NAFLD in Adolescents and Young Adults With PCOS

Study Overview
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Brief Summary
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This project focuses on an at-risk adolescent and young adult population who may gain long-term health benefits from detection of risk factors at a young age. The primary aims of this proposal are: 1) To observe whether adolescents and young adults with Polycystic Ovary Syndrome (PCOS) are more likely to have elevated liver fat (>/=4.8%) than controls by studying liver fat deposition measured by magnetic resonance spectroscopy (MRS); 2) To assess the association of percentage liver fat with biomarkers of Non-alcoholic fatty liver disease (NAFLD), dyslipidemia, insulin resistance and body composition in PCOS and controls. In the proposed study, 40 adolescents and young adults with PCOS and 40 age-comparable control subjects will be evaluated for metabolic disturbances and elevated liver fat using noninvasive and state-of-the-art techniques including MRI, dual-energy x-ray absorptiometry and an oral glucose tolerance test in order to fully assess the metabolic and body composition differences between these groups. This research proposal represents a critical step in understanding the metabolic and cardiovascular comorbidities of PCOS and their relationship to NAFLD. The investigator hopes to use the results generated by this research proposal in order to lay the groundwork for the prevention and treatment of metabolic disorders in adolescents with PCOS. The overarching goal is to decrease and prevent lifelong morbidity associated with this common disorder.

Detailed Description
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PCOS is a common condition that frequently presents in adolescence and young adulthood and is defined by the presence of hyperandrogenism and ovulatory dysfunction. Affected individuals are at increased risk of insulin resistance, NAFLD and dyslipidemia, which are features associated with the metabolic syndrome, a major public health concern. The associations between PCOS and both insulin resistance and dyslipidemia have been extensively described; however, its association with NAFLD has only recently been noted and superficially studied in adolescents and young adults. Additionally, it has not yet been fully elucidated why seemingly healthy nonobese adolescents with PCOS are predisposed to insulin resistance and its related complications. The susceptibility of certain PCOS patients to developing NAFLD is theorized to be due to the following potentiating factors: insulin resistance, hyperandrogenemia, and a genetic predisposition.

Official Title
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Nonalcoholic Fatty Liver Disease (NAFLD), Insulin Resistance and Dyslipidemia in Adolescents and Young Adults With Polycystic Ovary Syndrome (PCOS)

Conditions
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Polycystic Ovary Syndrome, Non-Alcoholic Fatty Liver Disease, Metabolic Syndrome

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All: Healthy; between 14 and 25 years; at least 2 years postmenarche PCOS: Clinical hyperandrogenism and/or hyperandrogenemia, menstrual dysfunction (oligomenorrhea or amenorrhea) and exclusion of other known disorders. PCOS will be diagnosed using the NIH 1990 criteria. Controls: Regular menses; no clinical hyperandrogenism and/or hyperandrogenemia Exclusion Criteria: Past or present history of a medical disorder or medication known to affect body composition, insulin secretion and sensitivity, or the growth hormone (GH)-insulin-like growth factor 1 (IGF1) axis (eg steroid hormone or thyroid replacement). History of current or past pregnancy Hormonal contraceptive or metformin use within 3 months of enrollment Nonclassical congenital adrenal hyperplasia

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PCOS subjects<br>Forty adolescents and young adults between the ages of 14 and 25 years with Polycystic Ovary Syndrome (PCOS) at least two years past menarche. | |
| Control subjects<br>Forty unaffected adolescents and young adults between the ages of 14 and 25 years at least two years past menarche. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference in percentage liver fat between PCOS and controls in adolescents and young adults | To compare percentage liver fat by magnetic resonance spectroscopy between adolescents and young adults with PCOS and controls to determine if there is a difference between these groups. | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The association of percentage liver fat by magnetic resonance spectroscopy with insulin resistance as measured by HOMA-IR. | The association of percent liver fat with insulin resistance as measured by HOMA-IR will be measured by correlation/regression. | 1 day | 
| The association of percentage liver fat by magnetic resonance spectroscopy with triglycerides | The association of percent liver fat with triglycerides will be measured by correlation/regression. | 1 day | 
| The association of percentage liver fat by magnetic resonance spectroscopy with visceral adipose tissue (VAT) | The association of percent liver fat with visceral adipose tissue (VAT) will be measured by correlation/regression. | 1 day | 
| The association of percentage liver fat by magnetic resonance spectroscopy with total body adipose tissue | The association of percent liver fat with total body adipose tissue will be measured by correlation/regression. | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MRI, Polycystic Ovary Syndrome, Non-Alcoholic Fatty Liver Disease, Adolescents, Young Women, MRS, DXA, Hirsutism, Amenorrhea, Metabolic syndrome, Dyslipidemia, Percentage liver fat