Insulin resistance and its correlation with body composition in patients with obese polycystic ovary syndrome

Objective To explore the prevalence andrelevant factors of metabolic syndrome (MS) in obese patients with polycystic ovary syndrome (PCOS), and the relationship with the body composition measured by bioelectrical impedance analysis (BIA). Methods A retrospective analysis was conducted with the questionnaire responses, blood biochemical examination, and body composition analysis results in 90 obese PCOS patients who accepted weight management in Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, from April 2013 to July 2015. We calculated homeostatic model assessment insulin resistance index (HOMA-IR), visceral fat index (VAI) and lipid accumulation index (LAP); identified patients with MS using the International Diabetes Federation consensus definition issued in 2005. Measurement data were compared using t-test; categorical data were compared using chi-square test; relevant factors of MS wereidentified using Logistic regression analysis. Results The mean body mass index (BMI) of the obese PCOS patients was (32.89 ±3.39)kg/m2; the MS prevalence was 64.44% (58/90). The MS group had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), fasting insulin level, HOMA-IR, LAP and VAI compared to the non-MS group (all P< 0.05); lower high density lipoprotein cholesterol (HDL-C)than in the non-MS group (P<0.05); higher lean body mass index (LBMI)than in the non-MS group [(18.83 ± 1.73)kg/m2vs. (17.96 ± 1.33)kg/m2,t=2.46, P=0.02]. The other body composition indexes showed no statistically significant differences between the two groups. Multivariate Logistic regression analysis found that MS was positively correlated with SBP (OR=1.20, 95% CI=1.08-1.33)and VAI (OR=3.12, 95% CI=3.12-7.25), but not with any body composition index. Conclusions Over half of obese PCOS patients have MS, and those with MS present with more severe dyslipidemia, insulin resistance (IR) and higher levels of VAI, LAP and LBMI. The presence of MS in obese PCOS patients may be positively correlated with SBP and VAI, but not with the body composition measured by BIA. Obese PCOS patients need to strictly control their weight. BIA method may not be applicable for PCOS patients with BMI≥34 kg/m2. Key words: Obesity; Polycystic ovary syndrome; Metabolic syndrome; Bioelectrical impedance analysis; Body composition

PurposeTo compare the endocrine and metabolic indexes of obese and normal body mass index (BMI) polycystic ovary syndrome (PCOS) patients, and explore factors affecting the pathogenesis and progression of PCOS.MethodsThis study included obese (n=79) and normal BMI (n=40) PCOS patients, and obese (n=30) and normal BMI (n=30) non-PCOS controls. Blood glucose, insulin (INS), blood lipids, sex hormones, and other metabolic and endocrine indicators were measured, and the correlations between the indicators were analyzed.ResultsHOMA-IR, 0min INS, 60min INS, 120min INS, 180min INS, FAI, TG, TC, LDL-C and sd-LDL in obese PCOS group were higher, while SHBG, LH, LH/FSH and HDL-C were lower than those in normal weight PCOS group (P <0.05). 120min PBG, HOMA-IR, FAI, T, LH, LH/FSH, AMH, TC and LDL-C in obese PCOS group were higher than those in obese control group (P <0.05). 0min PBG, 60min PBG, 120min PBG, 180min PBG, 0min INS, 60min INS, 120min INS, 180min INS, HOMA-IR, LH, LH/FSH and T in normal weight PCOS group were higher than those in normal weight control group (P <0.05). In both normal weight group and obesity group, HOMA-IR entered the regression equation with FAI as dependent variable, and the absolute value of HOMA-IR standardized partial regression coefficient was higher than that of hs-CRP and AMH. In PCOS patients, FAI in the obese and non-obese PCOS groups was positively correlated with HOMA-IR.ConclusionEndocrine metabolic disorders in women with PCOS were more obvious than that in women with non-PCOS with matched BMI. The abnormality of glucose and lipid metabolism in obese PCOS patients is more serious than that in PCOS patients with normal BMI. Both obese and normal BMI PCOS patients were affected by hyperinsulinemia, and IR may play a key role in the pathogenesis and development of PCOS.

