Table 1.

Epidemiology and risk factors for development of NAFLD in PCOS women.

Studies	Epidemiology	Risk Factors
Won et al. [24], retrospective cohort study	Prevalence of NAFLD in study population (586 women diagnosed with PCOS) was 8.7% (51/586).	MetS diagnosis (hazard ratio [HR] 5.6, 95% confidence interval [CI] 2.2–14.4, p < 0.01) Hyperandrogenism (HA) (HR 4.4, 95% CI 1.4–13.4, p = 0.01)
Romanowski et al. [25], case-control study	NAFLD was present in 23.8% of the PCOS group (101). At control group (33), it represented 3.3%, (p = 0.01). PCOS group (101 women) was subdivided into two subgroups: PCOS+NAFLD (24) and PCOS (77)	BMI, waist circumference, glucose intolerance, insulin levels was higher in PCOS+NAFLD group compared to only PCOS group.
Asfari et al. [26], National Inpatient Sample database between 2002 and 2014	77,415 of 50,785,354 women (0.15%) had PCOS.	Patients with PCOS had significantly higher rates of NAFLD (OR 4.30, 95% CI 4.11 to 4.50, p < 0.001).
Shengir et al. [27], cross-sectional cohort study, 101 women with diagnosed PCOS	Prevalence of NAFLD and liver fibrosis was 39.6% and 6.9%, respectively, in the study population.	Higher body mass index (adjusted odds ratio (aOR) 1.30, 95% CI: 1.13–1.52). Hyperandrogenism (aOR: 5.32, 95% CI: 1.56–18.17). Elevated ALT (aOR: 3.54, 95%CI: 1.10–11.47).
Salva-Pastor et al. [28], cross-sectional study, with 98 women with diagnosed PCOS (Rotterdam 2003 criteria), Controls were matched by age and body mass index (BMI)	Prevalence of NAFLD was markedly higher in patients with than without PCOS at 69.3% vs. 34.6%, respectively. NAFLD prevalence was 84.3% in PCOS patients with phenotype A, while in another phenotype, it was 41.1%.	Hyperandrogenism (OR 21.8) and BMI (OR 11.7) are risk factors for developing NAFLD in patients with PCOS.
Vassilatou et al. [29], Prospective, observational, and cross-sectional study	NAFLD was detected in 71/110 women (64.5%). Women with NAFLD compared to women without NAFLD were more commonly diagnosed with PCOS (43.7% vs. 23.1%, respectively), metabolic syndrome (30.2% vs. 5.3%), and abnormal lipid profile (81.1% vs. 51.3%).	HOMA-IR values (OR 2.2, 95% CI: 1.1–4.4) and triglyceride levels (OR 1.01, 95% CI: 1.00–1.02) are independent predictor factors for NAFLD
HarshaVarma et al. [30], prospective, cross-sectional study 60 women with PCOS (Rotterdam 2003 criteria)	23 (38.3%) women with PCOS had NAFLD.	HOMA IR Hyperandrogenemia
Sarkar et al. [31], Retrospective study of 102 women with biopsy-confirmed NAFLD between 2008–2019	36% (37 women) of study group had PCOS.	PCOS was risk factor for severe hepatocyte ballooning (OR 3.4, 95% CI 1.1–10.6, p = 0.03) and advanced fibrosis (OR 7.1, 95% CI 1.3–39, p = 0.02).
Macut et al. [32], cross-sectional study included 600 Caucasian women diagnosed with PCOS (Rotterdam criteria)	NAFLD was more prevalent in patients with PCOS than in controls (50.6% vs. 34.0%, respectively).	HOMA-IR and lipid accumulation products were independently associated with NAFLD (p ≤ 0.001).
Rocha et al. [4], Meta-analysis of 17 studies published between 2007 and 2017 that included 2734 PCOS patients and 2561 controls of similar age and body mass index (BMI)	PCOS patients have increased prevalence of NAFLD (OR 2.54, 95% CI 2.19–2.95). PCOS women with hyperandrogenism (classic phenotype) have a higher prevalence of NAFLD compared to women with PCOS without hyperandrogenism, even after correction for confounding variables.	Hyperndrogenism
Shengir et al. [33], Meta-analysis of 23 studies with 7148 participants	South American/Middle East PCOS women had a greater risk of NAFLD than women of European and Asia origin.	PCOS women had a 2.5-fold increase in the risk of NAFLD compared to controls (pooled OR 2.49, 95% CI 2.20–2.82). BMI seems to be the main cofactor.
Wu et al. [34], Meta-analysis of 17 studies	PCOS is significantly associated with high risk of NAFLD.	PCOS patients with hyperandrogenism had a significantly higher risk of NAFLD compared with controls (OR 3.31, 95% CI = 2.58–4.24).