NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) is a very common disorder to be associated with PCOS (poly cystic ovary syndrome). NAFLD is the accumulation of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non-serious condition called fatty liver. A small group of people with NAFLD may have a more serious condition named non-alcoholic steatohepatitis (NASH). In NASH, fat accumulation is associated with liver cell inflammation and different degrees of scarring. NASH is a potentially serious condition that may lead to severe liver scarring and cirrhosis.

NAFLD is highly prevalent in PCOS affecting females. It has been seen that 15% to 55% of women with PCOS are diagnosed with NAFLD. The liver isn’t meant to store fat. Its role is to serve as the detoxifying organ for the body filtering out harmful substances. Thus, when PCOS starts to contribute in accumulating fat inside liver then, the condition of the female worsens.

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NAFLD is a silent condition. Most women with PCOS won’t know that they have it until getting blood results. Having fatty liver or NAFLD increases the risk of cardiovascular disease. If not treated, NAFLD can progress to more advanced stages of liver damage such as NASH & liver cirrhosis.



  • Diagnosis by blood test named as “Liver function test” (LFT) including alanine aminotransferase (ALT) & aspartate aminotransferase (AST)
  • Confirmation by ultrasound of the liver or liver biopsy



Insulin resistance and obesity in PCOS causes NAFLD in women. Insulin resistance in adipose tissue results in accelerated lipolysis, causing an increased flow of free fatty acids to the liver, thus favoring hepatic fat accumulation. Visceral adipose tissue by increased free fatty acid flow to the liver seems to be an important regulator of fatty liver.


There are some factors which contribute in worsening the condition of NAFLD in women with PCOS. These are:


  • Excess abdominal weight
  • Insulin resistance5
  • Elevated androgens (testosterones)
  • Hightriglycerides
  • High LDL cholesterol level
  • Low HDL cholesterol level
  • Inactive lifestyle
  • Obstructive sleep apnea


Therapeutic interventions primarily target the risk factors for NAFLD – obesity, insulin resistance, dyslipidemia and hyperglycemia. Curing these risk factors might automatically prevent the development of NAFLD in PCOS females.

Dietary modification 6

Fat, sugar, and excessive intake of processed foods are the main nutrition contributors to fatty liver disease. Consumption of trans-fats, fats typically found in processed and fast food, is linked with insulin resistance, inflammation and increased triglycerides. Fructose is also linked to worsening insulin resistance and inflammation which is found in corn syrup, juice and other flavored beverages.

Keeping trans-fats, sugar and processed foods out of the diet will improve the condition of the liver. Liver can remain healthy by eating a healthy diet rich in whole grains, lean proteins, beans and legumes, fish and plenty of fruits and vegetables.

Lose Weight

7Weight loss is effective for treating fatty liver disease as it can improve insulin resistance, triglycerides and visceral fat. An inactive lifestyle is one of the contributing factors to NAFLD. Engaging in regular physical activity consisting of aerobic and resistance training, can decrease fatty liver even if weight loss isn’t achieved.

Participants who engaged in 30 to 60 minutes of exercise two to three times each week saw significant reductions in liver fat.

Thus diet, weight loss and exercise are the cornerstone of treatment and may be combined with insulin-sensitizers (metformin or pioglitazone), hypolipidemic drugs and hepato-protective agents like antioxidants and anti-inflammatory agents.

Fish Oil

8Omega-3 fatty acids like the ones found in cold water fish such as salmon, tuna and trout are effective at reducing triglycerides, inflammation and insulin in women with PCOS. In a clinical study, women with PCOS who supplemented their diets with 4 grams of fish oil for 8 weeks saw a significant decrease in liver fat and triglycerides.

Supplement with Vitamin E

9Women with PCOS have been shown to have higher levels of oxidative stress than women without PCOS. Oxidative stress is a contributing factor to diseases like NAFLD. Antioxidants work to fight oxidative stress and have been suggested in the treatment of NAFLD. Vitamin E, a powerful antioxidant, is commonly recommended to those with NAFLD.


10Fenugreek has been clinically shown to be effective in the treatment of PCOS and its complications. Fenugreek seeds extract-based product – Furocyst has shown to improve the condition of PCOS. It is a patented and clinically evaluated product proven safe and effective with patients in PCOS. Fenugreek is also reported to be a good antioxidant to fight against oxidative stress. It may be able to manage NAFLD in PCOS suffering females.

Non-alcoholic fatty liver disease (NAFLD) in women with PCOS is common and serious, but can easily be reversed with diet and lifestyle changes!

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