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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 13-16

Assessment of clinical, biochemical, and hormonal profile of lean versus overweight polycystic ovarian syndrome patients: A cross-sectional study


1 Department of Endocrinology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
2 Department of OBGYN, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
3 Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India

Date of Submission29-Dec-2020
Date of Decision01-May-2021
Date of Acceptance19-May-2021
Date of Web Publication06-Jan-2022

Correspondence Address:
Dr. Harpreet Kour
Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajim.ajim_117_20

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  Abstract 


Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder having escalation in its prevalence. This study was planned to understand the clinical, biochemical, and hormonal profile of lean versus overweight patients diagnosed newly with PCOS. Materials and Methods: A cross-sectional study was conducted for 1 year in the Department of Endocrinology of a tertiary care hospital. A total of 50 female patients newly diagnosed to have PCOS by the Rotterdam criteria 2003 were enrolled for the study. Assessment of clinical characteristics, biochemical, and hormonal profile was done. Results: Fasting serum insulin levels and homeostasis model assessment-insulin resistance signifying insulin resistance were higher in overweight compared to the lean PCOS. Insulin resistance was present in 50% of lean PCOS and 82% of overweight PCOS. Glucose abnormalities were noted in 13.7% of lean PCOS and 32.2% of overweight PCOS. Conclusion: Obese women with PCOS have a higher risk of increased obesity, impaired glucose tolerance, and insulin resistance as compared to lean PCOS women.

Keywords: Homeostasis model assessment, insulin resistance, lean polycystic ovary syndrome, obese polycystic ovary syndrome


How to cite this article:
Ghatnatti V, Patil S, Kour H. Assessment of clinical, biochemical, and hormonal profile of lean versus overweight polycystic ovarian syndrome patients: A cross-sectional study. APIK J Int Med 2022;10:13-6

How to cite this URL:
Ghatnatti V, Patil S, Kour H. Assessment of clinical, biochemical, and hormonal profile of lean versus overweight polycystic ovarian syndrome patients: A cross-sectional study. APIK J Int Med [serial online] 2022 [cited 2022 Jan 24];10:13-6. Available from: https://www.ajim.in/text.asp?2022/10/1/13/335075




  Introduction Top


Polycystic ovary syndrome (PCOS) accounts for up to 7%–10% of prevalence globally and is the most common endocrine disorder found in the reproductive age group.[1],[2] Menstrual irregularities, hyperandrogenism, hypertension, metabolic syndrome, insulin resistance, and endometrial hyperplasia are the most common symptoms among PCOS females.[3],[4] More than 50% of women with PCOS are insulin resistant, and it is estimated that they have a 5–8 fold increased risk of type 2 diabetes mellitus (type 2 DM) when compared with age and weight-matched controls. Furthermore, many women show impaired glucose tolerance (IGT) and are at risk of developing type 2 DM.[5],[6],[7] In clinical practice, we have come across with two types of patients diagnosed with PCOS i.e., overweight and lean. To understand more about lean and obese PCOS patients, this study was planned to assess and compare their clinical, biochemical, and hormonal profiles.

Objective

The objective of this study is to study the clinical, biochemical, and hormonal profile of lean versus overweight patients newly diagnosed with PCOS.


  Materials and Methods Top


This is a cross-sectional study conducted for 1 year in the Department of Endocrinology, at a tertiary care center. Written informed consent was taken from all patients involved in the study and institutional ethical clearance was obtained before the conduct of the study.

Inclusion criteria

PCOS was diagnosed using the Rotterdam 2003 criteria,[7] which defines PCOS as having two of the following oligoovulation or anovulation, clinical and or biochemical signs of hyperandrogenism or polycystic ovaries by ultrasonography

Exclusion criteria

  1. Patients with known medical illnesses such as diabetes, impaired fasting glucose (IFG), IGT, or active thyroid disorder
  2. Patients on medications such as corticosteroids, oral contraceptives, or metformin like drugs which could alter the endocrine and metabolic parameters under investigation
  3. Patients with disorders namely, 21-hydroxylase-deficient nonclassic adrenal hyperplasia, thyroid dysfunction, hyperprolactinemia, neoplastic androgen secretion, drug-induced androgen excess, the syndromes of severe insulin resistance, Cushing's syndrome, and glucocorticoid resistance.


