Visceral adiposity and insulin resistance in polycystic ovarian syndrome - A cross-sectional, observational study.

Polycystic ovarian syndrome (PCOS) has bidirectional effects on the skeleton due to hormonal dysfunction and insulin resistance (IR). We examined bone mineral density (BMD) and its relationship with IR using the homeostasis model of assessment (HOMA) in patients with PCOS and matched controls. In this case-control observational study, we included 74 patients newly diagnosed with PCOS and a similar number of age-and weight-matched healthy women as controls. Haematological, biochemical and hormonal parameters were measured in a fasting blood sample during the follicular phase, and the BMD Z score was calculated using dual energy X-ray absorptiometry. The results were analysed using relevant statistical methods, and P < 0.05 was considered significant. The study participants ( n = 148) had a mean age of 23.6 ± 3.7 years and a body mass index (BMI) of 25.2 ± 3.2 kg/m 2 . Among the PCOS patients, 25 (34%) had a normal BMI and 49 (66%) were obese. The BMD at the femoral neck ( P = 0.4313) and lumbar spine ( P = 0.1410) was comparable between the PCOS and control groups. Correlation analysis showed a positive correlation of BMD with testosterone and 17-hydroxy progesterone (17OHP) ( P < 0.001). None of the BMD parameters correlated with HOMA in either group. BMD at the lumbar spine and femoral neck was similar between patients with PCOS and controls. Further studies with a larger sample size, longer follow-up periods and fracture data are needed to confirm our findings.

IL-22 and its interaction with amino acid and glycolipid metabolite in polycystic ovary syndrome (PCOS) patients

ObjectiveIn polycystic ovary syndrome (PCOS), insulin resistance (IR) appears with high prevalence and represents the major cause of cardiometabolic complications. Lipin 1β regulates lipid metabolism and augments insulin sensitivity. The impact of lipin 1β expression in visceral and subcutaneous adipose tissue of PCOS patients on IR was studied for the first time.MethodsEighty-five PCOS patients and 44 controls were enrolled for subcutaneous tissue biopsy, of whom 25 patients and 30 controls also underwent visceral adipose tissue biopsy. Gene expression of lipin 1β was measured, together with that of peroxisome proliferator-activated receptor γ, lipoprotein lipase, hormone-sensitive lipase, adiponectin and glucose transporter 4 in subcutaneous and visceral adipose tissue. Markers of obesity, IR and PCOS were also measured.ResultsIn PCOS patients, lipin 1β expression in both adipose depots was lower than in controls: 0.76 (0.67–0.84) vs 1.16 (0.90–1.43) for visceral and 0.91 (0.73–1.10) vs 1.30 (1.03–1.57) for s.c. depot (both P&lt;10−4). The difference remained significant after adjustment for body mass index (BMI) and also when comparing only lean patients with lean controls. In PCOS patients, visceral adipose lipin 1β expression correlated negatively with homeostasis model assessment–IR (r=−0.474, P=0.017), BMI (r=−0.511, P=0.009) and waist circumference (r=−0.473, P=0.017), waist circumference remaining significant (P=0.027) in multiple regression. Subcutaneous lipin 1β expression in PCOS correlated negatively with BMI, waist circumference and plasma triglycerides, and positively with high density lipoprotein-cholesterol. Subcutaneous, but not visceral lipin 1β expression, correlated positively with the studied genes.ConclusionsLipin 1β appears to be involved in the pathogenesis of IR in PCOS.

