Association of Metabolic Syndrome with Non-Alcoholic Fatty Liver Disease in Women Diagnosed With Polycystic Ovary Syndrome: A Multicenter Cross-Sectional Study in Pakistan

Abstract

Background: The metabolic disturbances usually seen in women with polycystic ovary syndrome include insulin resistance, abdominal adiposity, abnormal lipid levels and impaired glucose regulation. These abnormalities can lead to development of non-alcoholic fatty liver disease. But there is still a lack of evidence in local clinical populations in Pakistan.

Objective: To determine whether metabolic syndrome is linked with non-alcoholic fatty liver disease in women with polycystic ovary syndrome.

Methods: It was a multicentre cross-sectional study conducted at Dr. Ziauddin Hospital, Sukkur and Gambat Medical college, Gambat, Sindh, Pakistan from March 2024 to March 2025. One hundred reproductive-age women (18–40 years old) with confirmed diagnosis of PCOS were recruited sequentially as a sample. Clinical presentation, anthropometric parameters, blood pressure, fasting glucose, serum lipid parameters, hepatic transaminase levels and abdominal ultrasound findings were recorded in the study records of each woman enrolled. Metabolic syndrome was defined based on adult criteria. Diagnosis of NAFLD was confirmed by ultrasonography of the liver revealing fatty infiltration of the liver after excluding other causes of hepatic steatosis.

Results: The prevalence of ultrasound NASH was 44.0% in women and 39.0% of women had metabolic syndrome. Metabolic syndrome was markedly more common in the fatty liver group than in the non-fatty liver group, affecting 61.4% compared with 21.4%, respectively, and the difference was statistically significant (p<0.001). Fatty liver women also showed worse metabolic and liver profile with higher BMI, WC, Fasting glucose, TG, BP, ALT, AST and lower fasting HDL cholesterol. In adjusted analysis, the association between metabolic syndrome and fatty liver disease remained independent.

Conclusion: Among Pakistani women with polycystic ovary syndrome, non-alcoholic fatty liver disease showed a strong relationship with metabolic syndrome. These results indicate that liver evaluation and early metabolic screening is warranted in this high-risk population.