Systematic review: association of polycystic ovary syndrome with metabolic syndrome and non-alcoholic fatty liver disease

Abstract

Aliment Pharmacol Ther 2011; 33: 801–814 Summary Background Polycystic ovary syndrome (PCOS) is a common disorder for women of child‐bearing age and is associated with metabolic syndrome (MS). Aim To assess the literature for associations between polycystic ovary syndrome and non‐alcholic fatty liver disease (NAFLD). Methods We performed a systematic review using PubMed‐search for peer‐reviewed articles related to polycystic ovary syndrome and NAFLD. Articles were summarised and grouped according to different sections defining interactions of polycystic ovary syndrome with metabolic syndrome and non‐alcholic fatty liver disease as well as risk factors, pathogenic pathways and treatment options. Results Obesity is a common factor involved in both polycystic ovary syndrome and non‐alcholic fatty liver disease. Obesity causes non‐alcholic fatty liver disease and aggravates hirsutism and menstrual disorders in polycystic ovary syndrome. Insulin resistance, a hallmark of metabolic syndrome is observed in 50–80% of women with polycystic ovary syndrome and patients with non‐alcholic fatty liver disease. Recent findings suggest that women with polycystic ovary syndrome may be at risk for developing non‐alcholic fatty liver disease and conversely, non‐alcholic fatty liver disease may be a risk for polycystic ovary syndrome. Based on the association of polycystic ovary syndrome and other metabolic abnormalities, such as insulin resistance, hyperandrogenism, obesity and non‐alcholic fatty liver disease, the candidate genes have been speculated for polycystic ovary syndrome. Closer scrutiny of these genes placed most of their proteins at the crossroads of three highly inter‐related conditions: metabolic syndrome, obesity and non‐alcholic fatty liver disease. In most studies, the prevalence of both polycystic ovary syndrome and non‐alcholic fatty liver disease rises proportionally to the degree of insulin resistance and increases in the mass of adipose tissue. Conclusions Non‐alcholic fatty liver disease is considered as the hepatic manifestation of metabolic syndrome. Similarly, it seems appropriate to consider polycystic ovary syndrome as the ovarian manifestation of metabolic syndrome. Both these conditions can co‐exist and may respond to similar therapeutic strategies.