OBJECTIVES: The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing in women with polycystic ovary syndrome (PCOS). Epidemiological literature regarding the risk factors for MASLD in PCOS women in East Asia are inconsistent. Studies of PCOS and MASLD in East Asia are restricted by limited data and various biases. Therefore, this meta-analysis was conducted. METHODS: This meta-analysis followed the MOOSE statement. Relevant studies published before 2023.7.13 were retrieved from the PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wan Fang, KISS, and Japan medical online databases. The related data were extracted, the weighted mean difference (WMD), odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated. RESULTS: Twenty-four studies were included. Through univariate analysis, age, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure (BP), alanine transaminase (ALT), aspartate transaminase (AST), fasting blood glucose (FBG), fasting insulin (FINS), homeostatic model assessment for insulin resistance (HOMA-IR), 2 h postprandial blood glucose (2 h PBG), 2 h insulin, HBA1C, low-density lipoprotein cholesterol (LDL), triglyceride (TG), total cholesterol (TC) and testosterone were notably higher in PCOS women with MASLD, with high-density lipoprotein cholesterol (HDL-c) markedly lower in PCOS women with MASLD. According to the pooled multivariate analysis, the WHR (P<
0.001), testosterone (p = 0.034), and HOMA-IR (P = 0.02) were substantially greater in PCOS women with MASLD. CONCLUSION: MASLD is associated with obesity, IR, and hyperandrogenaemia among PCOS women in East Asia. The abnormality of WHR, HOMA-IR and testosterone suggested early screening of MASLD in this population.