Newswise — According to new research by a group of Southern California researchers, women with polycystic ovary syndrome (PCOS) are at increased risk for developing nonalcoholic fatty liver disease (NAFLD). PCOS is a hormone imbalance manifested by insulin resistance that interferes with normal ovulation and fertility. The team’s results will be published in the February issue of Fertility and Sterility and is the first paper to show the association between PCOS and NAFLD.

The team was lead by University of California, San Diego (UCSD) physician, Jeffrey Schwimmer M.D. who said the research findings are important because many ob/gyn physicians are not aware that NAFLD can be a problem for these patients. As a result they do not screen for the disease and may treat PCOS patients with medications that can potentially cause toxicity to the liver if they have NAFLD.

The team found elevated blood levels of an enzyme known as alanine aminotransferase (ALT) in 30% of the PCOS patients studied. Liver specialists’ working diagnosis for patients with insulin resistance and elevated ALT when a panel of blood tests are negative for other causes of liver disease, is “suspected NAFLD”. The researchers noted that NAFLD represents a spectrum of liver diseases that can be mild in many patients but is also recognized as an important cause of cirrhosis, liver transplantation, and liver cancer.

They recommended that patients with PCOS be evaluated for liver disease and those with elevated ALT avoid alcohol and acetaminophen. Schwimmer added that liver disease is often silent and often isn’t discovered until it reaches advanced levels.

Schwimmer and his colleagues, Walter Schwimmer, M.D., of Kaiser Permanente Medical Center-Bellflower, California, Omid Khorran M.D. of Harbor-UCLA Medical Center, and Vicki Chiu, M.S. in the Southern California Permanente Medical Group comprised the team. Jeffrey Schwimmer established the Fatty Liver Clinic at Children’s Hospital – San Diego, the first of its kind for children and adolescents in the United States.

Jeffrey Schwimmer said the impetus for the study began with two observations: liver specialists have seen a large increase of fatty liver disease, which has been linked to insulin resistance; PCOS has also been linked to insulin resistance. The study noted that PCOS is the most common form of non-ovulating infertility and females are at a higher risk than men for the extreme manifestations of fatty liver disease such as cirrhosis and liver carcinoma.

“We had to ask, was there an increased risk of having fatty liver in this PCOS population?” Jeffrey Schwimmer asked. “The answer was yes. It was partially linked to body mass index but also to hirsutism (excessive body hair). That was very unexpected, we found hirsutism was an important indicator of fatty liver disease.”

“We hypothesized that women with PCOS would demonstrate a high incidence of NAFLD because of the link to insulin resistance,” said Walter Schwimmer. “Of the 73 women with infertility diagnosed with PCOS, 70 subjects had available ALT data. All subjects underwent a detailed medical history, physical examination and fertility related laboratory testing. The data in the study in fact demonstrate that elevated ALT is more common in women with PCOS than in the general population of women of a similar age, race, and body weight; thirty percent of the 70 patients had elevated ALT. We determined that insulin resistance explains the high rate of elevated ALT in women with PCOS and that these women with PCOS are at risk for NAFLD.”

Walter Schwimmer, Omid and Khorran and colleagues saw the study patients in the infertility service at Kaiser Permanente Medical Center in Bellflower, between May 2001 and October 2002. The researchers reviewed the medical records of 73 women with PCOS. Chiu compiled the statistics. Schwimmer and Schwimmer analyzed and interpreted the data.

http://www.newswise.com/articles/view/509800/

I think I might end up getting NAFLD someday because recently, an abdominal ultrasound revealed that I have a fatty liver. I am currently seeing a new endocrinolgist and I mentioned my concern about NAFLD and he dismissed it because he said that my liver function is very good. But now, after thinking about it, I don't think he knew what he was talking about. I might have to print out some information about NAFLD and the connection to PCOS. I think he needs to consider this or learn more about it.

I'm hoping that losing all my excess weight will reverse this. I am going to consider going back on metformin, but I'm a little leery of the drug after my last experience (had problems with GI irritation).

Is fatty liver and fatty liver disease different? I could be totally wrong because this is just self initiated research, but it was my understanding that it was the same. Now you can have a fatty streak or two, but if an ultrasound shows 'fatty liver' then I thought that was just the shortened version of disease. However, whatever it is called, since you have good liver enzymes, that is great because that is your best indicator (next to biopsy) to what is actually going on inside the liver and how it is working. Some studies have shown that Met can reverse it, but Met can also harm the liver - so it is a double edged sword.

Funny how doctors recommend to us a diet that is low-carb, high animal protein. If we are at risk for NAFLD, we REALLY need to watch the animal products, which exhaust the liver.

Which is why I like southbeach... right carbs, right fats,... lean animal products... some of the people doing it are vegetarians and the plan works great for them on south beach!

I've researched this. One can have a fatty liver, even a very fatty liver and it not be NAFLD or ever become so.

But if someone has a fatty liver AND her liver function tests are elevated, they are said to have NAFLD.

I was diagnosed with this too last year, after I had a CAT scan done on my abdomen.

My gastroenterologist told me that the PCOS was a cause of it, but specifically, it was high triglycerides and that what I really needed to do was to lose weight (of course) and also minimize/eliminate entirely any refined carbohydrates from my diet.

Since doing that, my triglycerides have gone down and I'll be back for a check up in the next few weeks to get his stamp of approval.

What I found out later was that my father (who was diagnosed with diabetes) was also diagnosed with fatty liver, but they told him to stop drinking. He's NOT a drinker, so he just shrugged it off thinking the doctors were crazy. He didn't know -- maybe the doctor's didn't either back then -- that this was a sign of prediabetes.

Thanks for the great info. I just had a hysterectomy and was found to have poly-cystic ovaries, I have a fatty liver and insulin resistance and after surgery I was told my liver labs came back high. I am worried about this and see my doctor tomorrow and am going to ask her if I may have PCOS. I appreciate being able to come here and learn more. Thanks so much!

I have known that I have had PCOS since about 2006 and recently by the way of testing for gallbladder problems found out that I have a NAF Liver, but the spec. I was seeing just watned to blame my weight on it and not look further into it. I am going to see my primary care because I want further testing, thanks for sharing this article.