Endocrine https://doi.org/10.1007/s12020-019-02085-7 REVIEW Nonalcoholic fatty liver disease in women with polycystic ovary syndrome Stavroula Α. Paschou 1 ● Stergios A. Polyzos 2 ● Panagiotis Anagnostis 3 ● Dimitrios G. Goulis 3 ● Christina Kanaka-Gantenbein 1 ● Irene Lambrinoudaki 4 ● Neoklis A. Georgopoulos 5 ● Andromachi Vryonidou 6 Received: 25 June 2019 / Accepted: 27 August 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Polycystic ovary syndrome (PCOS) affects 6–15% of women of reproductive age. Nonalcoholic fatty liver disease (NAFLD) affects 25–30% of the general population and its prevalence increases in parallel with the epidemics of obesity and type 2 diabetes mellitus. A growing body of evidence suggests that NAFLD and PCOS quite often co-exist. The aim of this article is to summarize and critically appraise the literature regarding: (1) the rates of co-existence of the two entities, (2) the possible pathophysiological links, (3) the proper diagnostic assessment and (4) the appropriate management of women with NAFLD and PCOS. Data from clinical studies and meta-analyses indicate a higher prevalence of NAFLD in women with PCOS ranging from 34% to 70% compared with 14% to 34% in healthy women. Inversely, women with NAFLD are more often diagnosed with PCOS. Insulin resistance (IR) and hyperandrogenism are two main potential pathophysiological links between the two entities. In this regard, IR seems to interplay with obesity and hyperandrogenism, thus affecting NAFLD and PCOS and being affected by them. Women with PCOS, particularly those with IR and/or hyperandrogenism, are suggested to be screened for NAFLD, while premenopausal women with NAFLD is suggested to be screened for PCOS. Lifestyle recommendations with a change in dietary habits, weight loss and exercise, constitute currently the cornerstone of the management of both NAFLD and PCOS. Insulin sensitizers maybe used for the treatment of these women, while there are limited promising data for the use of liraglutide. Keywords Nonalcoholic fatty liver disease ● Nonalcoholic steatohepatitis ● Polycystic ovary syndrome ● Ovaries, Hyperandrogenism, Insulin resistance, Metabolic syndrome Introduction Polycystic ovary syndrome (PCOS) represents the most common endocrine disorder in women of reproductive age, with a prevalence of 6–15% [1], varying according to the applied criteria [2–4]. The syndrome is characterized by chronic anovulation and hyperandrogenism, with women often presenting menstrual cycle disturbances and hirsutism or acne [1]. From a metabolic point of view, insulin resis- tance (IR) is a cardinal feature of PCOS. In this regard, many women with PCOS develop features of the IR or metabolic syndrome (MetS), such as obesity, dyslipidemia, hypertension, and glycemic dysregulation [1, 5, 6]. Nonalcoholic fatty liver disease (NAFLD) affects 25–30% of the general population, which may increase to 80–90% in specific populations, such as obese patients with type 2 diabetes mellitus (T2DM) [7]. NAFLD is diagnosed after the exclusion of secondary causes of fatty liver, including viral or autoimmune hepatitis, Wilson’s disease, * Stavroula Α. Paschou s.a.paschou@gmail.com 1 Division of Endocrinology and Diabetes, “Aghia Sophia” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2 First Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece 3 Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece 4 Division of Endocrinology and Diabetes, Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece 5 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Medical School, University of Patras, Rio, Patras, Greece 6 Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece 1234567890();,: 1234567890();,: