1a774b5787535a9aca6703478e8e6233 pmc_9917911.pdf c6f12d64309ff97fa11548ed11eb389ddad3f7fa pmc_9917911.pdf 1a6026aa6f268bcf2680c8675029e7e2191e2feea9ce1389dfa78aad7a037aa0 pmc_9917911.pdf Title: Non-Alcoholic Fatty Liver Disease in Patients with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression Subject: Background: The metabolic effects of polycystic ovary syndrome (PCOS) may increase the risk of non-alcoholic fatty liver disease (NAFLD). However, the burden of NAFLD in PCOS has not been unequivocally defined. This systematic review (SR), meta-analysis (MA) assessed NAFLD’s prevalence, and risk factors in patients with PCOS. Methods: A literature search was performed in MEDLINE, Scopus, and Scielo. First, we performed a MA of proportions to estimate the prevalence of NAFLD in PCOS. Second, we performed meta-analyses of precalculated adjusted odds ratios to examine NAFLD risk factors. Finally, we performed a meta-regression to model how the estimated prevalence changed with changes in prespecified variables. Results: We identified 817 articles from the database searches. Thirty-six were included. MA of proportions found a pooled NAFLD prevalence of 43% (95% CI, 35–52%) with high heterogeneity (I2 = 97.2%). BMI, waist circumference, ALT values, HOMA-IR values, free androgen index levels, hyperandrogenism, and triglycerides were associated with significantly higher risk-adjusted odds of NAFLD among patients with PCOS. Meta-regression showed that rises in NAFLD prevalence were mediated through increases in metabolic syndrome prevalence and higher levels of HOMA-IR, free androgen index, and total testosterone. Conclusion: The prevalence of NAFLD (43%) among PCOS patients is high despite their average young age, with several metabolic and PCOS-specific factors influencing its occurrence. Screening programs may aid in detecting metabolic-associated fatty liver disease and prevent its consequences. Further work is required to establish the burden of liver-related outcomes once NAFLD has progressed in the PCOS population. Keywords: non-alcoholic fatty liver disease; metabolic dysfunction associated fatty liver disease; polycystic ovary syndrome; prevalence; risk factors Author: Ramiro Manzano-Nunez, Marta Santana-Dominguez, Jesus Rivera-Esteban, Clara Sabiote, Elena Sena, Juan Bañares, Frank Tacke and Juan M. Pericàs Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Feb 2 08:52:03 2023 CET ModDate: Thu Feb 2 09:39:06 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 18 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1359330 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ZUQJJT+VnURWPalladioL Type 1 Custom yes yes no 10 0 GWNMII+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 BWMZSA+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 SFUYRW+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 WNWTFR+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 LWLIVD+EURM10 Type 1 Builtin yes yes no 80 0 ENCFJC+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 94 0 ENCFJE+PalatinoLinotype TrueType WinAnsi yes yes no 97 0 ENCFJG+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 100 0 XXUHRS+URWPalladioL-BoldItal Type 1 Custom yes yes no 107 0 ENCFJC+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 127 0 ENCFJE+PalatinoLinotype TrueType WinAnsi yes yes no 130 0 ENCFJG+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 133 0 ENCHML+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 136 0 ENCFJC+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 154 0 ENCFJE+PalatinoLinotype TrueType WinAnsi yes yes no 157 0 ENCFJG+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 160 0 ENCHML+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 163 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-07-12 02:30:59 CEST RepresentationInformation: pmc_9917911.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-30 02:15:26 CEST Size: 1359330 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 419 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Eligibility Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Inclusion Criteria and Exclusion Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Children: Item: Title: Types of Studies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Participants Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Electronic Search Strategies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Study Selection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Data Collection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Risk of Bias Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Data Synthesis and Meta-Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Subgroup Analyses and Meta-Regression Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Children: Item: Title: Characteristics of the Included Studies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Characteristics of Participants Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: NAFLD Assessment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Info: Title: Non-Alcoholic Fatty Liver Disease in Patients with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression Author: Ramiro Manzano-Nunez, Marta Santana-Dominguez, Jesus Rivera-Esteban, Clara Sabiote, Elena Sena, Juan Bañares, Frank Tacke and Juan M. Pericàs Subject: Background: The metabolic effects of polycystic ovary syndrome (PCOS) may increase the risk of non-alcoholic fatty liver disease (NAFLD). However, the burden of NAFLD in PCOS has not been unequivocally defined. This systematic review (SR), meta-analysis (MA) assessed NAFLD’s prevalence, and risk factors in patients with PCOS. Methods: A literature search was performed in MEDLINE, Scopus, and Scielo. First, we performed a MA of proportions to estimate the prevalence of NAFLD in PCOS. Second, we performed meta-analyses of precalculated adjusted odds ratios to examine NAFLD risk factors. Finally, we performed a meta-regression to model how the estimated prevalence changed with changes in prespecified variables. Results: We identified 817 articles from the database searches. Thirty-six were included. MA of proportions found a pooled NAFLD prevalence of 43% (95% CI, 35 52%) with high heterogeneity (I2 = 97.2%). BMI, waist circumference, ALT values, HOMA-IR values, free androgen index levels, hyperandrogenism, and triglycerides were associated with significantly higher risk-adjusted odds of NAFLD among patients with PCOS. Meta-regression showed that rises in NAFLD prevalence were mediated through increases in metabolic syndrome prevalence and higher levels of HOMA-IR, free androgen index, and total testosterone. Conclusion: The prevalence of NAFLD (43%) among PCOS patients is high despite their average young age, with several metabolic and PCOS-specific factors influencing its occurrence. Screening programs may aid in detecting metabolic-associated fatty liver disease and prevent its consequences. Further work is required to establish the burden of liver-related outcomes once NAFLD has progressed in the PCOS population. 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