To investigate the correlation between interleukin-1β (IL-1β), interleukin-1 receptor antagonist (IL-1ra) and the obesity of polycystic ovary syndrome (PCOS). (1) From Oct. 2006 to Jan. 2007, 118 PCOS patients were enrolled in this study in Peking University Third Hospital, which were divided into 56 patients in obese PCOS group and 62 patients in non-obese PCOS group according to the WHO International Obesity Task Force Asia-Pacific criteria [body mass index (BMI) 25 kg/m(2)]. The polymorphism of IL-1β gene promoter region, exon-5 and intron 2 of IL-1ra gene were detected by PCR. (2) Twenty-nine obese PCOS patients and 31 non-obese PCOS patients were selected randomizedly serum levels of IL-1β, IL-1ra were measured by ELISA, in the mean time, serum levels of fasting glucose, fasting insulin and the total white blood cell, hypersensitive C-reactive protein levels were measured. (1) Genetic test:the frequency of TT genotype and T allele of IL-1β promoter region (-511) in obese PCOS patients were significantly higher than those in non-obese patients (44.6% vs. 11.3%, 63.4% vs. 39.5%, all P < 0.05). The frequency of IL-1raI/V genotype and V allele of IL-1ra gene were 19.6% and 9.8% in obese PCOS patients, which were significantly higher than those in non-obese group (3.2% and 1.6%, P < 0.05). (2) Serological test:serum level of IL-1β and IL-1ra of (149 ± 36) and (284 ± 97) ng/L in obese PCOS group which were significantly higher than those in non-obese PCOS group [(96 ± 42) and (208 ± 84) ng/L, P < 0.05]. Fasting blood glucose, fasting insulin and hypersensitive C-reactive protein and white blood cell count were (5.1 ± 0.7) mmol/L, (17 ± 9) mU/L, (1.5 ± 0.6) mg/L and (7.0 ± 2.3) × 10(9)/L in obese PCOS group, which were significantly higher than in non-obese PCOS group [(4.9 ± 0.5) mmol/L, (11 ± 8) mU/L, (0.9 ± 0.4) mg/L and (5.9 ± 1.3) × 10(9)/L, P < 0.05]. (3)The correlation between interleukin and BMI: serum levels of IL-1β (r = 0.673) and IL-1ra (r = 0.557) were positively correlated with BMI in PCOS patients (P < 0.05). Inflammatory factors IL-1β and IL-1ra had correlation with obesity of PCOS patients, PCOS patients who carried T allele of IL-1β gene promoter region (-511) and V allele of IL-1ra gene were high risk of obesity.

Objective To determine the levels of serum pentraxin 3(PTX3)and visceral adipose tissue-derived serine protease inhibitor(vaspin)in newly-diagnosed polycystic ovary syndrome (PCOS) patients, and investigate the relationship between serum level of PTX3, vaspin and different phenotypes of PCOS. Methods Seventy five patients with newly-diagnosed PCOS and 70 age and body mass index (BMI)-matched healthy controls who visited the Department of Endocrinology and Reproduction Centre of the Affiliated Hospital of Zunyi Medical University were enrolled in the study. According to their BMI, the subjects were divided into non-obese PCOS group (BMI<23 kg/m2, n=33), overweight or obese PCOS group (BMI≥23kg/m2, n=42), non-obese control group(BMI<23 kg/m2, n=34) and overweight or obese control group(BMI≥23 kg/m2, n=36). Fasting plasma glucose(FPG), triglyceride(TG), total cholesterol(TC), high density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol(LDL-C), fasting plasma insulin(FINS), etradiol(E2), dehydroepiandrosterone(DHEAS), follicle stimulating hormone(FSH), luteinizing hormone(LH), progesterone, prolactin(PRL) and total testosterone were measured. Serum PTX3 and vaspin levels were detected with ELISA. The homeostasis model assessment of insulin resistance(HOMA-IR) was used to estimate insulin resistance and its correlations with PTX3 and vaspin level were analyzed. Results Compared with non-obese control group, the level of PTX3 was reduced, while the level of vaspin was elevated in non-obese PCOS group(F=3.446, 6.653, all P<0.05). The level of vaspin was elevated in overweight or obese PCOS group(F=4.125, P<0.05). Compared with non-obese PCOS group, the level of vaspin was elevated in overweight or obese PCOS group(F=6.238, P<0.05). Compared with overweight or obese control group, the level of serum PTX3 was reduced(F=5.273, P<0.01), and the level of vaspin was elevated(F=7.124, P<0.05)in overweight or obse PCOS group. Correlation analysis showed that the level of PTX3 was negatively correlated with FPG, TG, FINS, HOMA-IR, DHEAS and total testosterone(r=-0.172, -0.190, -0.294, -0.274, -0.236, -0.243, all P<0.05), and positively correlated with age(r=0.240, P<0.05). The level of vaspin was positively correlated with BMI, HOMA-IR and TC(r=0.331, 0.418, 0.172, all P<0.05). Conclusion PCOS patients have a low level of PTX3 but high level of vaspin, which might be related to hyperandrogenism and insulin resistance. Key words: Polycystic ovary syndrome; Obesity; PTX3; Vaspin

