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 versusthose with obesity. Materials and methods: Fifty premenopausal participants diagnosed with PCOS were divided into twogroups 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 hormonallevels. The prevalence of MASLD was determined using ultrasonography (USG). Statistical analysis: Mean ± SD (standarddeviation) was used for time-varying variables, and percentages for categorical variables. Univariate analysis includedChi-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 asignificantly higher proportion in Group B compared to Group A (62.06% vs. 9.50%; p < 0.001). IR was also more commonin Group B (79.30% vs. 23.80%; p < 0.001). In spite of lower IR, Group A participants also had elevated mean fasting insulinlevels (10.32 ± 7.01 mIU/mL), suggesting early metabolic disturbances. Also, Group B participants had significantly highertriglycerides (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 toGroup A participants. Conclusion: Our study shows a high prevalence of MASLD in obese women with PCOS, likely dueto IR. Lean women with PCOS also exhibited metabolic issues, suggesting they may be at risk. These findings highlight theimportance of early metabolic screening and interventions in PCOS women