Research Summary

Adolescent PCOS With MASLD Predicts Higher Adult Cardiometabolic Risk in Australian Cohort

Edited by:
Ashton L. Stahl

Key Highlights

  • Adolescents with polycystic ovary syndrome (PCOS) and metabolic dysfunction–associated steatotic liver disease (MASLD) had significantly higher insulin resistance by age 27.
  • PCOS without MASLD did not predict future insulin resistance or adverse cardiometabolic outcomes.
  • The coexistence of PCOS and MASLD was associated with obesity, dyslipidemia, and inflammatory markers in adulthood.

The coexistence of polycystic ovary syndrome (PCOS) and metabolic dysfunction–associated steatotic liver disease (MASLD) during adolescence is associated with a higher risk of adverse cardiometabolic outcomes in young adulthood, according to a longitudinal cohort study published in The Journal of Clinical Endocrinology & Metabolism. Investigators reported that PCOS alone, in the absence of MASLD or obesity, was not associated with future insulin resistance, highlighting the importance of identifying combined metabolic and endocrine risk phenotypes early in life.

The study analyzed data from women in the Raine Study, a community-based pregnancy and birth cohort from Western Australia. Using updated diagnostic criteria, PCOS was retrospectively identified at age 14 and MASLD at age 17. The study then assessed cardiometabolic outcomes at age 27.

At age 14, PCOS was defined based on irregular menstrual cycles with clinical or biochemical hyperandrogenism. MASLD at age 17 was diagnosed using abdominal ultrasound findings consistent with hepatic steatosis, in combination with at least 1 metabolic risk factor and exclusion of excessive alcohol intake. The researchers collected anthropometric measurements, fasting blood tests, and cardiovascular assessments at each study visit. Insulin resistance in adulthood was defined as a homeostasis model assessment of an insulin resistance (HOMA-IR) score of >2.5.

Study Findings

Among the 199 adolescent girls assessed for both conditions, 16.1% had PCOS and 18.6% had MASLD. Of those with PCOS, 37.5% also had MASLD. By age 27, 148 participants had complete follow-up data, including 10 women who had PCOS with MASLD during adolescence.

Women with adolescent PCOS plus MASLD had a higher BMI, central obesity, insulin resistance, remnant lipoprotein cholesterol, and triglyceride–to–high–density lipoprotein cholesterol ratios in adulthood than those with PCOS alone, MASLD alone, or neither condition. In contrast, PCOS without MASLD or obesity during adolescence did not predict insulin resistance at follow-up. Multivariable analysis showed that PCOS with MASLD was independently associated with insulin resistance at age 27 (odds ratio, 9.59; 95% CI, 1.57–58.51).

Clinical Implications

According to the study authors, the findings suggest the coexistence of PCOS and MASLD in adolescence identifies a subgroup of young women at substantially higher risk for adverse cardiometabolic outcomes in adulthood. The authors noted that PCOS alone, when not accompanied by MASLD or obesity, may not confer the same long-term metabolic risk.

Expert Commentary

“In conclusion, our results highlight that adolescents with PCOS + MASLD have an increased future cardiometabolic risk, compared with adolescents who have neither or either PCOS or MASLD alone,” the researchers concluded.

Reference:
Ayonrinde OT, Mori TA, Adams LA, et al. MASLD coexisting with PCOS increases cardiometabolic risk. J Clin Endocrinol Metab. 2026;00(0):1-8. doi:10.1210/clinem/dgag008