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Review
. 2023 Jan 20;12(3):856.
doi: 10.3390/jcm12030856.

Non-Alcoholic Fatty Liver Disease in Patients with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression

Ramiro Manzano-Nunez  1   2   3 , Marta Santana-Dominguez  4 , Jesus Rivera-Esteban  1   2   3 , Clara Sabiote  1   2 , Elena Sena  1   2 , Juan Bañares  1   2 , Frank Tacke  5 , Juan M Pericàs  1   2   6
Affiliations
Review

Non-Alcoholic Fatty Liver Disease in Patients with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression

Ramiro Manzano-Nunez et al. J Clin Med. .

Abstract

Background: The metabolic effects of polycystic ovary syndrome (PCOS) may increase the risk of non-alcoholic fatty liver disease (NAFLD). However, the burden of NAFLD in PCOS has not been unequivocally defined. This systematic review (SR), meta-analysis (MA) assessed NAFLD's prevalence, and risk factors in patients with PCOS.

Methods: A literature search was performed in MEDLINE, Scopus, and Scielo. First, we performed a MA of proportions to estimate the prevalence of NAFLD in PCOS. Second, we performed meta-analyses of precalculated adjusted odds ratios to examine NAFLD risk factors. Finally, we performed a meta-regression to model how the estimated prevalence changed with changes in prespecified variables.

Results: We identified 817 articles from the database searches. Thirty-six were included. MA of proportions found a pooled NAFLD prevalence of 43% (95% CI, 35-52%) with high heterogeneity (I2 = 97.2%). BMI, waist circumference, ALT values, HOMA-IR values, free androgen index levels, hyperandrogenism, and triglycerides were associated with significantly higher risk-adjusted odds of NAFLD among patients with PCOS. Meta-regression showed that rises in NAFLD prevalence were mediated through increases in metabolic syndrome prevalence and higher levels of HOMA-IR, free androgen index, and total testosterone.

Conclusion: The prevalence of NAFLD (43%) among PCOS patients is high despite their average young age, with several metabolic and PCOS-specific factors influencing its occurrence. Screening programs may aid in detecting metabolic-associated fatty liver disease and prevent its consequences. Further work is required to establish the burden of liver-related outcomes once NAFLD has progressed in the PCOS population.

Keywords: metabolic dysfunction associated fatty liver disease; non-alcoholic fatty liver disease; polycystic ovary syndrome; prevalence; risk factors.

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Conflict of interest statement

J.M.P. reports having received consulting fees from Boehringer Ingelheim and Novo Nordisk. He has received speaking fees from Gilead, and travel expenses from Gilead, Rubió, Pfizer, Astellas, MSD, CUBICIN, and Novo Nordisk. He has received educational and research support from Gilead, Pfizer, Astellas, Accelerate, Novartis, Abbvie, ViiV, and MSD, and funds from European Commission/EFPIA IMI2 853966-2, IMI2 777377, H2020 847989, and ISCIII PI19/01898 (all outside the submitted work). The rest of the authors have nothing to disclose.

Figures

Figure 1
Figure 1
PRISMA diagram flow chart.
Figure 2
Figure 2
Pooled prevalence estimation of NAFLD in patietns with PCOS. Ref: [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54].
Figure 3
Figure 3
Metaregression analysis.
See this image and copyright information in PMC

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