Polycystic ovary syndrome (PCOS) is a prevalent condition in women of reproductive age. It is characterized by androgen excess and chronic anovulation. Some trace elements, macroelements, and heavy metals have been linked to pathophysiological mechanisms of PCOS .&#x0D; To study the alterations in the serum levels of the trace element manganese (Mn), some macroelements, magnesium(Mg) and calcium (Ca), and the heavy metals cadmium (Cd) and lead (Pb), in obese and non-obese PCOS patients; and the association of these alterations with some of the hormonal changes occurring in PCOS.&#x0D; The study was carried out at Kamal Al-Samarrai Hospital (Center for Infertility treatment and in vitro Fertilization "IVF") Baghdad- Iraq. Eighty-two women were enrolled in the study. Fifty-four of them were diagnosed by a specialist gynecologist as PCOS patients; they were subdivided into two subgroups according to their body mass index (BMI); twenty-seven obese PCOS patients with BMI &gt; 30 kg/m2, and another twenty seven non obese patients PCOS with BMI &lt;30 kg/m2. Whereas, twenty-eight apparently healthy women with regular menstruation and of comparable age, were selected to serve as control groups; they were subdivided into, fourteen obese women with BMI &gt; 30kg/m2, and fourteen non obese women with BMI &lt;30 kg/m2.&#x0D; Blood lead and cadmium levels were significantly higher in both of the obese and the non-obese PCOS groups, than in their corresponding control groups. While, serum magnesium, calcium and manganese levels were significantly lower in both of the obese and the non-obese PCOS groups, as compared to their corresponding control groups. The results revealed no significant difference in the levels of the measured elements, between the obese PCOS group and the non-obese PCOS group. The serum FSH levels was significantly lower in obese PCOS patients than in the obese and non-obese control groups. There was a positive correlation between blood lead and serum TSH levels in non-obese PCOS women; and between serum total testosterone and cadmium levels in obese PCOS women. Finally, there was negative correlation between serum magnesium and serum LH levels in non-obese PCOS women.&#x0D; the study has demonstrated higher blood levels of lead and cadmium; and lower serum levels of magnesium, calcium and manganese in PCOS groups than control subject. There were no significant differences between obese PCOS women and non-obese PCOS women in the levels of the studied hormones, elements and heavy metals.

