The Interplay Between PMOS and MASLD: Pathophysiology and Evidence-Based Nutritional Interventions

Background: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is recognized as the most prevalent endocrine disorder among women of reproductive age, with an estimated prevalence of approximately 18% according to current Rotterdam diagnostic criteria. Conditions such as dyslipidemia, insulin resistance, hyperandrogenism, central adiposity, and chronic inflammation are frequently observed in women diagnosed with PMOS. These conditions predispose such individuals to an increased risk of developing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), which is the most prevalent chronic liver disease worldwide, affecting approximately 25% of the global population. PMOS and MASLD represent two interconnected metabolic disorders that share overlapping risk factors. Objective: The purpose of this narrative review is to investigate the underlying pathophysiological connections between PMOS and MASLD and to assess the efficacy of targeted nutritional interventions. Methods: An analysis of nearly 30 articles concerning nutritional strategies for PMOS and MASLD was conducted, including studies on dietary patterns, macronutrient-focused dietary strategies, and dietary supplement interventions. Results and Conclusions: The review concludes that a combined approach—comprising an anti-inflammatory dietary pattern, omega-3 supplementation, and myo-inositol—serves as a good evidence-based initial strategy for clinicians and dietitians managing women with coexisting PMOS and MASLD. It is noteworthy that most of the evidence for these recommendations comes from studies that focus solely on either PMOS or MASLD populations. Studies involving individuals with both conditions are currently lacking. Future research should prioritize long-term randomized controlled trials involving women from diverse backgrounds diagnosed with both PMOS and MASLD. These conditions, whether independently or concurrently, are imposing an increasing burden on women of reproductive age worldwide. As further research is conducted, nutritional interventions may serve as primary rather than supplementary therapeutic strategies for the management of PMOS and MASLD.