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Clinical Studies and Practice

High-free androgen index is associated with increased risk of non-alcoholic fatty liver disease in women with polycystic ovary syndrome, independent of obesity and insulin resistance

International Journal of Obesity volume 41, pages 1341–1347 (2017)Cite this article

Subjects

Abstract

Background/Objective:

Central obesity and insulin resistance (IR) are common conditions in women with polycystic ovary syndrome (PCOS) and in subjects with non-alcoholic fatty liver disease (NAFLD). However, few studies have addressed the association between hyperandrogenism (HA) and NAFLD. We aimed to determine whether variations in the free androgen index (FAI) might be associated with NAFLD prevalence.

Subjects/Methods:

A cross-sectional study was performed including 400 Chinese women with PCOS and 100 age, and body mass index (BMI)-matched women. The anthropometric and serum biochemical parameters related to sex steroids, glucose and lipid profiles were examined. Liver fat content (LFC) was measured by quantitative ultrasound.

Results:

The prevalence of NAFLD was 56.23% in PCOS patients and 38% in controls (P=0.001), and this prevalence increased with FAI quartile independently of obesity and homeostasis model assessment of insulin resistance (HOMA-IR). The FAI level increased from non-NAFLD group to NAFLD group. The FAI was positively associated with the metabolic parameters LFC, BMI, waist circumference, alanine aminotransferases, aspartate, triglyceride, total cholesterol and low-density lipoprotein cholesterol, and was negatively associated with high-density lipoprotein. Moreover, in multivariate logistic regression analysis BMI, high-sensitivity C-reactive protein (hsCRP), FAI, LFC and HOMA-IR were significantly associated with NAFLD. The cut-off values of FAI, LFC, BMI and hsCRP to predict NAFLD were 9.86%, 17.19%, 24.38% and 0.72%, respectively. The area under the curve for predicting NAFLD in PCOS patients showed comparable sensitivity and specificity between BMI and a new index combining FAI with hsCRP.

Conclusions:

A higher FAI level is associated with increased LFC and NAFLD prevalence independent of obesity and IR.

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Acknowledgements

We gratefully acknowledge Dr Xia Mingfeng and Prof Gao Xin from Zhongshan Hospital, Fudan University for sharing the quantitative ultrasonographic LFC measurement procedure. This study was supported by the National Natural Science Foundation of China (Grant Number: 81200628, 2012); Chinese Medical Association Clinical Research and Special Funds—Squibb Endocrinology Diabetes Research projects to TT, 2012; the Natural Science Foundation of Shanghai, China (Grant Number: 12ZR1417800, 2012); and the Shanghai Science and Technology Development Fund (Grant Number: 08411953000 to TT, 2008). We thank the women who participated in the study and gratefully acknowledge the assistance of the nursing staff at Shanghai Renji Hospital and the technical assistants who performed the biochemical analyses.

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Author notes

  1. J Cai, C H Wu and Y Zhang: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    J Cai, Y Zhang, Y Y Wang, W D Xu, T C Lin, S X Li, L H Wang, J Zheng, W Liu & T Tao

  2. Division of Ultrasonography, Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    C H Wu

  3. Shanghai Key laboratory for Assisted Reproduction and Reproductive Genetics, Center for Reproductive Medicine, Shanghai Jiaotong University School of Medicine, Pudong, Shanghai, China

    Y Sun

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Cai, J., Wu, C., Zhang, Y. et al. High-free androgen index is associated with increased risk of non-alcoholic fatty liver disease in women with polycystic ovary syndrome, independent of obesity and insulin resistance. Int J Obes 41, 1341–1347 (2017). https://doi.org/10.1038/ijo.2017.116

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