ArticlePLoS medicine2018
Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database.
Article in PLoS medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 98 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The RolE oF Androgen Excess in MUscle Energy MetaboLism in Women With PolyCystic Ovary Syndrome (The REFUEL PCOS) Study 1
Pilot Trial of Bicalutamide Versus Placebo in Reproductive-Aged Women With Nonalcoholic Fatty Liver Disease (NAFLD) and Polycystic Ovary Syndrome (PCOS)
Who cites it
98 citing papers in PubMed, 6 syntheses or guidelines pooled it, 191 citations in OpenAlex.
- Society for Endocrinology Clinical Practice Guideline for the Evaluation of Androgen Excess in Women.Clinical endocrinology · 2025Guideline
- Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis.Frontiers in endocrinology · 2025Pooled it
- The hepato-ovarian axis: genetic evidence for a causal association between non-alcoholic fatty liver disease and polycystic ovary syndrome.BMC medicine · 2023Pooled it
- A systematic review of models of care for polycystic ovary syndrome highlights the gap in the literature, especially in developing countries.Frontiers in endocrinology · 2023Pooled it
- Non-alcoholic fatty liver disease across endocrinopathies: Interaction with sex hormones.Frontiers in endocrinology · 2022Pooled it
- KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease.Clinical and molecular hepatology · 2021Guideline
- Trial
- Metabolic homeostasis and women's reproductive health.Nature metabolism · 2026Review
- Article
- Approach to the patient: investigation of postmenopausal androgen excess.The Journal of clinical endocrinology and metabolism · 2026Review
- Metabolic liver disease: A summary of major guidelines and identifying opportunities to improve future guidelines.Diabetes, obesity & metabolism · 2026Review
- From Childhood to Old Age: Current Knowledge and Practical Approaches to Metabolic Dysfunction-Associated Steatotic Liver Disease.Journal of clinical medicine · 2026Review
- The Cut-Off Values for SHBG Discriminating Insulin Resistance Based on the TyG, TyG-BMI, and TyG-WC Values in Women with PCOS.Biomedicines · 2026Article
- Causal Association between Arm Fat, Left Leg Fat, and Trunk Fat Masses and Risk of Polycystic Ovarian Syndrome: A Mendelian Randomization Study.Combinatorial chemistry & high throughput screening · 2026Article
- Metabolic dysfunction-associated steatotic liver disease is associated with androgenetic alopecia in adults with stronger effects in women and unhealthy lifestyles.Scientific reports · 2025Article
- Reproductive Toxicity and Transgenerational Effects of Anesthetic Etomidate in Zebrafish: PCOS-like Ovarian Changes, Oxidative Stress, and Metabolism Disruption.Environment & health (Washington, D.C.) · 2025Article
- Baicalin mitigates polycystic ovary syndrome‑associated non‑alcoholic fatty liver disease by inhibiting the AR/SREBP1 axis.International journal of molecular medicine · 2025Article
- The Ovary-Liver Axis: Molecular Science and Epidemiology.International journal of molecular sciences · 2025Review
- Management of metabolic dysfunction-associated steatotic liver disease (MASLD)-An expert consensus statement from Indian diabetologists' perspective.Diabetes, obesity & metabolism · 2025Review
- Advancement in early diagnosis of polycystic ovary syndrome: biomarker-driven innovative diagnostic sensor.Mikrochimica acta · 2025Review
38 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundAndrogen excess is a defining feature of polycystic ovary syndrome (PCOS), which affects 10% of women and represents a lifelong metabolic disorder, with increased risk of type 2 diabetes, hypertension, and cardiovascular events. Previous studies have suggested an increased risk of nonalcoholic fatty liver disease (NAFLD) in individuals with PCOS and implicated androgen excess as a potential driver. METHODS AND
findingsWe carried out a retrospective longitudinal cohort study utilizing a large primary care database in the United Kingdom, evaluating NAFLD rates in 63,120 women with PCOS and 121,064 age-, body mass index (BMI)-, and location-matched control women registered from January 2000 to May 2016. In 2 independent cohorts, we also determined the rate of NAFLD in women with a measurement of serum testosterone (n = 71,061) and sex hormone-binding globulin (SHBG; n = 49,625). We used multivariate Cox models to estimate the hazard ratio (HR) for NAFLD and found that women with PCOS had an increased rate of NAFLD (HR = 2.23, 95% CI 1.86-2.66, p < 0.001), also after adjusting for BMI or dysglycemia. Serum testosterone >3.0 nmol/L was associated with an increase in NAFLD (HR = 2.30, 95% CI 1.16-4.53, p = 0.017 for 3-3.49 nmol/L and HR = 2.40, 95% CI 1.24-4.66, p = 0.009 for >3.5 nmol/L). Mirroring this finding, SHBG <30 nmol/L was associated with increased NAFLD hazard (HR = 4.75, 95% CI 2.44-9.25, p < 0.001 for 20-29.99 nmol/L and HR = 4.98, 95% CI 2.45-10.11, p < 0.001 for <20 nmol/L). Limitations of this study include its retrospective nature, absence of detailed information on criteria used to diagnosis PCOS and NAFLD, and absence of data on laboratory assays used to measure serum androgens.
conclusionsWe found that women with PCOS have an increased rate of NAFLD. In addition to increased BMI and dysglycemia, androgen excess contributes to the development of NAFLD in women with PCOS. In women with PCOS-related androgen excess, systematic NAFLD screening should be considered.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.