Prevalence and predictors of non‐alcoholic fatty liver disease (NAFLD) and metabolic dysfunction‐associated fatty liver disease (MAFLD) in Indian women with polycystic ovarian syndrome

Abstract Aim To study the prevalence and predictors of non‐alcoholic fatty liver disease (NAFLD) and metabolic dysfunction‐associated fatty liver disease (MAFLD) in women with polycystic ovarian syndrome (PCOS). Materials and Methods Seventy‐eight PCOS patients and 78 age and body mass index (BMI)‐matched controls were studied. PCOS was diagnosed by Rotterdam criteria. Clinical examination, biochemical, and hormonal investigations, and transabdominal sonography were done for all participants. Based on gray‐scale sonography, NAFLD was graded as 0, 1, 2, and 3. MAFLD was diagnosed when imaging or serological evidence of fatty liver disease was present and one of the following three criteria was met: overweight/obesity, diabetes, or metabolic disorders. Results Women with PCOS had a higher prevalence of NAFLD (53.8% vs. 17.9%; p < 0.001), MAFLD (70.5% vs. 48.7%; p < 0.01), insulin resistance (HOMA‐IR 2.8 ± 1.3 vs. 1.4 ±0.3; p < 0.001) and metabolic syndrome (51.3% vs. 10.3%; p < 0.001) and higher values of waist‐hip ratio (0.88 ± 0.1 vs. 0.83 ± 0.1; p < 0.001), alanine transferase (44.1 ± 19.7 vs. 30.3 ± 7.6; p < 0.001), and free androgen index (FAI; 7.8 ± 4.4 vs. 3.4 ± 1.7; p < 0.001) than controls. Twenty‐three percent of PCOS patients with NAFLD and 18.4% with MAFLD had Grades 2 and 3 disease. Among different PCOS phenotypes, phenotype A was maximally affected with NAFLD and MAFLD. Multiple regression analysis showed that PCOS status and FAI were the predicting factors for NAFLD. MAFLD was significantly associated with hepatic steatosis index (HSI). Conclusion PCOS patients were at a higher risk for NAFLD and MAFLD than age‐ and BMI‐matched controls. The prevalence of NAFLD and MAFLD was highest in phenotype A. Hyperandrogenism is a predictor of NAFLD in PCOS.