The prevalence of NAFLD was 50.6% in PCOS patients vs. 34.0% in controls. WC, LAP, insulin and HOMA-IR, total cholesterol, and TGs were higher in PCOS patients than in controls (P < 0.001). NAFLD-liver fat score was most significantly associated with WC, BMI, glucose levels, LAP, HOMA-IR, FAI, and TGs. HOMA-IR and LAP were deemed as independent risk factors for NAFLD in PCOS patients. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.