. 2023 Apr 17;36(5):441-446. doi: 10.1515/jpem-2022-0527. Print 2023 May 25.

Authors

Namrata Patel-Sanchez¹, Emily Perito², Patrika Tsai², Marissa Raymond-Flesch³, Maya Lodish⁴, Monika Sarkar⁵

Affiliations

¹ Department of Gastroenterology, University of California, San Francisco, Benioff Children's Hospital- Oakland, Oakland, CA, USA.
² Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco, Benioff Children's Hospital- San Francisco, San Francisco, CA, USA.
³ Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, CA, USA.
⁴ Department of Pediatrics, Division of Pediatric Endocrinology, University of California, San Francisco, CA, USA.
⁵ Department of Gastroenterology, University of California, San Francisco, CA, USA.

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

MeSH terms

Adolescent
Adult
Child
Diabetes Mellitus, Type 2* / complications
Female
Humans
Hypercholesterolemia*
Insulin Resistance*
Non-alcoholic Fatty Liver Disease* / epidemiology
Obesity / complications
Overweight / complications
Polycystic Ovary Syndrome* / complications
Prevalence
Retrospective Studies
Risk Factors