Aim of the Study:This study aimed to compare the different adiposity parameters, namely visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) between patients with polycystic ovary syndrome (PCOS) and controls. In addition, it aimed to correlate these adiposity indices with hormonal parameters as well as cardiovascular (CV) risk factors in patients with PCOS.Materials and Methods:Newly diagnosed PCOS patients of reproductive age group according to Rotterdam criteria were included. Age- and body mass index (BMI)-matched healthy females with normal menstrual cycles were taken as controls. All the study participants underwent detailed clinical, biochemical, and hormonal evaluation. Transabdominal ultrasound (US) was performed for detailed ovary imaging and assessment of adiposity (SAT and VAT) parameters.Results:A total of 58 PCOS patients and 40 age- and BMI-matched controls were included. PCOS patients had significantly higher levels of androgens (P < 0.001), elevated highly sensitive C-reactive protein (P = 0.007), and higher degree of insulin resistance (P < 0.001) than controls. PCOS patients had a mean SAT of 2.37 ± 0.7 cm and mean VAT of 8.65 ± 1.78 cm. These parameters were significantly higher than controls who had a mean SAT of 2.01 ± 0.7 cm (P = 0.014) and mean VAT of 7.4 ± 1.89 cm (P = 0.003), despite both groups having similar BMI. Among PCOS cohort, VAT correlated positively with total testosterone (r = 0.295, P = 0.025) and negatively with dehydroepiandrosterone sulfate (r = −0.210, P = 0.114). However, no significant correlation was observed between SAT and androgens in PCOS group.Conclusion:PCOS patients, whether obese or nonobese, had elevated visceral adiposity than controls. VAT correlated positively with adverse CV risk factors and testosterone in PCOS patients. Hence, a simple and inexpensive ultrasonography screening of visceral fat may identify women who have adverse metabolic profile and enhanced CV risk.

Expression of 11β-hydroxysteroid dehydrogenase type 1 in visceral and subcutaneous adipose tissues of patients with polycystic ovary syndrome is associated with adiposity

Background: Evaluating the difference in body fat distribution between polycystic ovary syndrome (PCOS) and healthy controls may help to understand their roles in the pathogenesis of PCOS. Objectives: To compare the body fat distribution of women with PCOS with that of healthy controls, and to investigate the association of these measurements with anthropometric, metabolic, and hormonal profiles among PCOS patients. Methods: This case-control study was carried out in 50 reproductive-aged women with PCOS and 50 age-matched healthy controls in the Department of Endocrinology, Bangladesh Medical University (BMU). Anthropometry, blood pressure, biochemical tests, and USG of the ovaries were done. Body fat distribution was measured by DEXA scan in Nuclear Medicine, BMU campus. Insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Results: The frequency of obese participants was higher in the PCOS group than in the control group based on the fat mass index. Though the total body fat percentage was higher in women with PCOS, both groups were obese based on the cutoff point (total body fat% ≥35). PCOS patients showed higher android fat percentage and android-gynoid ratio (AGR). Both visceral and subcutaneous adipose tissue were higher in PCOS patients than in the controls. Almost all body fat indices were positively correlated with anthropometric parameters. AGR had a significant correlation with total cholesterol and triglyceride levels. HOMA-IR was positively correlated with nearly all body fat metrics. Multivariate logistic regression analyses showed no significant association between PCOS and body fat distribution after adjustment for age, modified Ferriman-Gallwey score, free androgen index, and HOMA-IR. Conclusion: Body fat distributions had no independent associations with PCOS. Body fat distributions correlated with anthropometric measurements and insulin resistance in women with PCOS. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S45]

Association of abdominal obesity, insulin resistance, and oxidative stress in adipose tissue in women with polycystic ovary syndrome

