Prevalence and Metabolic Predictors of Metabolic Dysfunction-Associated Steatotic Liver Disease in Lean Indian Women with Polycystic Ovary Syndrome versus Those with Obesity

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), linked to obesity and insulin resistance (IR),
is common in polycystic ovary syndrome (PCOS), but its prevalence in lean individuals with PCOS is not well-established.
Hence, the aim of the present study is to investigate the prevalence and predictors of MASLD in lean PCOS patients versus
those with obesity. Materials and methods: Fifty premenopausal participants diagnosed with PCOS were divided into two
groups based on their body mass index (BMI): Group A (lean + normal weight, n = 21) and Group B (overweight + obesity,
n = 29). Clinical, anthropometric, and biochemical variables were assessed, including IR, lipid profiles, and hormonal
levels. The prevalence of MASLD was determined using ultrasonography (USG). Statistical analysis: Mean ± SD (standard
deviation) was used for time-varying variables, and percentages for categorical variables. Univariate analysis included
Chi-square and independent t-tests (p < 0.05). Multivariate logistic regression assessed MASLD occurrence in PCOS subjects.
Analysis was conducted using Stata software version 14 IC. Results: The overall prevalence of MASLD was 40%, with a
significantly higher proportion in Group B compared to Group A (62.06% vs. 9.50%; p < 0.001). IR was also more common
in Group B (79.30% vs. 23.80%; p < 0.001). In spite of lower IR, Group A participants also had elevated mean fasting insulin
levels (10.32 ± 7.01 mIU/mL), suggesting early metabolic disturbances. Also, Group B participants had significantly higher
triglycerides (141.24 ± 42.75 vs. 114.10 ± 31.62 mg/dL; p = 0.018), lower high-density lipoprotein cholesterol (43.41 ± 7.57 vs.
51.41 ± 7.12 mg/dL; p < 0.001) and higher prevalence of metabolic syndrome (58.62% vs. 4.70%; p < 0.001) as compared to
Group A participants. Conclusion: Our study shows a high prevalence of MASLD in obese women with PCOS, likely due
to IR. Lean women with PCOS also exhibited metabolic issues, suggesting they may be at risk. These findings highlight the
importance of early metabolic screening and interventions in PCOS women.