Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

BACKGROUND Polycystic ovary disease(PCOS)may be a risk factor for nonalcoholic fatty liver disease(NAFLD)due to common pathogenetic pathways,including insulin resistance and obesity.Both PCOS and NAFLD are more severe in South Asian women.Data on NAFLD in South Asian women with PCOS are lacking.AIM To investigate prevalence and predictors of NAFLD and liver fibrosis in PCOS patients from South Asia.METHODS We conducted an observational routine screening program by means of transient elastography(TE)with associated controlled attenuation parameter(CAP).NAFLD was defined as CAP≥288 decibels per meter.Significant liver fibrosis(stage 2 and higher out of 4)was defined as TE measurement≥8.0 kilopascals.Elevated alanine aminotransferase(ALT)was defined as ALT>24 IU/L,as per upper limit of normal reported in South Asian women.Biochemical hyperandrogenism was defined as free androgen index>5.Predictors of NAFLD were determined by logistic regression analysis.RESULTS 101 PCOS patients(mean age 36.3 years)with no significant alcohol intake or viral hepatitis were included.Prevalence of NAFLD and significant liver fibrosis was 39.6% and 6.9%,respectively.Elevated ALT was observed in 40%and 11.5%of patients with and without NAFLD,respectively.After adjusting for duration of PCOS and insulin resistance measured by homeostasis model for assessment of insulin resistance,independent predictors of NAFLD were higher body mass index[adjusted odds ratio(aOR)1.30,95% confidence interval(CI):1.13-1.52],hyperandrogenism(aOR:5.32,95%CI:1.56-18.17)and elevated ALT(aOR:3.54,95%CI:1.10-11.47).Lifetime cardiovascular risk was higher in patients with NAFLD compared to those without NAFLD(0.31±0.11 vs 0.26±0.13).CONCLUSION Despite their young age,NAFLD diagnosed by TE with CAP is a frequent comorbidity in South Asian women with PCOS and is strongly associated with higher body mass index and hyperandrogenism.Non-invasive screening strategies could help early diagnosis and initiation of interventions,including counselling on weight loss,cardiovascular risk stratification and linkage to hepatology care where appropriate.

Metabolic and cardiovascular complications after virological cure in hepatitis C:What awaits beyond

The association between chronic hepatitis C(CHC)infection and extrahepatic manifestations(EHMs),particularly cardiometabolic diseases,has been extensively examined.However,there has still been insufficient evaluation for these EHMs after virological cure.Several multidirectional mechanisms have been proposed explaining the ability of hepatitis C virus(HCV)developing EHMs,cardiometabolic ones,as well as the effect of antiviral therapy to resolve these EHMs.Data on these manifestations after achieving sustained virologic response(SVR)are still conflicting.However,current evidence suggests that reversal of hepatic steatosis and its coexistent hypocholesterolemia after successful viral eradication led to unfavorable lipid profile,which increases cardiovascular disease(CVD)risk.Additionally,most observations showed that metabolic alterations,such as insulin resistance and diabetes mellitus(DM),undergo some degree of reduction after viral clearance.These changes seem HCV-genotype dependent.Interferon-based antiviral therapy and direct acting antiviral drugs were shown to minimize incidence of DM.Large epidemiological studies that investigated the effect of SVR on CVD showed great discrepancies in terms of results,with predominant findings indicating that CVD events decreased in patients with SVR compared to non-responders or untreated ones.In this review,we present a summary of the current knowledge regarding extrahepatic sequelae of CHC following SVR,which may have an impact on healthcare providers’clinical practice.