Type 2 diabetes and obesity in South Asian patients with polyendocrine metabolic ovarian syndrome: The emerging role of metabolomics.

Polyendocrine metabolic ovarian syndrome (PMOS) or polycystic ovary syndrome (PCOS) is highly prevalent in South Asian women and is frequently associated with early insulin resistance and elevated cardiometabolic risk at comparatively low body mass index (BMI), predisposing them to type 2 diabetes (T2D) and obesity. Conventional clinical markers (BMI, fasting glucose, and androgens) incompletely capture the metabolic heterogeneity of PCOS, particularly in lean or centrally adipose phenotypes common in this population. Metabolomics provides an integrated, pathway-level view of systemic metabolism and has identified perturbations in amino-acid networks, mitochondrial fatty-acid oxidation, complex lipids, bile acids, and steroid metabolism. Emerging evidence supports distinct metabolic endotypes that may refine early risk stratification for dysglycaemia and weight gain. We provide an overview of metabolomics research in PCOS, with a translational focus on early risk stratification for T2D and obesity in South Asian women, and outline priorities for the development of clinically actionable biomarkers.