ESPE Abstracts

Context: Polycystic ovary syndrome (PCOS) is a complex disorder affecting women from adolescence until menopause. PCOS in adolescent years shares common features with clinical presentation in adulthood, including the adverse metabolic profile. Non-alcoholic fatty liver disease (NAFLD) is a spectrum of hepatic changes, from liver steatosis to severe inflammation and fibrinogenesis.

Objective: To assess NAFLD in an adolescent sample diagnosed with PCOS, using non-invasive indices.

Patients: The study included 87 Caucasian adolescent girls (40 controls and 47 PCOS patients), aged 12.28-18.62 years (mean=15.20, SD=1.40) recruited from the Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, at the Aghia Sophia Children's Hospital.

Methods: Adolescents’ somatometric data were recorded and biochemical and hormonal parameters were measured with commercial methods. Fatty liver index (FLI), Liver fat score (LFS), Lipid accumulation product (LAP), Hepatic steatosis index (HSI) and PCOS hepatic steatosis index for obese individuals (PCOS-HS), Visceral adiposity index (VAI), FIB-4 index, NAFLD fibrosis score (NFS), AST to Platelet ratio index (APRI), BARD score, and BAAT score were calculated by given equations to assess liver steatosis and fibrosis. Imaging studies were also performed; specifically liver ultrasound to assess steatosis and Fibroscan for fibrotic changes.

Results: Class I NAFLD was detected by ultrasound in 13.5% of all adolescents, 22.7% of PCOS patients and 6.1% of controls (P=0.046). ALT levels were not significantly different between PCOS patients and controls; 15% of all adolescents had ALT>22U/l but only one adolescent had ALT>44U/L. LFS, FLI, HSI and ALT/triglycerides ratio were worse in PCOS patients than controls (P=0.019, 0.007, 0.004, 0.009 respectively). For VAI, LAP and PCOS-HS the differences were not statistically significant. Fibroscan stiffness and IQR were not significantly different between PCOS patients and controls (P=0.570 and 0.496 respectively) and only 3 adolescents of each group (PCOS patients and controls) had Fibroscan® values indicative of hepatic fibrosis (≥7.9kPa). Neither of the calculated scores for hepatic fibrosis (FIB4, NFS, APRI, BARD and BAAT) were more affected in PCOS patients than controls.

Conclusion: Data about PCOS and NAFLD in adolescents are scarce. Lack of ideal and safe diagnostic methods for NAFLD and lack of consensus for pediatric population’s diagnostic algorithm create heterogeneity in the literature. This is the first time a study uses such a variety of methods to measure NAFLD in adolescents with PCOS.