Polycystic ovary syndrome (PCOS) is associated with NASH severity and advanced fibrosis
Open accessAbstract
BACKGROUND: Polycystic ovary syndrome (PCOS) affects 10% of reproductive-aged women, and is marked by irregular menses and high androgens. PCOS is a known risk factor for imaging-confirmed steatosis, and we now aim to evaluate whether PCOS influences histologic severity of non-alcoholic fatty liver disease (NAFLD). METHODS: Retrospective study of women ages 18-45 years with biopsy-confirmed NAFLD between 2008 and 2019. Metabolic comorbidities were captured within 6 months of biopsy. Histologic features of non-alcoholic steatohepatitis (NASH) were independently evaluated by two pathologists blinded to PCOS status. RESULTS: , P < .01). NASH was present in 76% of women with PCOS vs 66% without PCOS (P = .3), and a higher proportion with PCOS had severe ballooning (32% vs 13%, P = .02), presence of any fibrosis (84% vs 66%, P = .06) and advanced fibrosis (16% vs 6%, P = .10). Adjusted for age and BMI, PCOS remained associated with severe hepatocyte ballooning (OR 3.4, 95% CI 1.1-10.6, P = .03) and advanced fibrosis (OR 7.1, 95% CI 1.3-39, P = .02). Among women with advanced fibrosis, median age was 5 years younger in those with as compared to those without PCOS (40 vs 45 years, P = .02). CONCLUSION: Polycystic ovary syndrome is independently associated with more severe NASH, including advanced fibrosis. Hepatologists should routinely inquire about PCOS in reproductive-aged women with NAFLD, and evaluate for more severe liver disease in this population.
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Both OSA and PCOS are associated with MASLD.
“Both OSA and PCOS are associated with MASLD,”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [66]
The Introduction identifies PCOS as an at-risk group for NAFLD, supporting the PCOS part of the claim under the paper’s terminology. The passages found for “OSA sleep apnea” do not address OSA, so this source does not support the OSA part. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOnly one study reported an association between PCOS and MASH severity or advanced fibrosis.
“while only one study reported an association between PCOS and MASH severity or advanced fi brosis.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [66]
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- Authors
- Sarkar, M., Terrault, N., Chan, W., Cedars, M. I., Huddleston, H. G., Duwaerts, C. C., Balitzer, D., & Gill, R. M.
- Affiliations
- University of California, San Francisco (US)
- University of Southern California (US)
- Corresponding author
- Sarkar, Monika
- ORCID
- Venue
- Liver International
- Publisher
- Wiley
- Published
- 2019-11-12
- Volume
- 40
- Issue
- 2
- Pages
- 355-359
- ISSN
- 0106-9543 (ISSN-L)
- 1478-3223
- 1478-3231
- PMC
- PMC6980925
- OpenAlex
- W2980707140
- Cited by
- 99
- References
- 17
- Citations by year
- 2026: 15 · 2025: 15 · 2024: 13 · 2023: 25 · 2022: 16 · 2021: 9 · 2020: 5 · 2019: 1
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Liver International (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (DK111944)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- polycystic ovary syndrome, nonalcoholic steatohepatitis, non-alcoholic fatty liver disease, liver fibrosis, hepatocyte ballooning, histologic severity, women of reproductive age, metabolic comorbidities
- MeSH terms
- Adolescent, Adult, Child, Preschool, Female, Fibrosis, Humans, Middle Aged, Polycystic Ovary Syndrome, Retrospective Studies, Young Adult, Non-alcoholic Fatty Liver Disease
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