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Biochemical, sex hormonal, and anthropometric indicators have been explored for screening NAFLD in PCOS patients. However, the accuracy of NAFLD screening using these indicators in PCOS patients remains uncertain. This study aimed to identify biochemical, sex hormonal, and anthropometric indicators associated with NAFLD in overweight and obese PCOS patients and assess the diagnostic efficacy of combined indicators.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This cross-sectional study (Clinical trial number ChiCTR1900020986; Registration date January 24th, 2019) involved 87 overweight or obese women with PCOS (mean age 29\u2009\u00b1\u20094 years). Measurements included anthropometric indices, biochemistry, sex hormone levels, and liver proton density fat fraction (PDFF). Correlation analysis, intergroup comparisons, and logistic regression analysis were used to identify risk factors for NAFLD (PDFF\u2009&gt;\u20095.1%). The receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were used to determine cut-off values and evaluate diagnostic accuracy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Liver PDFF was 7.69% (3.93%, 14.80%) in overweight and obese PCOS patients, with 67.8% diagnosed with NAFLD. NAFLD was associated with increased body mass index (BMI), abdominal circumference (AC), and triglyceride, total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), glucose, insulin, and free testosterone (FT) levels, and with decreased high-density lipoprotein-cholesterol (HDL-C) and sex hormone-binding globulin (SHBG) levels (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Risk factors for NAFLD in PCOS included BMI\u2009&gt;\u200926.8\u00a0kg\/m<jats:sup>2<\/jats:sup>, AC\u2009&gt;\u200988.3\u00a0cm, triglyceride\u2009&gt;\u20091.57 mmol\/L, TC\u2009&gt;\u20094.67 mmol\/L, LDL-C\u2009&gt;\u20093.31 mmol\/L, glucose\u2009&gt;\u20094.83 mmol\/L, insulin\u2009&gt;\u2009111.35 pmol\/L, FT\u2009&gt;\u20097.6 pg\/mL and SHBG\u2009&lt;\u200925 nmol\/L (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20091.411\u20132.667, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.005). A multi-indicator model including triglycerides, LDL-C, glucose, insulin, and SHBG showed higher diagnostic accuracy (AUC\u2009=\u20090.899, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) for screening NAFLD in PCOS patients than single indicators (AUC\u2009=\u20090.667\u20130.761, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Overweight and obese PCOS patients have higher incidences of liver PDFF and NAFLD. A multi-indicator model including triglycerides\u2009&gt;\u20091.57 mmol\/L, LDL-C\u2009&gt;\u20093.31 mmol\/L, glucose\u2009&gt;\u20094.83 mmol\/L, insulin\u2009&gt;\u2009111.35 pmol\/L, and SHBG\u2009&lt;\u200925 nmol\/L is highly accurate for screening NAFLD in overweight and obese PCOS patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12905-025-03648-9","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T09:06:52Z","timestamp":1741943212000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Biochemical, sex hormonal, and anthropometric predictors of non-alcoholic fatty liver disease in polycystic ovary syndrome"],"prefix":"10.1186","volume":"25","author":[{"given":"Xintong","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Min","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangfang","family":"Duan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangyan","family":"Ruan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"issue":"1","key":"3648_CR1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.fertnstert.2016.05.003","volume":"106","author":"D Lizneva","year":"2016","unstructured":"Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. 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