Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.20945/2359-3997000000242 http://hdl.handle.net/1843/56625 http://orcid.org/0000-0002-6641-1350 http://orcid.org/0000-0003-1014-0296 http://orcid.org/0000-0002-9776-4757 http://orcid.org/0000-0002-9080-2319 http://orcid.org/0000-0003-4676-7672 http://orcid.org/0000-0003-4364-7472 http://orcid.org/0000-0003-4504-4069 http://orcid.org/0000-0002-9258-7472 http://orcid.org/0000-0002-4717-9541 http://orcid.org/0000-0002-0226-3491 |
Resumo: | Objective: Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods: Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results: A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m2). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion: Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. |
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2023-07-18T20:13:49Z2023-07-18T20:13:49Z2020643235242https://doi.org/10.20945/2359-39970000002422359-4292http://hdl.handle.net/1843/56625http://orcid.org/0000-0002-6641-1350http://orcid.org/0000-0003-1014-0296http://orcid.org/0000-0002-9776-4757http://orcid.org/0000-0002-9080-2319http://orcid.org/0000-0003-4676-7672http://orcid.org/0000-0003-4364-7472http://orcid.org/0000-0003-4504-4069http://orcid.org/0000-0002-9258-7472http://orcid.org/0000-0002-4717-9541http://orcid.org/0000-0002-0226-3491Objective: Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods: Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results: A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m2). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion: Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS.Objetivo: A síndrome dos ovários policísticos (SOP) é um fator de risco reconhecido para a doença hepática gordurosa não alcoólica (DHGNA). Os objetivos deste estudo foram investigar a prevalência e os fatores associados à DHGNA em mulheres com SOP e avaliar os índices não invasivos de fibrose hepática em pacientes com SOP e DHGNA. Sujeitos e métodos: Foram incluídas pacientes com SOP (n = 87) e mulheres sem SOP (n = 40; controles). DHGNA foi diagnosticada por ultrassonografia abdominal após exclusão de etilismo e doença hepática viral ou autoimune. Variáveis antropométricas, clínicas e metabólicas, avaliação do modelo de homeostase do índice de resistência à insulina (HOMA-IR), produto de acúmulo lipídico (LAP), índice FIB-4, escore NAFLD e elastografia transitória (TE; FibroScan) foram obtidos em subconjuntos de pacientes com SOP e DHGNA. Resultados: Foram incluídas 87 pacientes com SOP (idade média: 34,4 ± 5,7 anos, índice de massa corporal [IMC] médio: 34,7 ± 4,7 kg/m2). NAFLD estava presente em 67 (77,0%) pacientes com SOP versus 21 de 40 (52,5%) controles (p = 0,005). Mulheres com SOP e esteatose hepática, em comparação com suas contrapartes sem NAFLD, apresentaram valores mais altos de IMC, circunferência da cintura, triglicerídeos, colesterol total, alanina e aspartato aminotransferases e γ-glutamiltransferase, juntamente com maiores frequências de obesidade, síndrome metabólica e resistência à insulina. NAFLD foi independentemente associada com circunferência da cintura, triglicerídeos séricos e níveis de alanina aminotransferase. O índice FIB-4 não foi compatível com fibrose avançada em nenhum dos pacientes avaliados, enquanto o escore NAFLD e TE foram compatíveis com fibrose hepática avançada em 1 de 26 (3,8%) e 3 de 25 (12%) pacientes, respectivamente. Conclusão: Mulheres com SOP apresentaram alto risco de DHGNA, e uma combinação de ambos foi associada à obesidade central, dislipidemia, resistência à insulina e síndrome metabólica. Métodos não invasivos sugeriram baixas taxas de insuficiência hepática grave fibrose em mulheres brasileiras com SOP.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICAMED - DEPARTAMENTO DE GINECOLOGIA OBSTETRÍCIAArchives of Endocrinology and MetabolismSíndrome do ovário policísticoHepatopatia gordurosa não alcoólicaObesidadeResistência à insulinaCirrose hepáticaInfertilidadePolycystic ovary syndromeNonalcoholic fatty liver diseaseObesityInsulin resistanceLiver fibrosisInfertilityNonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian centerDoença hepática gordurosa não alcoólica em mulheres com síndrome dos ovários policísticos: fatores associados e estadiamento da fibrose não invasiva em um único centro brasileiroinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.scielo.br/j/aem/a/H4CjdVGTsCGdrbwdsSwtnkM/?lang=en#Daniela Oliveira de Lima TarantoThais Cristine Moura GuimarãesClaudia Alves CoutoAna Lúcia CândidoRosana Correa Silva AzevedoFernanda Souza MattosMaria Luiza Cândido EliasFernando Marcos dos ReisAna Luiza Lunardi RochaLuciana Costa Fariaapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/56625/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALNonalcoholic fatty liver disease in women with polycystic ovary syndrome_ associated factors and noninvasive fibrosis staging in a single Brazilian center.pdfNonalcoholic fatty liver disease in women with polycystic ovary syndrome_ associated factors and noninvasive fibrosis staging in a single Brazilian center.pdfapplication/pdf147629https://repositorio.ufmg.br/bitstream/1843/56625/2/Nonalcoholic%20fatty%20liver%20disease%20in%20women%20with%20polycystic%20ovary%20syndrome_%20associated%20factors%20and%20noninvasive%20fibrosis%20staging%20in%20a%20single%20Brazilian%20center.pdfb8ce48de8827d38a688068a55075af4fMD521843/566252023-07-18 17:13:49.696oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-07-18T20:13:49Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