Polycystic ovary syndrome (PCOS) is a metabolic disorder associated with obesity and energy metabolic system disturbances in adipose tissue. Neuregulin 4 (NRG4), which is secreted by adipose tissue, regulates energy metabolism. In the present study, we aimed to evaluate the association between serum NRG4 levels in obese and normal weight PCOS patients. This cross-sectional study was conducted at a tertiary hospital in Turkey from April to August 2017. We included 148 women who were divided into four groups as follows: 40 normal weight and 39 obese PCOS women diagnosed according to the Rotterdam criteria as well as 38 normal weight and 31 obese, age-matched, non-hyperandrogenemic women with a regular menstrual cycle (controls). Levels of serum NRG4, anti-Müllerian hormone (AMH), fasting blood glucose (FBG), insulin, and high-sensitivity C-reactive protein (hs-CRP); lipid and hormone profiles; insulin resistance indices [homeostasis model assessment of insulin resistance (HOMA-IR)];and anthropometric parameters were evaluated. Serum NRG4 levels were elevated in the normal weight PCOS group than in the control group. Moreover, serum NRG4 levels were higher in the obese PCOS group than in the normal weight PCOS and obese control groups (p < .01). Serum NRG4 levels were positively correlated with body mass index (BMI); waist/hip ratio; HOMA-IR; and levels of triglycerides, hs-CRP, FBG, insulin, AMH, and dehydroepiandrosterone sulphate. Multiple regression analyses revealed that serum NRG4 levels were independently associated with BMI. Obesity appears to be the most influential factor for NRG4 secretion in PCOS patients. Management of obesity may be a key factor for resolving PCOS-related metabolic abnormalities and fertility problems.Impact SstatementWhat is already known on this subject? PCOS is a dynamic syndrome with different clinical and metabolic features during the reproductive age. PCOS is associated with various metabolic abnormalities, such as insulin resistance (IR), glucose intolerance, dyslipidemia, and obesity (particularly visceral obesity) as well as long-term complications, such as type 2 diabetes and cardiovascular diseases. Neuregulin 4 (NRG4), which is secreted by adipose tissue, regulates energy metabolism.What do the results of this study add? To the best of our knowledge, this was the first study investigating NRG4 levels in PCOS patients with different BMIs. Obesity appears to be the most influential factor for NRG4 secretion in these patients. Managing obesity may be a key factor for resolving PCOS-related metabolic abnormalities.What are the implications of these findings for clinical practice and/or further research? Further research in PCOS is warranted to ameliorate obesity, and our study can provide basis for future studies investigating NRG4 levels in PCOS patients with different phenotypes as well as studies of gene polymorphisms, AMH, and infertility and can contribute to the elucidation of problems related to the pathophysiology of PCOS.

Objective To determine the association of subclinical hypothyroidism (SCH) with body composition (measured by body impedance analysis) and insulin resistance (IR) in overweight/obese patients with polycystic ovary syndrome (PCOS). Methods A retrospective analysis was conducted of the clinical records of 109 overweight or obese [body mass index(BMI)≥24 kg/m2] PCOS patients who visited the Department of Endocrinology and Fertility Center of Nanjing Drum Tower Hospital between April 2013 and April 2016 for menstrual disorder or infertility and were referred to receive weight management. 24 of the patients had SCH, and 85 had euthyroid (EU). We determined the body composition of the patients with Biospace Inbody 720 body composition analyzer, measured the patients' serum lipid profiles, conducted in each patient the 75 g oral glucose tolerance test and the insulin release test, and calculated the homeostasis model assessment of insulin resistance (HOMA-IR) indices. Results Patients with SCH and autoimmune thyroiditis (AIT) accounted for 22.02% and 24.36% of the total. The obesity level[(145.19±13.75)% vs.(153.31±18.15)%, t=-2.032, P=0.045], VFA[(132.48±20.85)cm2vs.(147.35±24.26 )cm2, t=-2.730, P=0.007], body fat (BF) [(31.91±5.88)kg vs.(35.43±6.89) kg, t=-2.274, P=0.025], body fat percentage (BFP) [(40.92±3.701)% vs.(43.07±4.26)%, t=-2.241, P=0.027], body mass index (BMI)[(30.49±2.88)kg/m2vs.(32.19±3.81)kg/m2,t=-2.026, P=0.045]and waist circumference (WC) [(98.34±7.13)cm vs.(102.86±8.74)cm, t=-2.324, P=0.022]of SCH group were significantly lower than those of euthyroid , with significant statistical difference. The levels of serum thyroid hormone (TSH) in patients with EU were positively correlated with the degree of obesity, the BF, the BFP, the BMI and the hip circumference (P=0.019, 0.042, 0.025, 0.019, 0.039), but not with the VFA (t=1.797, P=0.076). There were no statistically significant differences (P> 0.05) between patients with SCH and those with EU in their HOMA-IR indices, insulin levels, blood glucose, blood lipid, and ratio of IR (defined as HOMA-IR≥2.69). Conclusions Obesity related body composition parameters were lower in PCOS patients with SCH than in those with EU. However, there was no significant difference between the two groups in blood lipid level and the ratio of IR. TSH levels in the EU group were correlated with the BMI and the BFP, but not with the VFA. A larger sample is needed to identify how and why thyroid hormones may affect the body composition and glycolipid metabolism of females with PCOS. Key words: Overweight and obesity; Polycystic ovary syndrome; Subclinical hypothyroidism; Body composition; Insulin resistance

