To evaluate anthropometric–metabolic biomarkers as predictors of metabolic syndrome (MS) in women with polycystic ovary syndrome (PCOS) with and without obesity.
Methods:
This was an observational cross-sectional study. Patients were classified as nonobese-PCOS (body mass index, BMI <30 kg/m2, n = 385), and obese-PCOS (BMI ≥30 kg/m2, n = 261). The anthropometric parameters waist circumference, waist/hip ratio, lean body mass, fat body mass, visceral adiposity index (VAI), lipid accumulating product, and biomarkers of glucose and lipid metabolisms were compared between groups. Binominal logistic regression analyses were performed to identify predictors of MS.
Results:
Obesity was diagnosed in 40% of all PCOS women (P < 0.001). Blood pressure and anthropometric abnormalities were significantly more frequent in obese-PCOS women (P < 0.001, for all comparisons). Glucose metabolism markers were higher in obese-PCOS compared with nonobese-PCOS (P < 0.001, for all comparisons). High-density lipoprotein cholesterol was lower in obese group than in nonobese group (1.26 mM vs. 1.08 mM, P < 0.001). MS was found in 23 of 385 (6%) nonobese-PCOS and in 116 of 261 (44.4%) obese-PCOS (P < 0.001). VAI was the best predictor of MS in both nonobese-PCOS (OR = 4.1, 95% CI 1.5–11.1) and obese-PCOS (OR = 12.9, 95% CI 5.7–29.0).
Conclusions:
MS is more prevalent in PCOS women with obesity. VAI was the strongest predictor of MS in both obese and nonobese PCOS women, and can be applied in clinical practice for early detection of risk for MS and precocious intervention in women with PCOS, particularly in obese women.
Get full access to this article
View all access options for this article.
References
1.
TeedeHJ, MissoML, CostelloMF, et al.International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril, 2018; 110:364–379.
2.
CarminaE, NapoliN, LongoRA, et al.Metabolic syndrome in polycystic ovary syndrome (PCOS): Lower prevalence in southern Italy than in the USA and the influence of criteria for the diagnosis of PCOS. Eur J Endocrinol, 2006; 154:141–145.
3.
GlintborgD, RubinKH, NyboM, et al.Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovasc Diabetol, 2018; 17:37.
4.
GanieMA, SaharT, RashidA, et al.Comparative Evaluation of biomarkers of inflammation among Indian women with polycystic ovary syndrome (PCOS) consuming vegetarian vs. Non-vegetarian diet. Front Endocrinol (Lausanne), 2019; 10:699.
5.
PaschouSA, PolyzosSA, AnagnostisP, et al.Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Endocrine, 2019; 67:1–8.
6.
EssahPA, NestlerJE. Metabolic syndrome in women with polycystic ovary syndrome. Fertil Steril, 2006; 8:S18–S19.
7.
HuangX, WangQ, LiuT, et al.Body fat indices as effective predictors of insulin resistance in obese/non-obese polycystic ovary syndrome women in the Southwest of China. Endocrine, 2019; 65:81–85.
8.
OhJY, SungYA, LeeHJ. The visceral adiposity index as a predictor of insulin resistance in young women with polycystic ovary syndrome. Obesity (Silver Spring), 2013; 21:1690–1694.
9.
DurmusU, DuranC, EcirliS. Visceral adiposity index levels in overweight and/or obese, and non-obese patients with polycystic ovary syndrome and its relationship with metabolic and inflammatory parameters. J Endocrinol Invest, 2017; 40:487–497.
10.
AgrawalH, AggarwalK, JainA. Visceral adiposity index: Simple tool for assessing cardiometabolic risk in women with polycystic ovary syndrome. Indian J Endocr Metab, 2019; 23:232–237.
11.
RandrianarisoaE, Lehn-StefanA, HieronimusA, et al.Visceral adiposity index as an independent marker of subclinical atherosclerosis in individuals prone to diabetes mellitus. J Atheroscler Thromb, 2019; 26:821–834.
12.
MazzucaE, BattagliaS, MarroneO, et al.Genderspecific anthropometric markers of adiposity, metabolic syndrome and Visceral Adiposity Index (VAI) in patients with obstructive sleep apnea. J Sleep Res, 2014; 23:13–21.
13.
AmatoMC, GiordanoC. Clinical indications and proper use of visceral adiposity index. Nutr Metab Cardiovasc Dis, 2013; 23:e31−e32.
14.
AmatoMC, GiordanoC, PitroneM, et al.Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis, 2011; 10:183.