Methods

  1. Age was noted in the years
  2. Body mass index (BMI) was calculated using Quetelet index. Internationally, a BMI over 25 kg/m2 is considered overweight. Due to the genetic tendency of Indians toward abdominal obesity and its associated risk of related lifestyle diseases such as diabetes and heart disease, guidelines for the diagnosis of obesity and abdominal obesity for India have been published in JAPI that a BMI over 23 kg/m2 is considered overweight.[8] Further definitions: Normal BMI: 18.0–22.9 kg/m2, overweight: 23.0–24.9 kg/m2, and obesity: >25 kg/m2 [Figure 1]
  3. Waist circumference (WC) was measured in a standing position midway between the lower costal margin and the iliac crest. Blood pressure was calculated as the mean of two manual sphygmomanometer readings with the patient in a seated position
  4. Clinical characteristics were evaluated through physical examination and detailed menstrual history, measurements of anthropometric variables, and calculating modified Ferriman-Gallwey score
  5. Biochemical parameters: An oral glucose tolerance test (OGTT) 75 g was performed, with venous blood samples taken at fasting and 2 h after the glucose load for glucose measurement. Normal glucose tolerance, IGT, and type 2 diabetes were defined using glucose levels during the OGTT, according to the criteria proposed by the World Health Organization. IFG was defined as fasting glucose levels between 100 mg/dl and 126 mg/dl and IGT as 2 h post glucose between 140 mg/dl and 200 mg/dl. Diabetes was diagnosed based on fasting plasma glucose more than 126 mg/dl and 2 h plasma glucose more than 200 mg/dl
  6. Plasma testosterone was assessed using a solid-phase, enzyme-labeled chemiluminescent immunometric assay
  7. Insulin resistance and β cell function were determined by “homeostasis model assessment”[9] (HOMA) based on the formulas as mentioned below.
  8. Figure I: Recruitment of Study Samples

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    • HOMA-insulin resistance (HOMA-IR) (μU/ml × mmol/dl) = Io × Go/22.5
    • HOMA-% B = (20 × Io)/(Go − 3.5).


(I0-fasting plasma insulin [μU/ml], G0-fasting plasma glucose [mmol/L])

An ideal normal-weight individual aged <35 years has a HOMA-IR of 1.0 mol × U/L2 and a HOMA-% B function.

Statistical analysis

Data are presented as mean + SD. The clinical hormonal, biochemical, and phenotype characteristics were tabulated into two groups and compared using the two-sample t-test. P < 0.05 was considered statistically significant. All data were analyzed with commercial software the IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY, USA: IBM Corp. IBM Corp. Released 2010.


  Results Top


The mean age group was comparable. BMI and WC were significantly higher in overweight as compared to lean PCOS. Acanthosis was significantly more in overweight compared to lean PCOS. The overweight PCOS patient has significant family history of diabetes mellitus [Table 1].
Table 1: Clinical Characteristics of lean versus overweight polycystic ovary syndrome

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Fasting blood glucose was similar between the two groups. Overweight PCOS patient's 2 h blood glucose was significantly higher. Fasting serum insulin levels and HOMA-IR signifying insulin resistance were higher in overweight compared to the lean PCOS. Insulin resistance was present in 50% of lean PCOS and 82% of overweight PCOS [Table 2].
Table 2: Biochemical and hormonal profile of lean versus overweight patients

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Glucose abnormalities were noted in 13.7% of lean PCOS and 32.2% of overweight PCOS. IGT was significantly more common in overweight compared to lean PCOS women (21.4% vs. 9.0%). Significantly more number of lean PCOS women had normal glucose levels compared to the overweight (86.3% vs. 67.8%) [Table 3].
Table 3: Categorization of glucose abnormalities in lean and overweight polycystic ovary syndrome

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  Discussion Top


In the present study, clinical features, biochemical, and hormonal profiles were on higher range in obese patients newly diagnosed with PCOS (P < 0.05). Various studies have documented the high prevalence of obesity in PCOS.[10],[11],[12],[13],[14] A study by Gambineri et al.[15] have reported 78% of the PCOS women were overweight with BMI, ≥25 kg/m2, and 73% were obese with BMI, ≥27 kg/m2. A battery of studies on Indian women with PCOS has also reported a higher mean of BMI ranging from 25 to 28 kg/m2.[16],[17],[18],[19]

In our study, 68% of the PCOS women were insulin resistant as defined by HOMA IR >2. Attempts to quantitate the prevalence of insulin resistance in PCOS are limited by the methods used to determine insulin sensitivity. The prevalence rates of insulin resistance have been reported from 44% to 70% using surrogate markers. Wijeyaratne et al., in their study have compared Asian PCOS women with Caucasian PCOS women and did find higher plasma insulin levels in Asians despite having equal plasma glucose levels.[20] In our study, insulin resistance was found in 50% of lean PCOS and 82% of overweight PCOS. Saxena et al. reported insulin resistance in 83.3% and 93.1% of lean and overweight PCOS, respectively. These high rates of insulin resistance in this study compared to our study maybe because of the different criteria used to define insulin resistance. The study by Gupta et al. has reported a higher insulin resistance between both obese and nonobese PCOS (44% and 36%) as compared to normal controls.[21] Saxena et al. used serum fasting and postprandial insulin levels to define insulin resistance rather than a more accurate index like HOMA IR. However, several studies have failed to demonstrate insulin resistance in lean women with PCOS using the highly sensitive euglycemic glucose clamp technique.[6] Some of these conflicting results can be accounted for by differences in the diagnostic criteria for PCOS that resulted in the inclusion of women with ovulatory cycles and hyperandrogenism who have minimal to absent evidence for insulin resistance.

