Polycystic Ovary Syndrome: Chapter 12 - Polycystic ovary syndrome and nonalcoholic fatty liver disease

Polycystic ovary syndrome (PCOS) has an overall prevalence estimated around 6%–10% of the female population of childbearing age and clusters a wide range of endocrine and metabolic disturbances with a tremendous impact on a woman's physical and psychological health. Nonalcoholic fatty liver (NAFL), which defines excessive triacylglycerol deposits in the liver, and nonalcoholic steatohepatitis (NASH), which delineates inflammation and hepatocellular ballooning are the most prevalent chronic liver diseases among patients with PCOS. Furthermore, PCOS emerged as a key risk factor for both the prevalence and severity of the fatty liver disease. Hepatic fibrosis might progress in either NAFL or NASH and results in increased mortality. Experimental studies and liver biopsy data suggest that PCOS and nonalcoholic fatty liver disease (NAFLD) are associated in an independent manner, beyond complex interconnections determined by sharing numerous common risk parameters such as insulin resistance, obesity, adipose tissue dysfunction, genetics, or a profoundly altered gut microbiota and point to an accelerated progression to steatohepatitis, and possibly, fibrosis, facilitated by the PCOS microenvironment. Under these circumstances, identification of accurate noninvasive clinically applicable biomarkers to allow adequate risk stratification remains a challenge and unmet need, as are therapeutic possibilities of real benefit. This chapter discusses the rate of prevalence, pathophysiological mechanisms, diagnosis and risk stratification, and therapeutic options of NAFLD in women with PCOS.