dc.title.alternative.pt_BR.fl_str_mv |
Doença hepática gordurosa não alcoólica em mulheres com síndrome dos ovários policísticos: fatores associados e estadiamento da fibrose não invasiva em um único centro brasileiro |
title |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
spellingShingle |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center Daniela Oliveira de Lima Taranto Polycystic ovary syndrome Nonalcoholic fatty liver disease Obesity Insulin resistance Liver fibrosis Infertility Síndrome do ovário policístico Hepatopatia gordurosa não alcoólica Obesidade Resistência à insulina Cirrose hepática Infertilidade |
title_short |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
title_full |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
title_fullStr |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
title_full_unstemmed |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
title_sort |
Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: associated factors and noninvasive fibrosis staging in a single Brazilian center |
author |
Daniela Oliveira de Lima Taranto |
author_facet |
Daniela Oliveira de Lima Taranto Thais Cristine Moura Guimarães Claudia Alves Couto Ana Lúcia Cândido Rosana Correa Silva Azevedo Fernanda Souza Mattos Maria Luiza Cândido Elias Fernando Marcos dos Reis Ana Luiza Lunardi Rocha Luciana Costa Faria |
author_role |
author |
author2 |
Thais Cristine Moura Guimarães Claudia Alves Couto Ana Lúcia Cândido Rosana Correa Silva Azevedo Fernanda Souza Mattos Maria Luiza Cândido Elias Fernando Marcos dos Reis Ana Luiza Lunardi Rocha Luciana Costa Faria |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Daniela Oliveira de Lima Taranto Thais Cristine Moura Guimarães Claudia Alves Couto Ana Lúcia Cândido Rosana Correa Silva Azevedo Fernanda Souza Mattos Maria Luiza Cândido Elias Fernando Marcos dos Reis Ana Luiza Lunardi Rocha Luciana Costa Faria |
dc.subject.por.fl_str_mv |
Polycystic ovary syndrome Nonalcoholic fatty liver disease Obesity Insulin resistance Liver fibrosis Infertility |
topic |
Polycystic ovary syndrome Nonalcoholic fatty liver disease Obesity Insulin resistance Liver fibrosis Infertility Síndrome do ovário policístico Hepatopatia gordurosa não alcoólica Obesidade Resistência à insulina Cirrose hepática Infertilidade |
dc.subject.other.pt_BR.fl_str_mv |
Síndrome do ovário policístico Hepatopatia gordurosa não alcoólica Obesidade Resistência à insulina Cirrose hepática Infertilidade |
description |
Objective: Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods: Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results: A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m2). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion: Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020 |
dc.date.accessioned.fl_str_mv |
2023-07-18T20:13:49Z |
dc.date.available.fl_str_mv |
2023-07-18T20:13:49Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/56625 |
dc.identifier.doi.pt_BR.fl_str_mv |
https://doi.org/10.20945/2359-3997000000242 |
dc.identifier.issn.pt_BR.fl_str_mv |
2359-4292 |
dc.identifier.orcid.pt_BR.fl_str_mv |
http://orcid.org/0000-0002-6641-1350 http://orcid.org/0000-0003-1014-0296 http://orcid.org/0000-0002-9776-4757 http://orcid.org/0000-0002-9080-2319 http://orcid.org/0000-0003-4676-7672 http://orcid.org/0000-0003-4364-7472 http://orcid.org/0000-0003-4504-4069 http://orcid.org/0000-0002-9258-7472 http://orcid.org/0000-0002-4717-9541 http://orcid.org/0000-0002-0226-3491 |
url |
https://doi.org/10.20945/2359-3997000000242 http://hdl.handle.net/1843/56625 http://orcid.org/0000-0002-6641-1350 http://orcid.org/0000-0003-1014-0296 http://orcid.org/0000-0002-9776-4757 http://orcid.org/0000-0002-9080-2319 http://orcid.org/0000-0003-4676-7672 http://orcid.org/0000-0003-4364-7472 http://orcid.org/0000-0003-4504-4069 http://orcid.org/0000-0002-9258-7472 http://orcid.org/0000-0002-4717-9541 http://orcid.org/0000-0002-0226-3491 |
identifier_str_mv |
2359-4292 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Archives of Endocrinology and Metabolism |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
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application/pdf |
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Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE CLÍNICA MÉDICA MED - DEPARTAMENTO DE GINECOLOGIA OBSTETRÍCIA |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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Universidade Federal de Minas Gerais (UFMG) |
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UFMG |
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UFMG |
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Repositório Institucional da UFMG |
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Repositório Institucional da UFMG |
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