This study was performed to investigate the changes and influencing factors of liver controlled attenuation parameter (CAP) in obese patients with polycystic ovary syndrome (PCOS), and to determine the prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD) in PCOS patients with obesity. Forty-one PCOS patients with obesity and twenty age- and body mass index (BMI)-matched control women without PCOS were enrolled in this study. General data, body composition, biochemical parameters, sex hormones, and liver CAP in the two groups were collected and compared. Liver CAP was measured using transient elastography. NAFLD was more common in the Obese PCOS group than in the control group (75.61% vs. 45.00%, P=0.018). Compared to the control group, the obese PCOS group showed apparent increases in alanine transaminase (ALT), aspartate transaminase (AST), CAP, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), totle testosterone (TT), free androgen index (FAI), fasting insulin (FIns), and homeostasis model assessment-insulin resistance (HOMA-IR), along with lower high-density lipoprotein cholesterol (HDL-C) and sex hormone binding globulin (SHBG) levels. In addition, as shown by Spearman analysis, liver CAP in PCOS patients with obesity had a positive correlation with ALT, AST, TG, TT, FAI, FIns, and HOMA-IR, and a negative correlation with SHBG. Logistic regression analysis showed that TG, TT, FIns, and HOMA-IR were risk factors for NAFLD, while TT was an independent risk factor for NAFLD in PCOS patients with obesity. PCOS patients with obesity had a significantly higher prevalence of NAFLD. Furthermore, in PCOS patients with obesity, liver CAP was associated with disorders of lipid metabolism, insulin resistance, and hyperandrogenemia, with elevated testosterone levels being an independent risk factor for NAFLD in PCOS patients with obesity.

Objectives:The objective was to compare body composition, metabolic characteristics, and insulin resistance between obese (body mass index [BMI] ≥25 kg/m2) polycystic ovary syndrome (PCOS) and nonobese PCOS (BMI <25 kg/m2) women and their age- and BMI-matched controls.Materials and Methods:A total of 81 PCOS women (Rotterdam criteria) (obese – 42; nonobese – 39) and 86 controls (obese – 42; nonobese –44) were recruited in this cross-sectional study. All women underwent a detailed assessment of clinical, anthropometric, and metabolic parameters, insulin resistance indices, and body composition measurements with visceral adipose tissue assessment (VAT) (dual-energy X-ray absorptiometry scan).Results:Of PCOS women, 27% (80% – obese PCOS; 20% – nonobese PCOS) were diagnosed with metabolic syndrome (International Diabetes Federation criteria), 35% of PCOS women (46% – obese PCOS; 54% – nonobese PCOS) had impaired glucose tolerance, and 7% of PCOS women (2/3rd – obese PCOS; 1/3rd – nonobese PCOS) had diabetes mellitus. Insulin resistance was seen in about 80% in obese PCOS women and 20% in nonobese PCOS women based on various insulin resistance indices such as fasting insulin (≥12.2 μU/ml), Homeostasis Model Assessment-Insulin Resistance (≥2.5), and Quantitative Insulin Sensitivity Check Index (<0.33). Total body fat, estimated (Est.) VAT, and corrected Est. VAT (corrected for body weight) were significantly increased (P = 0.0001) in both obese and nonobese PCOS women when compared to those of their age- and BMI-matched controls. However, corrected Est. VAT (corrected for body weight) was not significantly different between obese and nonobese PCOS women.Conclusion:Both obese and nonobese PCOS women when compared with their age- and BMI-matched controls were metabolically worse and had more visceral adiposity. Nonobese PCOS poses similar risk as that of obese PCOS in having similar amount of VAT (corrected for body weight).