In our study, about 21.4% of the obese PCOS patients had IGT. The study by Majumdar and Singh have reported a higher prevalence of IGT and type 2 DM in obese PCOS women with respect to lean ones. Legro et al. have reported 31% IGT and 7.5% type 2 DM in the obese PCOS patients and 10.3% IGT and 1.5% DM in nonobese PCOS which was 3 times that of the general population.[22],[23] PCOS women are at higher risk for IGT and eventually develop type 2 DM.


  Conclusion Top


Although insulin resistance is inherent to overweight PCOS, it is also present in a significant number of lean PCOS patients. Hence, even patients with lean PCOS should be considered to be at risk for cardiovascular disease and merit screening for cardiometabolic risk with regular blood pressure monitoring and periodic OGTT and lipid profile.

Acknowledgment

We are thankful to the Department of Endocrinology, Gauhati Medical College, Guwahati for all the support in the conduct of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet 2007;370:685-97.  Back to cited text no. 1
    
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Driscoll DA. Polycystic ovary syndrome in adolescence. Ann N Y Acad Sci 2003;997:49-55.  Back to cited text no. 2
    
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Legro RS, Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, et al. Endotext. In: Evaluation and Treatment of Polycystic Ovary Syndrome. Feingold KR, Anawalt B, Boyce A, et al, editors. South Dartmouth (MA): MDText.com, Inc.,; 2000. [Last accessed on 2021 Sep 21].  Back to cited text no. 3
    
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Charalampakis V, Tahrani AA, Helmy A, Gupta JK, Singhal R. Polycystic ovary syndrome and endometrial hyperplasia: An overview of the role of bariatric surgery in female fertility. Eur J Obstet Gynecol Reprod Biol 2016;207:220-6.  Back to cited text no. 4
    
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Glintborg D, Henriksen JE, Andersen M, Hagen C, Hangaard J, Rasmussen PE, et al. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004;82:1570-9.  Back to cited text no. 5
    
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Glintborg D, Andersen M. An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecol Endocrinol 2010;26:281-96.  Back to cited text no. 6
    
7.
Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.  Back to cited text no. 7
    
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Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163-70.  Back to cited text no. 8
    
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DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril 2005;83:1454-60.  Back to cited text no. 9
    
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Ilagan MK, Paz-Pacheco E, Totesora DZ, Clemente-Chua LR, Jalique JR. The modified Ferriman-Gallwey score and hirsutism among Filipino women. Endocrinol Metab (Seoul) 2019;34:374-81.  Back to cited text no. 10
    
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Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Obese and nonobese polycystic ovarian syndrome: Comparison of clinical, metabolic, hormonal parameters, and their differential response to clomiphene. Indian J Endocr Metab 2019;23:257-62.  Back to cited text no. 11
[PUBMED]  [Full text]  
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Kim MJ, Lim NK, Choi YM, Kim JJ, Hwang KR, Chae SJ, et al. Prevalence of metabolic syndrome is higher among nonobese PCOS women with hyperandrogenism and menstrual irregularity in Korea. PLoS One 2014;9:e99252.  Back to cited text no. 13
    
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Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord 2002;26:883-96.  Back to cited text no. 15
    
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Saxena P, Prakash A, Nigam A, Mishra A. Polycystic ovary syndrome: Is obesity a sine qua non? A clinical, hormonal, and metabolic assessment in relation to body mass index. Indian J Endocrinol Metab 2012;16:996-9.  Back to cited text no. 16
    
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Karoli R, Fatima J, Siddiqi Z, Vatsal P, Sultania AR, Maini S. Study of early atherosclerotic markers in women with polycystic ovary syndrome. Indian J Endocrinol Metab 2012;16:1004-8.  Back to cited text no. 18
    
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Diamanti-Kandarakis E, Kouli C, Alexandraki K, Spina G. Failure of mathematical indices to accurately assess insulin resistance in lean, overweight, or obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004;89:1273-6.  Back to cited text no. 19
    
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Wijeyaratne CN, Seneviratne Rde A, Dahanayake S, Kumarapeli V, Palipane E, Kuruppu N, et al. Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): Results of a large database from a specialist Endocrine Clinic. Hum Reprod 2011;26:202-13.  Back to cited text no. 20
    
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Gupta N, Radhakrishnan G, Madhu SV, Radhika AG. Comparison of metabolic and endocrinal parameters in obese and nonobese women of polycystic ovarian syndrome with normal controls. Fertil Sci Res 2015;2:19-23.  Back to cited text no. 21
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Majumdar A, Singh TA. Comparison of clinical features and health manifestations in lean vs. obese Indian women with polycystic ovarian syndrome. Endocr Abstr 2006;11:341.  Back to cited text no. 22
    
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Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for Type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165-9.  Back to cited text no. 23
    


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    Tables

  [Table 1], [Table 2], [Table 3]



 

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