OR24-04 High Prevalence Of Elevated ALT In Adolescent Females With Obesity And PCOS
Authors: Zhang Sherry , Darbinian Jeanne A , Greenspan Louise C , Schwimmer Jeffrey B , Lo Joan C 
Published: October 2023

Abstract
Disclosure: S. Zhang: None. J.A. Darbinian: None. L.C. Greenspan: None. J.B. Schwimmer: Grant Recipient; Self; Intercept, Seraphina. J.C. Lo: None.
Background: We recently observed that US Asian/Pacific Islander (PI) adolescents have two-fold higher odds of polycystic ovary syndrome (PCOS) compared to non-Hispanic White adolescents, with prevalence strongly associated with higher BMI. Moreover, similar to Hispanic/Latina adolescents, Asian/PI adolescents with obesity have much higher odds of elevated alanine aminotransferase (ALT), a biochemical marker for suspected non-alcoholic fatty liver disease (NAFLD). In a pilot study, we observed that PCOS was an independent predictor of elevated ALT in adolescent females with obesity. In this study, we characterized the association of PCOS and elevated ALT in a much larger population of adolescent females and further examined the burden of elevated ALT within the PCOS subset. Methods: We used data from 15,683 females aged 13-17 years who were members of a US integrated healthcare system, had a well-child visit in 2012-2018, met BMI criteria for obesity (BMI ≥95th percentile), and had ALT measured within 1 year of the visit. Elevated ALT was defined as ≥44 U/L (NASPHGAN criteria). PCOS was identified based on clinical diagnosis within 1 year of the visit. Class I, II, III obesity were defined by BMI percent of the 95th percentile from 100 to &lt;120%, 120% to &lt;140%, and ≥140%, respectively. Differences between PCOS and non-PCOS groups were compared using the Chi-square test. Multivariable logistic regression was used to examine the association of PCOS and elevated ALT. Results: Among 15,683 adolescent females with obesity and measured ALT (23.5% White, 14.1% Black, 11.0% Asian/PI, 46.8% Hispanic, and 4.7% other/unknown race and ethnicity), 5.5% had diagnosed PCOS and 39.5% had severe (class II-III) obesity. The prevalence of elevated ALT was 5.1% overall and was substantially higher among those with PCOS (10.6%) compared to those without PCOS (4.7%, p&lt;0.001). In multivariable analyses, PCOS was associated with a 1.8-fold (CI 1.4-2.2) higher odds of elevated ALT, adjusting for age, race/ethnicity, and level of obesity. Similar to our prior report, greater obesity severity, Asian/PI race, and Hispanic ethnicity were significant predictors of elevated ALT. Among the subset of 865 adolescents with obesity and PCOS (40.9% class I, 34.9% class II, 24.2% class III obesity), the prevalence of elevated ALT varied by race and ethnicity, ranging from 15.8% among Asian/PI, 12.8% among Hispanic/Latina, 8.5% among White, and 2.0% among Black females. Conclusion: Our findings confirm a strong independent association of PCOS and elevated ALT among adolescent females with obesity. Among those with both obesity and PCOS, about 1 in 10 had elevated ALT, increasing to 1 in 8 among Hispanic/Latina females and nearly 1 in 6 among Asian/PI females. These findings support recommendations for NAFLD screening in adolescents with PCOS and consideration of screening in young adult women with PCOS, especially high-risk subsets.
Presentation: Saturday, June 17, 2023