Polycystic ovary syndrome (PCOS) is the most common reproductive, endocrine, and metabolic disorder with a prevalence rate of 1 in every 10 women of reproductive age. It is characterized by excessive androgens (male hormones) and ovarian dysfunction in women.2 This ends up in disturbed menstrual cycles, infertility, and hirsutism (male characteristics) in females.
Women with PCOS are at increased risk of insulin resistance, obesity, cardiovascular disease, anxiety and depression, dyslipidemia, and endometrial cancer.
Recently, PCOS has also been linked to non-alcoholic fatty liver disease with a twofold increase in the non-alcoholic fatty liver due to the syndrome.
With a global prevalence of 25.24%, non-alcoholic fatty liver is showing up as one of the most common chronic liver diseases worldwide and may soon turn into a major cause of end-stage liver disease in the coming decade.
It is characterized by the deposition of 5% or more fat in the liver and is independent of viral hepatitis, excessive alcohol consumption, drug-related liver disease, autoimmune liver disease, genetic liver disease, and other causative agents.
Till the year 2005, excessive intake of calories from unhealthy fat was considered the only cause of non-alcoholic fatty liver, when in the same year, a 24-year-old obese patient with PCOS, non-diabetic without any history of alcohol was diagnosed with chronically elevated serum transaminase levels in Alanine transaminase blood test in a liver biopsy confirming non-alcoholic fatty liver. From there, it was suggested that non-alcoholic fatty liver might occur in women with PCOS.1 Since then, there has been a gradual increase in clinical studies to unveil the link between non-alcoholic fatty liver and PCOS.
What Leads to Non-Alcoholic Fatty Liver in PCOS?
1. Insulin resistance
Insulin resistance there's a well-established link between insulin resistance and PCOS. Besides, it has been estimated that about 80% of patients with non-alcoholic fatty liver have insulin resistance. Insulin resistance leads to elevated insulin and glucose level in blood than normal which leads to a decrease in the fatty acid breakdown in cells and creates inflammation, necrosis, fibrosis, and fat accumulation in the liver.
All these factors ultimately lead to the progression of non-alcoholic fatty liver. Hence, elevated levels of insulin are an independent risk factor for non-alcoholic fatty liver.
There is high insulin resistance in PCOS women with non-alcoholic fatty liver than in PCOS women without non-alcoholic fatty liver.
So if you are dealing with PCOS, it’s important to keep a track of your blood glucose levels in your routine to avoid non-alcoholic fatty liver in making.
Obesity and adipose tissue dysfunction are also interconnected to non-alcoholic fatty liver and PCOS. A case study on 145 premenopausal women with PCOS demonstrated fat accumulation in the liver and high fatty liver index.3
Hyperandrogenaemia (excess of male hormones; testosterone, androsterone, and androstenedione in females) is also known to trigger non-alcoholic fatty liver in PCOS women.
Hyperandrogenaemia is also linked to insulin resistance and obesity, but its direct influence on non-alcoholic fatty liver is yet to be studied.
It has been hypothesized that low-grade inflammation also mediates insulin resistance in PCOS women.2 Simultaneously, inflammation is also a risk factor for the progression of non-alcoholic fatty liver.
These strategies can help you manage non-alcoholic fatty liver in PCOS
1. Lifestyle modification
Lifestyle modification includes a combination of a balanced diet, calorie deficit, and an appropriate physical regimen to be followed to achieve the target weight.
Check out the Diets that can effectively control your non-alcoholic fatty liver.
Besides, if you are dealing with PCOS, it’s important to keep a track of your blood glucose levels in routine with glucometers to avoid non-alcoholic fatty liver in making.
There’s no medication as such to treat non-alcoholic fatty liver in PCOS. However, the following drugs have been studied to improve the liver condition and reduce fat accumulation in PCOS women.
This is the medicine used to control blood sugar levels in diabetics. But this medicine has also shown some improvement in non-alcoholic fatty liver in PCOS, especially in overweight and obese women with high insulin levels.
It is also reported to control testosterone, follicle-stimulating hormone, luteinizing hormone, and LDL or bad cholesterol in PCOS women. 4
Thiazolidinediones are the class of medicines to improve insulin sensitivity. But this medicine can also be used in the treatment of non-alcoholic fatty liver in non-obese women with PCOS.
This medicine is used to control blood sugar levels in children above 10 years. But a randomized clinical trial for 26 weeks on women with PCOS exhibited that this medicine can reduce the liver fat content by 44%, visceral adipose tissue by 18%, and reduce the prevalence of non-alcoholic fatty liver by two-thirds in PCOS women.6
This medicine is used to treat high blood pressure patients. But it can also reduce serum free fatty acid levels in PCOS women.5
But it’s extremely important to take these medications under the supervision of your doctor.
3. Nutritional Supplements
Besides, lifestyle modifications and medications, these nutritional supplements or food high in these nutrients can work wonders to control your non-alcoholic fatty liver if you are already dealing with PCOS.
- Omega-3 fatty acids
- Vitamin E
- Vitamin D
A 12-week supplementation of 1000 mg omega-3 fatty acids and 400 IU vitamin E for PCOS women are studied to significantly improve insulin resistance and reduced testosterone levels.7
Besides, Vitamin D supplementation of 3200 IU/d for 3 months in 40 PCOS women was found to reduce transaminase levels in liver biopsy.8
The link between non-alcoholic fatty liver and PCOS in women is yet to be fully established. But research has enough evidence to comment on PCOS for the progression of non-alcoholic fatty liver in women.
Insulin resistance, obesity, Hyperandrogenaemia, and inflammation are the main factors that lead to non-alcoholic fatty liver in women with PCOS.
The risk of developing non-alcoholic fatty liver in PCOS can be effectively prevented and improved with lifestyle modifications including a balanced diet, calorie deficit, weight loss, and physical activities; pharmacologic therapy including metformin, thiazolidinediones, liraglutide, and spironolactone with the advice of your doctor.
Get a balanced diet plan here to manage your PCOS and prevent non-alcoholic fatty liver.
Besides, nutritional supplementation with Omega-3 fatty acids, Vitamin D, and Vitamin E are safe and recommended to manage non-alcoholic fatty liver in women with PCOS with additional health benefits.