After synthesizing data from 36 studies published worldwide (n = 5021 PCOS patients), two key points can be extracted: (1) the burden of NAFLD in PCOS patients is concerning, with an estimated pooled prevalence of 43% (95% CI, 35–52%); (2) obesity (BMI and waist circumference), metabolic abnormalities (HOMA-IR, ALT, and triglycerides), and PCOS specific hallmarks (hyperandrogenism and free androgen index) were identified as risk factors for NAFLD in PCOS populations. The gene discussed is GPT; the disease is obesity due to melanocortin 4 receptor deficiency.