Androgen excess is characteristic hallmark of polycystic ovary syndrome (PCOS), affecting 10% of women worldwide. PCOS is a lifelong metabolic disorder which causes increased risk of type 2 diabetes, hypertension, and cardiovascular events. It has been observed in previous studies that PCOS is associated with increased risk of nonalcoholic fatty liver disease (NAFLD) and wherein, androgen excess acts as a potential catalyst.

The current retrospective longitudinal cohort study undertook a large primary care database, assessing NAFLD rates in 63,120 women with PCOS and 121,064 controls which were comparable in age, body mass index (BMI), and location, registered from January 2000 to May 2016. The authors also evaluated 2 independent cohorts that analysed the rate of NAFLD in women with a measurement of serum testosterone and sex hormone-binding globulin (SHBG).

Multivariate Cox models was used to determine the hazard ratio (HR) for NAFLD and it was revealed that women with PCOS had an increased rate of NAFLD (HR = 2.23, 95% CI 1.86-2.66), after adjustment for BMI or dysglycemia. 

The results demonstrated that an association existed between serum testosterone >3.0 nmol/L and an increase in NAFLD (HR = 2.30, 95% CI 1.16-4.53 for 3-3.49 nmol/L and HR = 2.40, 95% CI 1.24-4.66 for >3.5 nmol/L). Similarly, SHBG <30 nmol/L was also related to increased NAFLD hazard (HR = 4.75, 95% CI 2.44-9.25 for 20-29.99 nmol/L and HR = 4.98, 95% CI 2.45-10.11, for <20 nmol/L). 

Thus, the study concluded that women with PCOS are associated with an increased rate of NAFLD. Apart from increased BMI and dysglycemia, androgen excess is also implicated in the development of NAFLD in these women. Therefore, systematic NAFLD screening is warranted in women with PCOS-related androgen excess.

Source: PLoS Med. 2018 Mar 28;15(3):e1002542.