Background and Objectives: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Women with PCOS often have metabolic disorders such as insulin resistance (IR), type 2 diabetes (T2DM), obesity, and metabolic syndrome (MetS). The assessment of visceral adiposity and dysfunctional adipose tissue is crucial for understanding the metabolic risks associated with PCOS. The visceral adiposity index (VAI) and the dysfunctional adiposity index (DAI) are two novel metabolic indices that more specifically assess adipose tissue dysfunction and visceral fat accumulation. This study aimed to evaluate the clinical utility of VAI and DAI as predictive markers for metabolic complications such as insulin resistance (IR) and metabolic syndrome (MetS) in women with PCOS. Materials and Methods: This cross-sectional study included 92 women diagnosed with PCOS based on the 2023 revised Rotterdam criteria, as well as 68 healthy controls. Anthropometric and biochemical parameters, including fasting glucose, insulin, lipid profile, and hormonal markers, were recorded. VAI and DAI were calculated using established formulas derived from previous validated studies. Results: The mean VAI in PCOS patients was 4.26 ± 3.23, compared to 2.61 ± 1.92 in controls (p = 0.003). The mean DAI in PCOS patients was 3.00 ± 1.86, while in controls it was 1.86 ± 1.22 (p = 0.003). Both VAI (Area Under the Curve [AUC] = 0.639) and DAI (AUC = 0.635) did not demonstrate statistically significant diagnostic performance for PCOS itself, but they were strongly associated with metabolic disturbances within the PCOS group. VAI and DAI values were significantly elevated in PCOS patients with IR (p < 0.001) and MetS (p < 0.001). For MetS in PCOS patients, VAI demonstrated the highest predictive ability, with an AUC of 0.87 and a cutoff of 4.73 (sensitivity 62%, specificity 92%), while DAI had an AUC of 0.86 with a cutoff of 2.44 (sensitivity 74%, specificity 80%). Regarding IR in PCOS patients, VAI had an AUC of 0.75 with a cutoff of 2.56 (sensitivity 82%, specificity 56%), while DAI had an AUC of 0.74 with a cutoff of 1.59, showing a sensitivity of 82% and a specificity of 55%. Conclusions: Although VAI and DAI are not suitable for diagnosing PCOS, they provide valuable insights into the metabolic risks associated with the condition. VAI and DAI can serve as promising biomarkers for identifying IR and MetS risk in women with PCOS. Their integration into clinical practice may facilitate the early detection of cardiometabolic complications, offering a more specific metabolic risk assessment compared to traditional anthropometric measures.

This Month in Gastroenterology

Visceral Adipose Tissue Attacks Beyond the Liver: Esophagogastric Junction as a New Target

The high cardiometabolic risk associated with polycystic ovary syndrome (PCOS) may be linked to central fat accumulation. This study compared fat distribution between women with PCOS and controls matched by body mass index. It also sought to determine if insulin resistance (IR), androgens, or inflammatory markers correlate with body composition parameters in PCOS patients. In total, thirty-five women with PCOS and 37 controls, aged 18-40 years, were included. Hormonal/metabolic profiles, inflammatory biomarkers [tumor necrosis factor-alpha (TNF-α and interleukin-6 (IL-6)], anthropometry (waist circumference, waist-to-hip ratio, lipid accumulation product [LAP], visceral adiposity index [VAI]), and body composition assessed through dual-energy X-ray absorptiometry were assessed. The PCOS group exhibited significantly higher androgen levels and markers of IR. However, levels of TNF-α and IL-6 were comparable between the groups. Despite having similar total body fat mass (FM), the PCOS group had excessive central fat, including increased truncal FM and visceral adipose tissue (VAT). In PCOS, androgens were not associated with body fat or its distribution. IL-6 was positively correlated with total and truncal FM, while insulinemia and the homeostatic model assessment for IR were positively associated with VAT, as well as with total and truncal FM. Although anthropometric measurements and indices were positively associated with DXA-derived central FM parameters, our data suggest that LAP is the most effective tool for assessing central fat deposition and metabolic dysfunction in the PCOS patients studied herein. Furthermore, in this population, IR, rather than androgens or proinflammatory cytokines, is more closely associated with abdominal obesity.

A variant in the fibrillin-3 gene is associated with TGF-β and inhibin B levels in women with polycystic ovary syndrome

Periodontal disease in polycystic ovary syndrome

219-LB: The Changes in Body Composition in Obese Patients with Polycystic Ovary Syndrome after Laparoscopic Sleeve Gastrectomy: A 12-Month Follow-Up

Serum insulin-like growth factor I (IGF-I) and IGF-binding protein 3 (IGFBP-3) in IVF patients with polycystic ovary syndrome: correlations with outcome