Vol 1 No 1 (2018): Current Issue
Research Article

The Association of Hispanic Ethnicity with Nonalcoholic Fatty Liver Disease in Polycystic Ovary Syndrome

Sarkar M
Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
Terrault N
Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
Duwaerts CC
Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
Tien P
Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
Cedars MI
Center for Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
Huddleston H
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, California, USA
Published April 5, 2018
Keywords
  • Fatty liver,
  • Hispanic,
  • Polycystic ovary syndrome,
  • Nonalcoholic steatohepatitis

Abstract

Polycystic Ovary Syndrome (PCOS) affects 10-15% of reproductive age women and is a recognized risk factor for hepatic steatosis, a form of nonalcoholic fatty liver disease (NAFLD). The more severe form of NAFLD, known as nonalcoholic steatohepatitis (NASH), results in liver inflammation, and is now a leading cause of cirrhosis. Ethnic differences are apparent in NAFLD, with higher prevalence in Hispanics, although the role of Hispanic ethnicity on risk for NAFLD/NASH in women with PCOS is not known.
Objective: The aim of this study was to evaluate ethnic differences in the prevalence and risk of NAFLD in women with PCOS.
Study Design: Among PCOS women followed in a large academic medical center the association of Hispanic ethnicity with elevated biomarkers of NASH, including plasma cytokeratin 18 (CK18) M30 fragments and/or ALT levels (n=303), was assessed. Prevalence of hepatic steatosis by Controlled Attenuation Parameter (CAP) imaging was evaluated in a subset of PCOS women (n=35).
Results: The median cohort age (n=303) was 28 years (IQR 8), and 15.5% (n=47) were Hispanic, the majority of whom reported white race (94%). Most Hispanic women had hepatic steatosis on imaging, which was markedly higher than in non-Hispanics (83% vs 24%, p=0.005). Approximately 17% of PCOS women had elevated ALT or elevated CK18, which was more common in Hispanics than non-Hispanics, at 34% vs 14%, respectively, p=0.002. On univariate analysis, Hispanic ethnicity was associated with two-fold higher odds of NASH (OR 2.0, 95% CI 1.0-3.9, p=0.038), and the association persisted after adjustment for HOMA-IR and waist circumference (AOR 3.1, 95% CI 1.1-8.9, p=0.034).
Conclusion: NAFLD/NASH is an important condition to be considered by PCOS providers and Hispanic women with PCOS are a particularly high-risk group that may warrant routine screening.