Objective To analyze the correlation between insulin resistance (IR) status and body composition indices in patients with polycystic ovary syndrome (PCOS). Methods A total of 28 patients with PCOS treated at the First Affiliated Hospital of Guangxi Medical University from December 2023 to July 2024 were enrolled as research subjects. Body composition indices were measured by bioelectrical impedance analysis, while the fasting blood glucose (FBG), fasting insulin (FIN), sex hormone‑binding globulin (SHBG), and free testosterone (FT) levels were detected. According to the homeostasis model assessment of insulin resistance (HOMA‑IR), patients were divided into a non-insulin resistance (NIR) group (HOMA‑IR<2.69) or an IR group (HOMA‑IR≥2.69). Body weight, body mass index (BMI), body fat mass, muscle mass, skeletal muscle mass, percentage of body fat (PBF), visceral fat area (VFA), fat mass index (FMI), and phase angle (PhA) were compared between the two groups. The point‑biserial correlation was used to determine the extent to which IR occurrence is related to body composition in PCOS patients. Results The IR group had higher/larger body weight, BMI, FBG level, FIN level, body fat mass, PBF, VFA, FMI, muscle mass, skeletal muscle mass, and PhA than the NIR group, while its SHBG level was lower (all P<0.05); IR status in PCOS patients was positively correlated with body fat mass (rpb=0.691), PBF (rpb=0.687), VFA (rpb=0.690), FMI (rpb=0.696), muscle mass (rpb=0.457), skeletal muscle mass (rpb=0.468), and PhA (rpb=0.551) (all P<0.05). Conclusion Among patients with PCOS, IR status is associated with a “high-fat, high-muscle” body composition phenotype. This association suggests that the detailed characteristics of body composition (especially visceral fat and muscle mass) should be considered when evaluating metabolic risk in this population.

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