15.
AmatoMC, GuarnottaV, FortiD, et al. Metabolically healthy polycystic ovary syndrome (MH-PCOS) and metabolically unhealthy polycystic ovary syndrome (MU-PCOS): A comparative analysis of four simple methods useful for metabolic assessment. Hum Reprod 2013b;28:1919–1928.
16.
TehraniFR, MinooeeS, AziziF. Comparison of various adiposity indexes in women with polycystic ovary syndrome and normo-ovulatory non-hirsute women: A population-based study. Eur J Endocrinol, 2014; 171:199–207.
17.
CarminaE, OberfieldSE, LoboRA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol, 2010; 203:201.e1–e5.
18.
Rotterdam EA-SPCWG. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril, 2004; 81:19–25.
19.
DewaillyD, DuhamelA, RobertY, et al.Interrelationship between ultrasonography and biology in the diagnosis of polycystic ovarian syndrome. Ann N Y Acad Sci, 1993; 687:206–216.
20.
Diabetes Trial Unit. The Oxford Centre for Diabetes, Endocrinology and Metabolism [internet]. Oxford, UK: Oxford University; 2013 May 1. Accessed at http://www.dtu.ox.ac.uk/homacalculator on January 18, 2020.
21.
CookS, WeitzmanM, AuingerP, et al.Prevalence of a metabolic syndrome phenotype in adolescents: Findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med, 2003; 157:821–827.
22.
WitchelSF, OberfieldS, RosenfieldRL, et al.The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr, 2015; 83:376–389.
23.
JamesW. Research on Obesity: A Report of the DHSS/MRC Group. HM Stationery Office, Illinois, 1976.
24.
YangRF, LiuXY, LinZ, et al.Correlation study on waist circumference-triglyceride (WT) index and coronary artery scores in patients with coronary heart disease. Eur Rev Med Pharmacol Sci, 2015; 19:113–118.
25.
AmatoMC, GiordanoC, GaliaM, et al.Visceral Adiposity Index: A reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care, 2010; 33:920–922.
26.
KahnHS, ValdezR. Metabolic risks identified by the combination of enlarged waist and elevated triacylglycerol concentration. Am J Clin Nutr, 2003; 78:928–934.
27.
FriedewaldWT, LevyRI, FredricksonDS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem, 1972; 18:499–502.
28.
de MedeirosSF, YamamotoMMW, Souto de MedeirosMA, et al.Changes in clinical and biochemical characteristics of polycystic ovary syndrome with advancing age. Endocr Connect, 2020; 9:74–89.
29.
de MedeirosSF, BarbosaJS, YamamotoMMW. Comparison of steroidogenic pathways among normoandrogenic and hyperandrogenic polycystic ovary syndrome patients and normal cycling women. J Obstet Gynaecol Res, 2015; 41:254–263.
30.
KristensenSL, Ramlau-HansenCH, ErnstE, et al.A very large proportion of young Danish women have polycystic ovaries: Is a revision of the Rotterdam criteria needed?. Hum Reprod, 2010; 25:3117–3122.
31.
Vrbíková J, Vondra K, Cibula D, et al. Metabolic syndrome in young Czech women with polycystic ovary syndrome. Hum Reprod, 2005; 20:3328–3332.
32.
DokrasA, BochnerM, HollinrakeE, et al.Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol, 2005; 106:131–137.
33.
MarcondesJA, HayashidaSA, BarcellosCR, et al.Metabolic syndrome in women with polycystic ovary syndrome: Prevalence, characteristics and predictors. Arq Bras Endocrinol Metabol, 2007; 51:972–979.
34.
NevesEM, da FonsecaAM, BagnoliVR, et al.Polycystic ovary syndrome: Correlation between phenotypes and metabolic syndrome. J Steroids Hormon Sci, 2014; 5:2.
35.
BorruelS, Moltó JF, Alpañés M, et al. Surrogate markers of visceral adiposity in young adults: Waist circumference and body mass index are more accurate than waist hip ratio, model of adipose distribution and visceral adiposity index. PLoS One, 2014; 9:e114112.
36.
MarioFM, GraffSK, SpritzerPM. Adiposity indexes as phenotype-specific markers of preclinical metabolic alterations and cardiovascular risk in polycystic ovary syndrome: A cross-sectional study. Exp Clin Endocrinol Diabetes, 2017; 125:307–315.
37.
