Metabolic dysfunction-associated steatotic liver disease in women with polycystic ovary syndrome and its relation with other concomitant factors

Background & Aims Metabolic dysfunction-associated steatotic liver disease (MASLD) has an increasing prevalence in patients with polycystic ovary syndrome (PCOS). The purpose of this cross-sectional study was to assess MASLD status and the potential associated factors for MASLD in women with PCOS. Methods A total of 68 female subjects with PCOS, between the ages of 18 to 38 years, were recruited to this cross-sectional study. PCOS was diagnosed according to the revised 2003 Rotterdam Consensus as the presence of at least two of the following three criteria: (i) oligomenorrhoea or anovulation; (ii) clinical and/or biochemical signs of hyperandrogenaemia and (iii) polycystic ovaries on ultrasound. Fasting plasma glucose, insulin, lipid profile, and liver function tests were assessed. Body weight and composition were assessed using bioelectrical impedance analysis. Abdominal ultrasonography was administered for MASLD diagnosis. Results A total of 35 subjects (48.5%) were diagnosed with MASLD. Mean body mass index (34.9 ± 5.46 vs. 28.9 ± 5.13 kg/m 2 , p < 0.001), body fat (46.9 ± 5.32 vs. 40.7 ± 6.77%, p < 0.001), Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) (4.0 ± 1.88 vs. 2.1 ± 1.01, p < 0.001), triglycerides (147.1 ± 84.34 vs. 102.5 ± 57.11 mg/dL, p = 0.010) and liver function markers were significantly higher in subjects with MASLD. Conclusion This study identifies key metabolic factors associated with the development of MASLD in women with PCOS. Specifically, insulin resistance, high body fat, waist/hip ratio, triglyceride levels, lower high-density lipoprotein (HDL) levels, and smoking were found to be associated with MASLD in this population. While these parameters are recognized as risk factors for MAFLD in general, their role in the PCOS population may differ due to the unique metabolic and hormonal profile of these women. These findings highlight the importance of monitoring and managing metabolic dysfunctions in PCOS patients to mitigate the risk of MASLD, offering valuable insights for clinical management and future research.