Polycystic ovary syndrome (PCOS) is estimated to affect around 10% of reproductive-aged women. Provided PCOS is a risk factor for imaging-confirmed steatosis, Sarkar and colleagues conducted a study to determine if PCOS affects histologic severity of non-alcoholic fatty liver disease (NAFLD).

This was a retrospective study involving women 18-45 years of age with biopsy-confirmed NAFLD from 2008 to 2019. Metabolic comorbidities were apprehended within 6 months of biopsy. Two pathologists, who were blinded to PCOS status, assessed the histologic features of non-alcoholic steatohepatitis (NASH).

Overall, 102 women met the study criteria. Of these, 36% had PCOS; median age was 35 years; with 27% white, 6% black, 19% Asian and 47% of Hispanic ethnicity.

Women with PCOS were found to have higher LDL (122 vs 102 mg/dL) and body mass index (BMI) (38 vs 33 kg/cm²). About 76% of women with PCOS had NASH compared to 66% without PCOS. Additionally, 32% of women with PCOS had severe ballooning compared to 13% of those without. A higher proportion of women with PCOS had presence of any fibrosis (84% vs 66%) as well as advanced fibrosis (16% vs 6%). After adjusting for age and BMI, PCOS was still linked with severe hepatocyte ballooning and advanced fibrosis. In women with advanced fibrosis, median age was 5 years younger in those with PCOS compared to those without (40 vs 45 years).

Polycystic ovary syndrome therefore has an independent association with more severe NASH, including advanced fibrosis, suggests the present study. Investigators thus advised that hepatologists should inquire about PCOS in reproductive-aged women with NAFLD, and evaluate for more severe liver disease in this patient population. 

Source: Sarkar M, Terrault N, Chan W, et al. Polycystic Ovary Syndrome (PCOS) Is Associated With NASH Severity and Advanced Fibrosis. Liver Int. 2020 Feb;40(2):355-359.