Unraveling the Interplay between Nonalcoholic Fatty Liver Disease and Polycystic Ovary Syndrome in Adolescents: Pathogenesis, Prevalence, and Management Strategies

Kinga Półkośnik; Agnieszka Łebkowska; Irina Kowalska; Dariusz M. Lebensztejn

doi:10.12659/MSM.940398

17 July 2023: Meta-Analysis

Unraveling the Interplay between Nonalcoholic Fatty Liver Disease and Polycystic Ovary Syndrome in Adolescents: Pathogenesis, Prevalence, and Management Strategies

Kinga Półkośnik ^1ABCDEFG* , Agnieszka Łebkowska ^2ACDEF , Irina Kowalska ^2ACDEF , Dariusz M. Lebensztejn ^1ABCDEFG

DOI: 10.12659/MSM.940398

Med Sci Monit 2023; 29:e940398

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Table 1 Characteristics of the studies included in the systematic review.

No.	First author (year)	Reference	Region, country	PCOS criteria	NAFLD/MAFLD/HS diagnosis	Study design	No. of participants
1.	Ayonrinde et al (2016)	[]³⁶	Australia	NIH 1990^*	USG	Prospective	199
2.	Tollefson et al (2018)	[]³⁷	USA	Previous diagnosis based on International Classification of Diseases	Previous diagnosis based on International Classification of Diseases	Retrospective	59 914
3.	Garoufi et al (2021)	[]¹²	Greece	Rotterdam 2003^**	USG	Prospective	32
4.	Carreau et al (2019)	[]³⁸	USA	NIH 1990^*	MRI	Prospective/retrospective	108
5.	Kim et al (2016)	[]³⁹	USA	Endocrine Society Clinical Practice Guidelines 2013^***	CT	Prospective	70
6.	de Zegher et al (2021)	[]²²	Spain	An International Consortium of Pediatric Endocrinology update 2018^#	MRI; MAFLD triad: hepatic fat, HOMA-IR, CRP	Retrospective	62
7.	Garcia-Beltran et al (2021)	[]²³	Spain	An International Consortium of Pediatric Endocrinology update 2018^#	MRI	Prospective	30
8.	Cree-Green et al (2016)	[]²⁹	USA	NIH 1990^*	MRI	Prospective	71
9.	Jobira et al (2021)	[]³⁰	USA	NIH 1990^*	MRI, MR elastography	Prospective	34
10.	Cree-Green et al (2017)	[]³¹	USA	NIH 1990^*	MRI	Prospective	38
11.	Díaz et al (2018)	[]²⁴	Spain	Endocrine Society Clinical Practice Guidelines 2013^***	MRI	Prospective	35
12.	Castro-Correia et al (2018)	[]⁴⁰	Portugal	Endocrine Society and Rotterdam criteria^**	USG and/or hepatic cytolysis markers (AST, ALT, GGTP)	Prospective	44
13.	Won et al (2021)	[]⁴¹	Korea	Excess androgen and PCOS society in 2009^##	USG, transient elastography and/or MRI	Retrospective	586
14.	Ibáñez et al (2017)	[]²⁵	Spain	Endocrine Society Clinical Practice Guidelines 2013^***	MRI	Prospective	34
15.	Ware (2022)	[]³²	USA	NIH 1990^*	MRI	Prospective	113
16.	Michaliszyn et al (2013)	[]⁴²	USA	NIH 1990^*	CT	Prospective	30
17.	Simon et al (2020)	[]³³	USA	NIH 1990^*	MRI	Prospective	66
18.	Leon et al (2018)	[]⁴³	Canada	Pre-existing diagnosis, or Endocrine Society Clinical Practice Guidelines 2013^***	USG and/or elevated ALT/AST activity	Retrospective	199
19.	Andrisse et al (2021)	[]³⁴	USA	NIH 1990^*	MRI	Prospective/retrospective	101
20.	de Zegher et al (2021)	[]²⁶	Spain	An International Consortium of Pediatric Endocrinology update 2018^#	MRI	Prospective/retrospective	78
21.	Ibáñez et al (2020)	[]²⁷	Spain	An International Consortium of Pediatric Endocrinology update 2018^#	MRI	Retrospective	114
22.	Malpique et al (2019)	[]²⁸	Spain	An International Consortium of Pediatric Endocrinology update 2018^#	MRI	Prospective/retrospective	51
23.	Urbano et al (2022)	[]⁴⁴	Italy	NIH 1990^*	USG	Prospective	32
ALT – alanine aminotransferase activity; AST – aspartate aminotransferase activity; CRP – C-reactive protein; CT – computed tomography; GGTP – gamma-glutamyl transpeptidase; HOMA-IR – the homeostatic model assessment for insulin resistance; HS – hepatic steatosis; MAFLD – metabolic dysfunction-associated fatty liver disease; MR – magnetic resonance; MRI – magnetic resonance imaging; NAFLD – non-alcoholic fatty liver disease; NIH 1990–1990 National Institute of Health Guidelines; No. – number; PCOS – polycystic ovary syndrome; USA – United States of America; USG – ultrasonography. ^* 1990 NIH guidelines: irregular menses (ovulation frequency 35 days) and hyperandrogenism – clinical and/or biochemical; ^ Rotterdam 2003 Guidelines – 2 out of 3: oligo- and/or anovulation, clinical and/or biochemical signs of hyperandrogenism, polycystic ovaries, and exclusion of other etiologies; ^* Endocrine Society Clinical Practice Guidelines 2013: hyperandrogenism- clinical and/or biochemical, oligomenorrhea, and the exclusion of secondary etiologies; ^# An International Consortium of Pediatric Endocrinology update 2018: hyperandrogenism - biochemical or clinical, oligomenorrhea ≥2 years after menarche, and the exclusion of secondary etiologies; ^## Androgen excess and PCOS society in 2009: oligomenorrhea and hyperandrogenism.

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Unraveling the Interplay between Nonalcoholic Fatty Liver Disease and Polycystic Ovary Syndrome in Adolescents: Pathogenesis, Prevalence, and Management Strategies

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