Metabolic and Hormonal Predictors of Non-Alcoholic Fatty Liver Disease in PCOS/PMOS: A Clinicobiochemical Study
Abstract
Introduction: PCOS, newly named PMOS (polyendocrine-metabolic-ovarian-syndrome) is now closely linked to NAFLD fueled by a toxic trifecta of insulin resistance, hormonal shifts and lifestyle choices, which frequently remains underdiagnosed among young PCOS patients in India. This study henceforth assessed the association between fasting insulin levels and ultrasonographically detected fatty liver in young Indian women with PCOS, alongside metabolic and dietary predictions. Methods: A hospital-based cross-sectional study was conducted among 384 women (aged 18-40) diagnosed with PCOS (Rotterdam criteria). Clinical, biochemical, anthropometric and dietary data were collected. Abdominal ultrasonography was used to detect the grade-level fatty liver. Statistical analysis included chi square tests, t-tests and logistic regression, with p<0.05 considered significant. Results: Fatty liver was present in 62.8% of participants (with PCOS). Elevated fasting insulin (>20 µIU/mL) showed a strong association with fatty liver (p<0.001). Women with fatty liver demonstrated significantly higher HOMA-IR, LH/FSH ratio and serum compared to those without fatty liver (all p<0.001). High-glycemic diet, fasting insulin, BMI >25 kg/m² WHR >0.85 and high CI were identified as significant independent biomarkers of fatty liver as well as visceral/central obesity. Increased ALT:AST ratio, elevated-TG and decreased-SHBG were identified as significant biomarkers of metabolic-hormonal disturbance, termed PMOS. Conclusion: This study highlights a high prevalence of fatty liver and metabolic–hormonal disturbances in PCOS/PMOS, primarily mediated by insulin resistance, hyperandrogenism and unhealthy dietary patterns. The findings underscore the necessity of early metabolic screening and lifestyle interventions to mitigate long-term reproductive and metabolic risks. Key words: PCOS, PCOM, NAFLD, Insulin Resistance, LH/FSH Ratio, Hyperandrogenism, High-Glycemic Diet, Fatty Liver