This study was designed to evaluate the relationship of two new biomarkers [tribbles homolog 3 (TRB3) and sestrin 2 levels], which were previously associated with obesity, with metabolic parameters in obese and nonobese women with polycystic ovary syndrome (PCOS). This cross-sectional case control study was conducted between September 2017 and August 2019 in the gynecology department of a tertiary referral hospital. The values of the plasma sestrin 2, TRB3, insulin, fasting plasma glucose, lipid profile, and homeostasis model assessment of insulin resistance (HOMA-IR) were compared in 90 obese women with PCOS (BMI > 30), 90 women with nonobese PCOS (BMI < 30), and 90 control patients (BMI < 30). The mean age of the study group consisting of all PCOS patients (26.11 ± 4.64 years) and the mean age of the control group (26.3 ± 4.4 years) were statistically similar (p = 0.239). The serum sestrin 2 values of the obese PCOS group were found to be statistically significantly lower than the control and non-obese PCOS groups (p = 0.001, p = 0.0001), while the sestrin 2 values of the nonobese PCOS group were found to be statistically significantly lower than the control group (p = 0.0001). The TRB3 values of the control group were found to be statistically significantly lower than the obese and nonobese PCOS groups (p = 0.0001), while the TRB3 values of the nonobese PCOS group were found to be statistically significantly lower than the obese PCOS group (p = 0.0001). A negative correlation was observed between the sestrin 2 level and BMI (r = -0.272 p = 0.0001), insulin (r = -0.261 p = 0.0001), and HOMA-IR levels (r = -0.250 p = 0.0001). A positive correlation was observed between the TRB3 values and TG (r = 0.248 p = 0.0001), and LDL-C values (r = 0.235 p = 0.0001). According to the findings in this study, low sestrin 2 and high TRB3 levels may be related to impaired metabolic status in the obese PCOS group. Thus, it may be promising for the development of treatment of PCOS and associated metabolic disorder in the future.

The effects of metformin treatment on soluble leptin receptor (sOB-R) levels in women with polycystic ovary syndrome (PCOS) were investigated. This prospective and open-label study was conducted by the Department of Obstetrics & Gynecology at Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, China. Fifty-five women with PCOS and insulin resistance (IR) were treated with metformin for 6 months. According to body mass index (BMI), the patients were divided into two groups: lean PCOS group (BMI <23 kg/m2, n=34) and overweight or obese PCOS group (BMI ≥23 kg/m2, n=21). Before and after treatment, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), insulin and sOB-R levels were determined. Thirty-one BMI-matched ovulatory women served as controls. The results showed: (1) The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), androgen levels and hirsutism scores were higher, and sOB-R levels were lower in PCOS groups than in control group. A subgroup analysis of lean and overweight or obese PCOS patients revealed there was significant difference in sOB-R level between lean PCOS group and overweight or obese PCOS group. There were no significant differences in anthropometric parameters between lean PCOS patients and BMI-matched controls. However, sOB-R level was significantly lower in lean PCOS women than in controls. (2) There was no correlation between sOB-R level and BMI, waist and hip circumference, total testosterone, androstendione, DHEAS, LH or hirsutism scores in PCOS patients, but there was a significant negative correlation between sOB-R and HOMA-IR. (3) After treatment with metformin for 6 months, serum insulin levels decreased, and sOB-R levels increased significantly (P<0.01). It was suggested that considering low sOB-R levels supposedly compensate diminished leptin action, PCOS per se might cause leptin resistance. It is likely that reduction of hyperinsulinemia produced by metformin effectively improves the sOB-R levels in PCOS.

Do women with PCOS have a unique predisposition to obesity?

