Department of Gastroenterology, University of California, San Francisco, Benioff Children's Hospital- Oakland, Oakland, CA, USA.
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco, Benioff Children's Hospital- San Francisco, San Francisco, CA, USA.
J Pediatr Endocrinol Metab. 2023 Apr 17;36(5):441-446. doi: 10.1515/jpem-2022-0527. Print 2023 May 25.
Polycystic ovary syndrome (PCOS) increases non-alcoholic fatty liver disease (NAFLD) risk and severity in adults, but data in adolescents with diverse backgrounds are limited. We evaluated NAFLD prevalence and characterized NAFLD risk factors in overweight/obese adolescents by PCOS status.
Retrospective study of overweight (n=52)/obese (n=271) female adolescents (12-18 years old), evaluated clinically 2012-2020, was conducted comparing PCOS patients to age-matched non-PCOS controls. NAFLD was defined as ALT≥44U/L x2 and/or ≥80U/L x1, hepatic steatosis on imaging, or NAFLD on biopsy, in absence of other liver disease. Metabolic comorbidities were captured. Log-binomial regression models estimated prevalence risk ratios (PR).
NAFLD prevalence was 19.1 % in adolescents with PCOS (n=161), similar to those without (n=162) (16.8 %, p=0.6). Adolescents with PCOS were more likely to have insulin resistance, hypercholesterolemia, and higher triglycerides (p<0.05). Those with PCOS and concomitant type 2 diabetes (T2DM) did have increased NAFLD risk (PR 2.5, p=0.04), but those with PCOS without T2DM did not (PR 0.9, p=0.8). Adolescents with PCOS and NAFLD, compared to those with PCOS without NAFLD, had a higher prevalence of metabolic comorbidities including hypercholesterolemia (77 vs. 48 %), T2DM (29 vs. 8 %), and hypertriglyceridemia (65 vs. 37 %) (p<0.01).
Almost 1 in 5 overweight/obese female adolescents had NAFLD, but PCOS did not increase NAFLD risk in this diverse cohort. Among young women with PCOS, concomitant T2DM did increase the risk for NAFLD. Closer monitoring of obesity comorbidities in adolescents with PCOS is essential for optimizing health and merits updating current guidelines.
多囊卵巢综合征（PCOS）会增加成年人非酒精性脂肪性肝病（NAFLD）的风险和严重程度，但在背景多样化的青少年中，相关数据有限。我们评估了超重/肥胖青少年中 PCOS 状态下 NAFLD 的患病率，并对其 NAFLD 危险因素进行了特征描述。
回顾性研究了 2012 年至 2020 年期间就诊的超重（n=52）/肥胖（n=271）女性青少年（12-18 岁），并将 PCOS 患者与年龄匹配的非 PCOS 对照组进行了比较。NAFLD 的定义为 ALT≥44U/L x2 且/或 ALT≥80U/L x1，影像学上存在肝脂肪变性，或肝活检存在 NAFLD，但无其他肝病。检测了代谢合并症。采用对数二项式回归模型估计患病率风险比（PR）。
PCOS 患者（n=161）的 NAFLD 患病率为 19.1%，与非 PCOS 患者（n=162）相似（16.8%，p=0.6）。PCOS 患者更易发生胰岛素抵抗、高胆固醇血症和高甘油三酯血症（p<0.05）。合并 2 型糖尿病（T2DM）的 PCOS 患者确实存在更高的 NAFLD 风险（PR 2.5，p=0.04），但无 T2DM 的 PCOS 患者则没有（PR 0.9，p=0.8）。与无 NAFLD 的 PCOS 患者相比，有 NAFLD 的 PCOS 患者更易发生代谢合并症，包括高胆固醇血症（77%比 48%）、T2DM（29%比 8%）和高甘油三酯血症（65%比 37%）（p<0.01）。
近五分之一的超重/肥胖女性青少年患有 NAFLD，但在这一多民族队列中，PCOS 并未增加 NAFLD 的风险。在患有 PCOS 的年轻女性中，合并 T2DM 确实会增加患 NAFLD 的风险。密切监测 PCOS 青少年的肥胖合并症对于优化健康状况至关重要，值得更新当前的指南。
