Endocrine Abstracts

Serum ALT concentrations give some insight into liver fat accumulation and relate to metabolic syndrome: values>29 IU/L double risk of type 2 diabetes independent of other risk predictors. Women with PCOS are at increased risk of diabetes and CVD whereas metformin treatment modulates the progress of metabolic syndrome. Consequently, we investigated the effects of protracted metformin treatment on circulating ALT in obese women with PCOS.

Methods

83 women (BMI≥30) with PCOS were randomized to 2 doses of metformin with assessments including ALT before treatment (T0) and at 4 and 8 months. Changes within groups were assessed using repeated measures ANOVA, while relationships between the parameters were assessed using correlation statistics.

Results

67 women completed the study. At T0, 70% of the patients demonstrated circulating ALT values>19 U/L: mean activity=35 U/L. Circulating ALT values correlated with BMI, waist, blood pressure (systolic), free androgen index, and triglycerides, but even more strongly with fasting insulin, glucose, HOMA, AST and GGT (r squared=0.21, 0.13, 0.25, 0.85, and 0.15 respectively).

Metformin treatment led to modest reductions in weight (ca 5 kgs) and ALT (repeated measures Anova, p=0.018; mean reduction=4.6 U/L: CI 0.96 to 8.4). Changes in ALT correlated only with change in weight (r squared=0.14) and GGT, not with changes in fasting insulin or HOMA-IR.

Discussion

Elevated ALT levels in women with PCOS correlated strongly with BMI and markers of insulin resistance. Protracted treatment with metformin resulted in a 13% reduction in ALT in conjunction with changes in BMI. These results suggest that protracted metformin may lead to a reduction in liver adiposity, and, in turn, concur with a potential risk reduction for type 2 diabetes in women with PCOS.