To investigate and analyze the clinical presentation, hormonal profile, and metabolic abnormalities of obese women with polycystic ovary syndrome (PCOS). The data of the anthropometric measurements, clinical manifestations of hyperandrogenism, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E(2)), testosterone (T), prolactin (PRL), dehydro-epiandrosterone sulfate (DHEAS), sex-hormone-binding globulin (SGBG), and 17-oxyhydroprogesterone (17-OHP), fasting plasma glucose (FPG) and fasting insulin (FINS) detected after oral glucose tolerance test (OGTT), serum lipid levels, including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), homeostasis model assessment (HOMA) and area under curve (AUC) so as to assess the insulin resistance (IR), free androgen index (FAI) to estimate the extent of hyperandrogenism, HOMA IS and DeltaI(30)/DeltaG(30) used to assess the function of islet beta cells, were collected from 192 women with PCOS, aged 24 +/- 6, that were divided into 2 groups according to the body mass index (BMI): Group A (n = 70) with the BMI > or = 25 kg.m(-2) and Group B (n = 122) with the BMI < 2 5 kg.m(-2), and 65 age-matched bilateral tubal block factor infertile women served as controls that were divided into 2 groups as well: Group C (n = 25) with the BMI > or = 25 kg.m(-2); and Group D (n = 79) with the BMI < 25 kg.m(-2), and underwent a cross-sectional study. (1) Clinical phenotype: The presence of obesity was 36.46% (70/192) of which 80.00% (56/70) was central obesity. The incidence of acanthosis nigricans was 17.18% (33/192), 35.71% in Group A and 6.56% in Group B. (P < 0.01). Groups A and C showed increased frequency of acanthosis nigricans compared with Group B. The value of FAI of Group A was 3.40 +/- 1.84, significantly higher than those of Group B (1.75 +/- 1.20) and Group C (1.65 +/- 0.90), (both P < 0.01). The LH/FSH ratio of Group B was 2.41 +/- 1.13, significantly higher than those of Groups A, C, and D (all P < 0.01). (2) Hormonal profile: The IR rate was 43.23% in the 192 patients, 82.86% in Group A and 20.49% in Group B. The LH and LH/FSH ratio were significantly higher in Group B than in Groups A, C, and D (all P < 0.01); T level was higher in Groups A and B than in Group C and D (all P < 0.05). SHBG was lower in Group A (108.70 +/- 81.35 nmol.L(-1)) and Group C (150.34 +/- 106.23 nmol.L(-1)) compared with Group B (192.49 +/- 98.30 nmol.L(-1)) and Group D (231.84 +/- 90.09 nmol.L(-1)) (P < 0.01 and P < 0.05). FAI level was 3.40 +/- 1.84 in Group A, significantly higher than those of Groups B (1.75 +/- 1.20), C (1.65 +/- 0.90), and D (0.84 +/- 0.45) (all P < 0.01). The FINS, TG, and HOMA IR of Groups A and C were all significantly higher than those of Groups B and D (all P < 0.01). The OGTT GAUC was significantly higher than those of Groups B, C, and D (P = 0.006, 0.028, and 0.031 respectively). (3) Metabolic profile: The prevalence of IR was 43.23% (83/192) with a higher prevalence rate in Group A (82.76%, 58/70) compared with Group B (20.49%, 25/122). The values of FINS, HOMA IR, GAUC, IAUC, and TG were all higher in Group A than in Group B (all P < 0.01). BMI and WHR were positively correlated with FAI and HOMA-IR (all P < 0.01), whereas negatively correlated with LH/FSH ratio (r = -0.345, -0.260, P < 0.01). There were no significant differences in HOMA-IS and DeltaI(30)/DeltaG(30) among these groups (all P > 0.05). Obese PCOS women have more severe hyperandrogenism, IR and hyperinsulinism than normal-weight PCOS women, which may have some health implications later in life.

