The link between PCOS and Fatty Liver Disease

1 in 10 women suffer from polycystic ovarian syndrome(1), a hormonal disorder commonly found in women of reproductive age. PCOS does not have a definitive cause, although metabolic and genetic factors are said to play a major role in the development of PCOS. The most common symptoms of PCOS are acne, excessive hair growth, irregular and painful periods, infertility, and weight gain.

PCOS is often a part of an overall metabolic syndrome that is a combination of obesity, diabetes, high blood pressure, and an abnormal lipid profile. Most women with PCOS are often unaware of a liver disease that could co-exist in this situation and which could have potentially serious complications with advancing age. As part of the metabolic syndrome, accumulation of excess fat in the liver damages it slowly over a period of several years. This condition is known as non-alcoholic fatty liver diseases (NAFLD).

Fatty liver is well known to occur in those who consume alcohol. What is less known is that fatty liver also occurs commonly in individuals who do not drink alcohol at all. Non-alcoholic fatty liver disease (NAFLD) is extremely common in individuals who are overweight, have sedentary lifestyles, unhealthy dietary practices and in those with diabetes. As many as 50 percent of this group of individuals may suffer from NAFLD. NAFLD has now become the most common cause of liver cirrhosis and liver failure requiring liver transplantation. NAFLD can be classified into two subgroups NAFL (or simple fatty liver) and NASH (non-alcoholic steato-hepatitis). It is important to differentiate between these two conditions since NASH is a progressive disease and can lead to advanced liver disease over a period of time. In individuals with NASH, excess fat in the liver is associated with inflammation and scarring of the liver. On the other hand, individuals with simple fatty liver usually do not progress. Individuals with NAFLD do not have any specific symptoms related to liver disease and very few come to a doctor for assessment. An ultrasound scan may reveal fat in the liver but based to simple blood tests and ultrasound, it is often not possible to distinguish between simple fatty liver and NASH. Women with PCOS are likely to have fatty liver disease, which is often ignored because women don’t get tested for it. Even if tested and found to have fatty liver, they are often not aware whether they have simple fatty or NASH, which can silently progress to liver cirrhosis.

In order to understand the condition of fatty liver, it is necessary to understand the role of fat in the liver and how fatty liver can cause liver damage. Overindulgence in unhealthy food causes excess intake of calories, fructose and fat. This when combined with decreased fat burning owing to sedentary lifestyles, causes the fat to be stored in the liver cells. Insulin is one of the hormones required for burning excess fat in the liver. Diabetic patients are often deficient in insulin or have

insulin resistance similar to women with PCOS who also have insulin resistance. Patients with NAFLD due to reasons other than diabetes also have insulin resistance. With excess amounts of fat in the liver, the liver enlarges in size. Excess fat then leads to inflammation in the liver that damages the liver cells and leads to scarring. Repeated inflammation and scarring over a period of several years leads to liver cirrhosis.

A 2013 study conducted on the prevalence of fatty liver disease in women with PCOS, revealed that fatty liver disease is very common in them.(2) Women with PCOS who have a large waistline, high BMI, fluctuating cholesterol levels are at a greater risk of developing fatty liver disease. Fatty liver disease does not manifest any symptoms and is only usually diagnosed once it reaches an advanced stage. Women with PCOS who are older than 40 years, diabetic, overweight, and/or have a family history of diabetes or liver disease must be aware of the condition and should get screened for fatty liver. It is ideal for women diagnosed with PCOS at any age to be screened for fatty liver as well as all other related metabolic risk factors. Fatty liver diagnosed at an early stage can be reversed and long-term complications can be prevented. Fatty liver and its associated metabolic conditions such as diabetes, high blood pressure and high cholesterol are all independently responsible for causing cardiovascular disease.

Women suffering from PCOS with fatty liver disease can make a variety of lifestyle changes that can help curb both conditions. Losing weight, avoiding alcohol, avoiding the consumption processed foods and increasing consumption of food rich in nutrients is essential for overall health and wellbeing. There is ongoing research on several new drugs that have beneficial effect on fatty liver disease and few of these drugs are now licensed for treatment.

A healthy liver is extremely important in order to maintain hormonal balance in the body. Women with PCOS need to be aware of fatty liver disease and the higher risk they are at. However, if diagnosed and treated in its early stages, fatty liver is one of the conditions that can be reversed.

Dr. Kaiser Raja, 

Chief Hepatologist 

Aster Integrated Liver Care Program 

Aster Hospital Mankhool