Common pathogenetic mechanisms of non-alcoholic fatty liver disease and polycystic ovary syndrome

The prevalence of polycystic ovary syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD) has a clear association with each other, and the presence of one disease increases the risks of developing the other, which must be taken into account when comprehensively assessing the patient’s condition. Both diseases increase the risk of developing socially significant diseases associated with decreased life expectancy, such as type 2 diabetes mellitus and cardiovascular diseases. The purpose of this review was to summarize current data on the prevalence and pathophysiology of NAFLD in PCOS. Publications on PCOS and NAFLD were analyzed using a search of the Russian Science Citation Index, MEDLINE and Pub Med over the past 10 years, using the keywords: “PCOS”, “NAFLD”, “insulin resistance”, “hyperandrogenemia”. The author of the review included the most interesting works, covering the problem broadly and comprehensively. The analysis of the literature showed that the pathogenesis of both PCOS and NAFLD involves factors such as hyperandrogenemia, insulin resistance with compensatory hyperinsulinemia (involving in the process of metabolic dysregulation of all “classical” insulin target organs, including skeletal muscles), mitochondrial dysfunction and intestinal dysbiosis. The pathophysiological process of the formation of PCOS and NAFLD is characterized by the formation of “vicious” circles, when a violation of one link in the pathogenesis activates other links, aggravating and maintaining primary deviations. This indicates that it is necessary to search for complex, non-trivial approaches to the diagnosis and treatment of these diseases, using drugs from various groups, including insulin sensors, metabiotics, antioxidants and hepatoprotectors. The role of each drug have to be assessed in clinical trials.