Evaluation of the Predictive Value of Body Mass Index (BMI), Waist Circumference, and Visceral Fat to Differentiate Non-alcoholic Fatty Liver (NAFLD) in Women with Polycystic Ovary Syndrome

Overview

Journal J Res Med Sci

Specialty General Medicine

Date 2022 Aug 15

PMID 35968215

Authors

Bita Eslami

Najmeh Aletaha

Arezoo Maleki-Hajiagha

Mahdi Sepidarkish

Ashraf Moini

Affiliations

Soon will be listed here.

Abstract

Background: Our objective was to determine the overall prevalence of nonalcoholic fatty liver disease (NAFLD) in women with polycystic ovarian syndrome (PCOS) in our sample population. The second aim was to evaluate the predictive value of body mass index (BMI), waist circumference (WC), and visceral fat for the onset of NAFLD in these patients.

Materials And Methods: This cross-sectional study was performed on 71 women with PCOS who were referred to Arash Women's Hospital in Tehran. Demographic and clinical information and anthropometric and biomedical indices were collected by a trained nurse. Liver ultrasonography was performed for all participants by a radiologist.

Results: NAFLD was identified in 53.5% ( = 38) of subjects and the frequency of mild, moderate, and severe grades were 65.8%, 31.6%, and 2.6%, respectively. BMI and visceral fat of patients with NAFLD were significantly higher than non-NAFLD ( < 0.001). Receiving operating characteristic (ROC) curve analysis revealed that BMI was the best indicator of predicting NAFLD (cutoff = 25.5 kg/m, sensitivity 75%, and specificity 75%), whereas visceral fat (cutoff = 5.5%, sensitivity 79%, and specificity 67%) and WC (cutoff = 89.5 cm, sensitivity 73%, and specificity 64%) were inferior for predicting NAFLD in PCOS patients.

Conclusion: The prevalence of NAFLD in the study population is high. Our findings supported the use of BMI as a simple and practical predictive factor for the NAFLD onset, with a cutoff level of 25.5. The use of this cutoff level will enable physicians to identify PCOS patients at risk for NAFLD.

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References

Tiniakos D, Vos M, Brunt E . Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol. 2010; 5:145-71. DOI: 10.1146/annurev-pathol-121808-102132. View

Younossi Z, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H . Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011; 9(6):524-530.e1. DOI: 10.1016/j.cgh.2011.03.020. View

Kumarendran B, OReilly M, Manolopoulos K, Toulis K, Gokhale K, Sitch A . Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database. PLoS Med. 2018; 15(3):e1002542. PMC: 5873722. DOI: 10.1371/journal.pmed.1002542. View

Scatarige J, Scott W, Donovan P, Siegelman S, Sanders R . Fatty infiltration of the liver: ultrasonographic and computed tomographic correlation. J Ultrasound Med. 1984; 3(1):9-14. DOI: 10.7863/jum.1984.3.1.9. View

Zheng R, Ding C . [Prevalence of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome: a case-control study]. Zhonghua Fu Chan Ke Za Zhi. 2008; 43(2):98-101. View

Moini A, Javanmard F, Eslami B, Aletaha N . Prevalence of metabolic syndrome in polycystic ovarian syndrome women in a hospital of Tehran. Iran J Reprod Med. 2014; 10(2):127-30. PMC: 4163274. View

Akbarzadeh M, Naderi T, Dabbaghmanesh M . The glucose metabolism disorder and dyslipidemia among girls with different phenotype polycystic ovary syndrome. J Res Med Sci. 2019; 24:72. PMC: 6734671. DOI: 10.4103/jrms.JRMS_804_16. View

Gambarin-Gelwan M, Kinkhabwala S, Schiano T, Bodian C, Yeh H, Futterweit W . Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Clin Gastroenterol Hepatol. 2007; 5(4):496-501. DOI: 10.1016/j.cgh.2006.10.010. View

Brzozowska M, Ostapowicz G, Weltman M . An association between non-alcoholic fatty liver disease and polycystic ovarian syndrome. J Gastroenterol Hepatol. 2009; 24(2):243-7. DOI: 10.1111/j.1440-1746.2008.05740.x. View

10.

Harsha Varma S, Tirupati S, Pradeep T, Sarathi V, Kumar D . Insulin resistance and hyperandrogenemia independently predict nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Diabetes Metab Syndr. 2019; 13(2):1065-1069. DOI: 10.1016/j.dsx.2018.12.020. View

11.

Kim J, Kim D, Yim J, Kang J, Han K, Kim S . Polycystic ovary syndrome with hyperandrogenism as a risk factor for non-obese non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2017; 45(11):1403-1412. DOI: 10.1111/apt.14058. View

12.

Shields M, Tremblay M, Connor Gorber S, Janssen I . Abdominal obesity and cardiovascular disease risk factors within body mass index categories. Health Rep. 2012; 23(2):7-15. View

13.

Ramezani Tehrani F, Simbar M, Tohidi M, Hosseinpanah F, Azizi F . The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011; 9:39. PMC: 3070632. DOI: 10.1186/1477-7827-9-39. View

14.

Ma R, Liu K, Lam P, Cheung L, Tam W, Ko G . Sonographic measurement of mesenteric fat predicts presence of fatty liver among subjects with polycystic ovary syndrome. J Clin Endocrinol Metab. 2010; 96(3):799-807. DOI: 10.1210/jc.2010-1608. View

15.

Gutierrez-Grobe Y, Ponciano-Rodriguez G, Ramos M, Uribe M, Mendez-Sanchez N . Prevalence of non alcoholic fatty liver disease in premenopausal, posmenopausal and polycystic ovary syndrome women. The role of estrogens. Ann Hepatol. 2010; 9(4):402-9. View

16.

Vassilatou E . Nonalcoholic fatty liver disease and polycystic ovary syndrome. World J Gastroenterol. 2014; 20(26):8351-63. PMC: 4093689. DOI: 10.3748/wjg.v20.i26.8351. View

17.

Alberti K, Zimmet P, Shaw J . The metabolic syndrome--a new worldwide definition. Lancet. 2005; 366(9491):1059-62. DOI: 10.1016/S0140-6736(05)67402-8. View

18.

Parente D, Oliveira Neto J, Brasil P, Paiva F, Ravani J, Gomes M . Preperitoneal fat as a non-invasive marker of increased risk of severe non-alcoholic fatty liver disease in patients with type 2 diabetes. J Gastroenterol Hepatol. 2017; 33(2):511-517. DOI: 10.1111/jgh.13903. View

19.

Tison G, Blaha M, Nasir K, Blumenthal R, Szklo M, Ding J . Relation of Anthropometric Obesity and Computed Tomography Measured Nonalcoholic Fatty Liver Disease (from the Multiethnic Study of Atherosclerosis). Am J Cardiol. 2015; 116(4):541-6. PMC: 4522195. DOI: 10.1016/j.amjcard.2015.05.012. View

20.

Hossain N, Stepanova M, Afendy A, Nader F, Younossi Y, Rafiq N . Non-alcoholic steatohepatitis (NASH) in patients with polycystic ovarian syndrome (PCOS). Scand J Gastroenterol. 2010; 46(4):479-84. DOI: 10.3109/00365521.2010.539251. View