Introduction Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women in adolescence and reproductive age. The distribution of PCOS across different body mass index (BMI) categories can vary, and research has shown associations between PCOS and weight status. This study tries to evaluate the distribution of PCOS in relation to BMI in women attending the PCOS clinic in a tertiary hospital in eastern India. Methodology This hospital-based cross-sectional study was carried out in the gynecology outpatient departmentof a tertiary care center. The study population included all the women in the age group between 15 and 45 years diagnosed as having PCOSusing the Rotterdam definition. The various physical, clinical, and biochemical parameters were measured in the study population and compared among the obese and lean PCOS patients. Results and discussion A total of 143 women were included in the study. The mean age of the study population was 26.8 years. Among these, the underweight and normal weight patients were categorized as lean PCOS patients, 35 in number (24.5%), and overweight and obese patients were categorized as obese PCOS patients, 108 in number (75.5%). All the physical parametermeasures like age (mean = 28.05, SD = 5.722), height (mean = 153.384, SD = 6.679), weight (mean = 68.182, SD = 11.501), waist circumference (mean = 95.135, SD = 10.291), hip circumference (mean = 101.47, SD = 9.320), waist-to-hip ratio (mean = 0.940, SD = 0.0831), and neck circumference (mean = 34.85, SD = 2.445) were significantly higher in the obese group as compared to the lean group. Menstrual irregularity was significantly more common in the obese PCOS patients as compared to the lean PCOS group (p = 0.02). There was a significant difference (p < 0.05) between the obese and lean PCOS patients when the biochemical parameters like fasting insulin, fasting glucose, and homeostatic model assessment of insulin resistance (HOMA-IR) were compared. There is a strong link between obesity, insulin resistance, and PCOS. Obesity can exacerbate insulin resistance, a common feature of PCOS, leading to increased levels of insulin and androgens. Conclusion The demographic distribution of PCOS in relation to BMI is essential for tailoring interventions and treatments.

Objective: To investigate the correlation between body composition parameters, adiponectin, leptin and the adiponectin/leptin ratio and the LH/FSH ratio in women with polycystic ovary syndrome (PCOS).&#x0D; Methods: A cross-sectional study was conducted at Reproductive Cluster Yasmin, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, with sixty women with PCOS and sixty healthy women as controls (matched for age and BMI). Body composition parameters, including body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), percent body fat (PBF), visceral fat area (VFA), percent subcutaneous fat (PSF) and skeletal muscle mass (SMM), were measured; levels of fasting glucose, fasting insulin, testosterone, and sex hormone binding globulin (SHBG) were measured; and homeostatic model assessment for insulin resistance (HOMA-IR) values, anti-Mullerian hormone (AMH), free androgen index (FAI), Ferriman-Gallwey (FG) score, adiponectin levels, leptin levels, adiponectin/leptin ratio, LH, FSH and LH/FSH ratio were measured.&#x0D; Results: Body composition parameters (body weight, BMI, WC, WHR, PBF, VFA, PSF, SMM) were not significantly different between women with PCOS and controls. Fasting insulin (P&lt;0.05), HOMA-IR (P&lt;0.05), AMH (P&lt;0.01), FAI (P&lt;0.01), FG score (P&lt;0.01) and LH/FSH ratio (P&lt;0.05) were higher in PCOS women. Adiponectin (P&lt;0.01) was lower in PCOS women, while leptin and the adiponectin/leptin ratio were not significantly different between groups. Most of body composition parameters, adiponectin, leptin and adiponectin/leptin ratio were correlated with HOMA-IR in both groups.&#x0D; SMM was positively correlated with the LH/FSH ratio, while body weight, BMI, WC, PBF, VFA, and PSF were inversely correlated with the LH/FSH ratio in PCOS patients but not in controls. WHR was not correlated in either group. Leptin (r=-0.278; P&lt;0.05) was negatively correlated with the LH/FSH ratio only in the PCOS group. Adiponectin (r=0.394; P&lt;0.01) and the adiponectin/leptin ratio (r=0.413; P&lt;0.01) were also positively correlated with the LH/FSH ratio only in the PCOS group. AMH was correlated with the LH/FSH ratio, whereas testosterone level, FAI, FG score, fasting insulin level and HOMA-IR value were not correlated with the LH/FSH ratio in PCOS women.&#x0D; Conclusion: Most of the body composition parameters, leptin, adiponectin and the adiponectin/leptin ratio were significantly correlated with HOMA-IR in both groups. However, correlations of those parameters with LH/FSH ratio were found only in PCOS but not in women without PCOS. Adiponectin and leptin may play a significant role in the mechanism of neuroendocrine disorders in PCOS, which is characterized by an increased LH/FSH ratio.&#x0D; Keywords: adiponectin, adiponectin/leptin ratio, body composition, HOMA-IR, leptin, LH/FSH ratio, PCOS