Evecare • Vol 11 • No. 2 • Sep–Dec 2023 2 Nonalcoholic Fatty Liver Disease in Women With Polycystic Ovary Syndrome prolonging the half-life of very low-density lipoproteins and LDL. As a result, lipids accumulate in the liver, thus, increasing the risk of NAFLD.3 Inflammatory response Hyperandrogenemia can induce a low-grade inf lammatory state by increasing the transcripts of the androgen receptor. Excess androgens can induce mitochondrial β-oxidation imbalance, cause de novo lipogenesis, and exacerbate hepatic inf lammatory damage by upregulating the expression and release of tumor necrosis factor-a and interleukins 6 and 1β, thus contributing to the development of NAFLD.2,3 Visceral fat accumulation Increased androgen level can promote visceral fat accumulation by inhibiting the activation of adenosine monophosphate–activated protein kinase (AMPK)—a potent inhibitor of lipogenesis in adipose tissues. The release of the nonesterified fatty acids from visceral adipocytes and impaired adipocyte differentiation and adipokine formation lead to adipose tissue buildup in the abdomen. In obesity, due to lipodystrophy, the ability of the adipose tissue to store excess energy is also diminished, which causes the hepatocytes to store excess lipids.2,3 Apoptosis Androgens are known as proapoptotic agents that target many types of peripheral cells, including hepatocytes. Hyperandrogenism leads to hepatocyte damage through its apoptotic function, in women with PCOS, and therefore, contributes to an increased risk of NAFLD progression.4 Thus, hyperandrogenemia may directly or indirectly contribute to NAFLD in women with PCOS. The Importance of Medical Intervention Reports of a few patients with PCOS having ultrasonographic evidence of fatty liver also show concurrent abnormal levels of aminotransferases. Without timely diagnosis, such significant liver pathology could potentially go unrecognized for long periods in women who are at risk of progressive and severe hepatic diseases.4 Given the inf luence of PCOS on clinically significant liver diseases such as NAFLD, early detection of NAFLD is crucial, especially at a young age. Medical intervention at an early stage may decrease or even eliminate the possibility of NAFLD progression.4 Lifestyle Intervention Both PCOS and NAFLD can be managed by adopting lifestyle modifications such as increased physical activity and consumption of a low-calorie diet for weight management. However, if the condition worsens, the disease could progress to nonalcoholic steatohepatitis, and lifestyle modifications would become ineffective.2 Lifestyle modifications help maintain healthy weight, increase insulin sensitivity, decrease hyperandrogenemia, and reduce the harmful effects of endocrine and metabolic disorders on the liver in women with PCOS.2 References 1. Khan MS, et al. Int J Mol Sci. 2023;24(8):7454. 2. Wang D, He B. Diabetes Metab Syndr Obes. 2022;15:1281– 1291. 3. Wu J, et al. Reprod Health. 2018;15(1):77. 4. Kelley CE, et al. World J Gastroenterol. 2014;20(39):14172– 14184. Impaired hepatic lipid metabolism, apoptosis and autophagy imbalance, impaired branched-chain amino acid metabolism, and inflammation contribute to the development and progression of NAFLD in PCOS.2
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