Essential Amino Acid Supplement Decreases Liver Fat in Adolescents with PCOS and Obesity

• Published in: Obesity (Silver Spring, Md.) Md.), 2021-12, Vol.29, p.12-13
• Main Authors: Morelli, Nazeen, dham, Talyia, Garcia-Reyes, Yesenia, Ware, Meredith, Rahat, Haseeb, Sundararajan, Divya, Severn, Cameron, Pyle, Laura, Parks, Elizabeth, Wolfe, Robert, Cree-Green, Melanie
• Format: Article
• Language: English
• Subjects: Insulin resistance; Obesity; Polycystic ovary syndrome; Teenagers
• ISSN: 1930-7381; 1930-739X

Background: Polycystic ovary syndrome (PCOS) is common and characterized by hyperandrogenism and oligomenorrhea. In adolescents with PCOS + obesity, insulin resistance is universal, and rates of hepatic steatosis (HS) are 2-3 fold higher than in those without PCOS. HS is one of the best predictors for future development of type 2 diabetes. Essential amino acid (EAA) supplementation decreases patic (IHTG) in aging and alcoholic fatty liver disease, but EAA effects on IHTG in youth with PCOS and obesity were unknown. Methods: In a double-blind crossover placebo-controlled trial in adolescents with PCOS and obesity, metabolic studies were performed after 28 days of twice daily placebo and EAA drinks. Measures included fasting labs, a 4-hour oral sugar tolerance test (OSTT, 75 g of glucose and 25 g of fructose), IHTG by MRI, and body composition by DXA. Insulin resistance was estimated with HOMA-IR for the fasted state and sensitivity was estimated with the oral minimal model during the OSTT. One sample t-tests of change were used to assess treatment effects. Results: Twenty-one girls with PCOS completed the study (BMI 37.3 ± 6.5 kg/m2, age 15.6 ± 1.3 years). Weight (Д 1 kg [-1.8, 2.8]) and lean mass (Д -0.03 kg [-0.06, 0.01]) were unchanged with EAA supplementation. Following EAA, absolute IHTG decreased by 0.8% ± 1.3 (p = 0.013), which is a relative decrease of 7.5%. In those with HS at baseline (IHTG > 5.4%, N = 12), absolute IHTG decrease was -1.1% (-1.8, -0.3) with a relative decrease -9.1% (-1.5, -11.5). EAA supplementation decreased fasting triglycerides (-16 mg/dL [-36.5, -1], p = 0.019) and aspartate aminotransferase (AST) (-3 U/L ± 3, p = 0.003). Decreased testosterone (-3.0 ng/dL[-8.5, -1.5], p = 0.066) was seen following EAA. Fasting insulin resistance (HOMA-IR Д -0.33 ± 2.1) and OSTT insulin sensitivity (Д 3.67 x 10-5 dl/kg/min per U/ml ± 1.28 x 10-4) remained unchanged. Conclusions: Short-term EAA supplementation decreases IHTG, serum TG and AST in adolescents with PCOS and obesity. No worsening of insulin sensitivity was noted, and in those with HS at baseline, the relative change of -9% approached clinical significance with just 1 month of treatment. Evaluation of the long-term long-term effects of EAA supplementation in PCOS with HS is needed, especially in youth where pharmacologic options are extremely limited.