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Liver Injury Indicating Fatty Liver but Not Serologic NASH Marker Improves under Metformin Treatment in Polycystic Ovary Syndrome.

Tan S, Vollmar N, Benson S, Sowa JP, Bechmann LP, Gerken G, Fuhrer D, Canbay A - Int J Endocrinol (2015)

Bottom Line: In PCOS-PIR, ALT levels increased significantly accompanied by a nominal, nonsignificant M30 increase.Conclusions.This could either indicate a missing effect of metformin on NAFLD or slowed disease progression.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Division of Laboratory Research, University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

ABSTRACT
Objective. Polycystic ovary syndrome (PCOS) is associated with obesity and insulin resistance (IR), key features of nonalcoholic steatohepatitis (NASH). Cytokeratin 18 fragments (M30) have been established as a serum marker for NASH. The insulin sensitizer metformin improves hepatic IR. This study evaluates the influence of MF on serologic NASH (sNASH) in patients with PCOS. Patients and Methods. In 89 patients, metabolic parameters, liver injury indicating fatty liver (LIFL), and M30 were assessed at baseline and after metformin treatment. Patients with initial IR were subdivided into dissolved (PCOS-exIR) and persistent IR (PCOS-PIR) after treatment and compared to an initially insulin sensitive PCOS group (PCOS-C). Results. Improvement of LIFL prevalence could be seen in PCOS-C and PCOS-exIR compared to PCOS-PIR (-19.4, resp., -12.0% versus 7.2%, Chi(2) = 29.5, P < 0.001) without change in sNASH prevalence. In PCOS-PIR, ALT levels increased significantly accompanied by a nominal, nonsignificant M30 increase. Conclusions. Metformin improves LIFL in subgroups of patients with PCOS without influencing sNASH. This could either indicate a missing effect of metformin on NAFLD or slowed disease progression. Further studies are needed to elucidate NAFLD in the context of PCOS and potential therapeutic options.

No MeSH data available.


Related in: MedlinePlus

Comparison of metabolic/hepatic markers in the three PCOS groups (PCOS-C: patients who were insulin sensitive at baseline; PCOS-PIR: patients with IR at baseline and after treatment; PCOS-exIR: initially insulin resistant patients whose IR dissolved after treatment). Data are presented as percent changes (between baseline and after treatment) of prevalence and were analyzed using Chi²-tests.
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Related In: Results  -  Collection


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fig2: Comparison of metabolic/hepatic markers in the three PCOS groups (PCOS-C: patients who were insulin sensitive at baseline; PCOS-PIR: patients with IR at baseline and after treatment; PCOS-exIR: initially insulin resistant patients whose IR dissolved after treatment). Data are presented as percent changes (between baseline and after treatment) of prevalence and were analyzed using Chi²-tests.

Mentions: A significant loss in body weight (−6 kg) and BMI (−2.2 kg/m²) was observed only in PCOS-exIR patients (body weight: F = 6.3, P < 0.01; BMI: F = 6.3, P < 0.01, interaction effects; for post hoc comparisons, see Table 2). MF treatment led to a slight but significant increase in HDL-cholesterol (F = 4.5, P < 0.05), while no significant changes in cholesterol, LDL-cholesterol and triglycerides could be demonstrated in all patients (Table 2). Both PCOS-exIR and PCOS-PIR groups showed significantly greater reductions in MBS prevalence (delta MBS) compared to PCOS-C (Chi² = 43.0, P < 0.001; Figure 2).


Liver Injury Indicating Fatty Liver but Not Serologic NASH Marker Improves under Metformin Treatment in Polycystic Ovary Syndrome.

Tan S, Vollmar N, Benson S, Sowa JP, Bechmann LP, Gerken G, Fuhrer D, Canbay A - Int J Endocrinol (2015)

Comparison of metabolic/hepatic markers in the three PCOS groups (PCOS-C: patients who were insulin sensitive at baseline; PCOS-PIR: patients with IR at baseline and after treatment; PCOS-exIR: initially insulin resistant patients whose IR dissolved after treatment). Data are presented as percent changes (between baseline and after treatment) of prevalence and were analyzed using Chi²-tests.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4383456&req=5

fig2: Comparison of metabolic/hepatic markers in the three PCOS groups (PCOS-C: patients who were insulin sensitive at baseline; PCOS-PIR: patients with IR at baseline and after treatment; PCOS-exIR: initially insulin resistant patients whose IR dissolved after treatment). Data are presented as percent changes (between baseline and after treatment) of prevalence and were analyzed using Chi²-tests.
Mentions: A significant loss in body weight (−6 kg) and BMI (−2.2 kg/m²) was observed only in PCOS-exIR patients (body weight: F = 6.3, P < 0.01; BMI: F = 6.3, P < 0.01, interaction effects; for post hoc comparisons, see Table 2). MF treatment led to a slight but significant increase in HDL-cholesterol (F = 4.5, P < 0.05), while no significant changes in cholesterol, LDL-cholesterol and triglycerides could be demonstrated in all patients (Table 2). Both PCOS-exIR and PCOS-PIR groups showed significantly greater reductions in MBS prevalence (delta MBS) compared to PCOS-C (Chi² = 43.0, P < 0.001; Figure 2).

Bottom Line: In PCOS-PIR, ALT levels increased significantly accompanied by a nominal, nonsignificant M30 increase.Conclusions.This could either indicate a missing effect of metformin on NAFLD or slowed disease progression.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Division of Laboratory Research, University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

ABSTRACT
Objective. Polycystic ovary syndrome (PCOS) is associated with obesity and insulin resistance (IR), key features of nonalcoholic steatohepatitis (NASH). Cytokeratin 18 fragments (M30) have been established as a serum marker for NASH. The insulin sensitizer metformin improves hepatic IR. This study evaluates the influence of MF on serologic NASH (sNASH) in patients with PCOS. Patients and Methods. In 89 patients, metabolic parameters, liver injury indicating fatty liver (LIFL), and M30 were assessed at baseline and after metformin treatment. Patients with initial IR were subdivided into dissolved (PCOS-exIR) and persistent IR (PCOS-PIR) after treatment and compared to an initially insulin sensitive PCOS group (PCOS-C). Results. Improvement of LIFL prevalence could be seen in PCOS-C and PCOS-exIR compared to PCOS-PIR (-19.4, resp., -12.0% versus 7.2%, Chi(2) = 29.5, P < 0.001) without change in sNASH prevalence. In PCOS-PIR, ALT levels increased significantly accompanied by a nominal, nonsignificant M30 increase. Conclusions. Metformin improves LIFL in subgroups of patients with PCOS without influencing sNASH. This could either indicate a missing effect of metformin on NAFLD or slowed disease progression. Further studies are needed to elucidate NAFLD in the context of PCOS and potential therapeutic options.

No MeSH data available.


Related in: MedlinePlus