RibeiroVB, KogureGS, LopesIP, et al.Association of measures of central fat accumulation indices with body fat distribution and metabolic, hormonal, and inflammatory parameters in women with polycystic ovary syndrome. Arch Endocrinol Metab, 2019; 63:417–426.
38.
AmatoMC, MagistroA, GambinoG, et al.Visceral adiposity index and DHEAS are useful markers of diabetes risk in women with polycystic ovary syndrome. Eur J Endocrinol, 2015; 172:79–88.
39.
OhJY. Regional adiposity, adipokines, and insulin resistance in type 2 diabetes. Diabetes Metab J,, 2012; 36:412–414.
40.
TehraniDM, WongND. Cardiovascular Disease Risk Assessment: Review of Established and Newer Modalities. Curr Treat Options Cardiovasc Med, 2015; 17:57.
41.
Brończyk-Puzoń A, Jagielski P, Kulik-Kupka K, et al. Usefulness of a new anthropometric indicator - VAI (Visceral Adiposity Index) in the evaluation of metabolic and hormonal disorders in women with polycystic ovary syndrome. Adv Clin Exp Med, 2017; 26:825–828.
42.
WangG, DiBariJ, BindE, et al.Association Between Maternal Exposure to Lead, Maternal Folate Status, and Intergenerational Risk of Childhood Overweight and Obesity. JAMA Netw Open, 2019; 2:e1912343.
43.
de MedeirosSF, de MedeirosMAS, BarbosaBB, et al.Relationship of biological markers of body fat distribution and corticosteroidogenic enzyme activities in women with polycystic ovary syndrome. Horm Metab Res, 2019; 51:639–648.
44.
FonsekaS, SubhaniB, WijeyaratneCN, et al.Association between visceral adiposity index, hirsutism and cardiometabolic risk factors in women with polycystic ovarian syndrome: A cross-sectional study. Ceylon Med J, 2019; 64:111–117.
45.
EhrmannDA, LiljenquistDR, KaszaK, et al.Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab, 2006; 91:48–53.
46.
SungYA, OhJY, ChungH, et al.Hyperandrogenemia is implicated in both the metabolic and reproductive morbidities of polycystic ovary syndrome. Fertil Steril, 2014; 101:840–845.
MeyerC, McGrathBP, CameronJ, et al.Vascular dysfunction and metabolic parameters in polycystic ovary syndrome. J Clin Endocrinol Metab, 2005; 90:4630–4635.
49.
PerriniS, NatalicchioA, LaviolaL, et al.Dehydroepiandrosterone stimulates glucose uptake in human and murine adipocytes by inducing GLUT1 and GLUT4 translocation to the plasma membrane. Diabetes, 2004; 53:41–52.
50.
RiceSP, ZhangL, Grennan-JonesF, et al.Dehydroepiandrosterone (DHEA) treatment in vitro inhibits adipogenesis in human omental but not subcutaneous adipose tissue. Mol Cell Endocrinol, 2010; 320:51–57.
51.
Mannerås-HolmL, LeonhardtH, KullbergJ, et al.Adipose tissue has aberrant morphology and function in PCOS: Enlarged adipocytes and low serum adiponectin, but not circulating sex steroids, are strongly associated with insulin resistance. J Clin Endocrinol Metab, 2011; 96:E304–E311.
52.
Hernandez-MoranteJJ, MilagroF, GabaldonJA, et al.Effect of DHEA-sulfate on adiponectin gene expression in adipose tissue from different fat depots in morbidly obese humans. Eur J Endocrinol, 2006; 155:593–600.
53.
YamamotoMMW, de MedeirosSF. Differential activity of the corticosteroidogenic enzymes in normal cycling women and women with polycystic ovary syndrome. Rev Endocr Metab Disord, 2019; 20:3–13.
54.
ChenGP, QiJC, WangBY, et al.Applicability of visceral adiposity index in predicting metabolic syndrome in adults with obstructive sleep apnea: A cross-sectional study. BMC Pulm Med, 2016; 16:37.
55.
GlintborgD, PetersenMH, RavnP, et al.Comparison of regional fat mass measurement by whole body DXA scans and anthropometric measures to predict insulin resistance in women with polycystic ovary syndrome and controls. Acta Obstet Gynecol Scand, 2016; 95:1235–1243.
56.
AbruzzeseGA, CerrroneGE, GamezJM, et al.Lipid accumulation product (LAP) and visceral adiposity index (vai) as markers of insulin resistance and metabolic associated disturbances in young argentine women with polycystic ovary syndrome. Horm Metab Res, 2017; 49:23–29.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
