Association of polycystic ovary syndrome with metabolic syndrome and its components in adolescents: a systematic review and meta-analysis

Background Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder among adolescent girls, while metabolic syndrome (MetS) is a major precursor to cardiovascular disease and type 2 diabetes. The strength of the association between PCOS and MetS, as well as between PCOS and its core components, in adolescents remains unclear. This study aimed to conduct a systematic review and meta-analysis to clarify the risk of MetS and its individual metabolic abnormalities in adolescents with PCOS. Methods We systematically searched PubMed, Embase, the Cochrane Library, and the Web of Science databases for observational studies published up to September 2025 that included adolescent girls aged 10–20 years, with and without PCOS. For categorical variables, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, while weighted mean differences (WMDs) with 95% CIs were used for continuous variables. All meta-analyses were performed using a random-effects model. Results The final meta-analysis included 13 studies (5 cross-sectional, 6 case–control, and 2 cohort studies) comprising 1,789 participants (1,005 with PCOS and 784 controls). Pooled results indicated a significantly higher risk of MetS in adolescents with PCOS than in controls (OR: 2.61, 95% CI: 1.83–3.74, p < 0.001). Furthermore, the PCOS group exhibited significantly higher values for specific MetS components, including waist circumference (WMD: 3.23 cm, 95% CI: 0.91–5.55, p = 0.006), systolic blood pressure (WMD: 3.80 mmHg, 95% CI: 0.59–7.00, p = 0.020), and triglycerides (WMD: 5.76 mg/dL, 95% CI: 1.05–10.46, p = 0.017). In contrast, no statistically significant differences were observed in diastolic blood pressure, high-density lipoprotein, or fasting blood glucose levels. Conclusion Adolescent PCOS is significantly associated with an elevated risk of MetS, with abnormalities primarily clustered in abdominal obesity, systolic blood pressure, and triglyceride levels. Integrating these three key metrics into routine metabolic screening for adolescents with PCOS is clinically essential. Prioritizing lifestyle interventions to address these risk factors is critical for mitigating long-term cardiometabolic complications. Systematic review registration The study was registrated in International Platform of Registered Systematic Review and Meta-analysis Protocols (Registration number: INPLASY2025100048).