Metabolic and hormonal predictors of NAFLD in obese women with PCOS

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Created On: 21/08/2025

Polycystic ovary syndrome (PCOS) is closely connected with non-alcoholic fatty liver disease (NAFLD), especially in overweight and obese individuals.

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Key take away

A multi-marker model combining triglycerides, LDL-C, glucose, insulin, and SHBG accurately identifies NAFLD in overweight and obese women with PCOS.

Background

Polycystic ovary syndrome (PCOS) is closely connected with non-alcoholic fatty liver disease (NAFLD), especially in overweight and obese individuals. Although various biochemical, hormonal, and anthropometric markers have been proposed for NAFLD screening, their diagnostic utility in PCOS remains unclear.

Therefore, this study sought to identify key indicators linked to NAFLD in overweight/obese PCOS patients and examine the diagnostic performance of a combined marker model.

Method

A total of 87 overweight or obese PCOS sufferers (mean age 29 ± 4 years) were evaluated. Data collected encompassed anthropometric measurements, biochemical parameters, sex hormone levels, and liver fat content assessed by proton density fat fraction (PDFF). NAFLD was defined as PDFF >5.1%. For identifying predictors and checking diagnostic accuracy, statistical analyses included logistic regression, correlation testing, group comparisons, and receiver operating characteristic (ROC) curve analysis.

Result

In this cross-sectional study, the median liver PDFF was 7.69% (interquartile range [IQR]: 3.93–14.80%), with 67.8% of participants diagnosed with NAFLD. Compared to those without NAFLD, the affected individuals showed markedly higher abdominal circumference, body mass index (BMI), triglycerides, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), glucose, insulin, and free testosterone levels. They also exhibited reduced levels of high-density lipoprotein-cholesterol (HDL-C) and sex hormone-binding globulin (SHBG).

Independent risk factors included BMI >26.8 kg/m², abdominal circumference >88.3 cm, triglycerides >1.57 mmol/L, total cholesterol >4.67 mmol/L, LDL-C >3.31 mmol/L, glucose >4.83 mmol/L, insulin >111.35 pmol/L, free testosterone >7.6 pg/mL, and SHBG <25 nmol/L (β = 1.411–2.667). A combined model incorporating triglycerides, LDL-C, glucose, insulin, and SHBG yielded high diagnostic accuracy (area under the curve [AUC] = 0.899), outperforming individual markers (AUC = 0.667–0.761).

Conclusion

NAFLD was highly prevalent among overweight and obese women with PCOS. A diagnostic model incorporating triglycerides, LDL-C, glucose, insulin, and SHBG levels provided greater accuracy for NAFLD screening in this population than any single marker alone.