All Title Author
Keywords Abstract

PLOS ONE  2014 

Prevalence of Metabolic Syndrome Is Higher among Non-Obese PCOS Women with Hyperandrogenism and Menstrual Irregularity in Korea

DOI: 10.1371/journal.pone.0099252

Full-Text   Cite this paper   Add to My Lib


Background Hyperandrogenism (HA) has been linked with several components of metabolic syndrome (MetS). Few studies in Asian women have evaluated the important risk factors for and prevalence of MetS according to PCOS subtype. In this study, we investigated differences in metabolic parameters and the prevalence of MetS in two major phenotypic subgroups of PCOS in Korea. Furthermore, we investigated the relationship between HA-associated parameters and MetS. Materials and Methods This cross-sectional observational study was conducted from May 2010 to December 2011 in Korea. A total of 837 females with PCOS, aged 15–40, were recruited from Departments of Obstetrics and Gynecology at 13 hospitals. Of those, 700 subjects with either polycystic ovaries (PCO)+HA+oligomenorrhea/amenorrhea (O) or PCO+O were eligible for this study. MetS was diagnosed according to the modified National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines and the International Diabetes Federation (IDF) criteria. Results MetS was more prevalent in the PCO+HA+O group (19.7%) than in the PCO+O (11.9%) group. There were statistically significant trends for an increased risk of MetS in the PCO+HA+O group compared to the PCO+O group. After adjustment for age, the odds ratio of MetS was 2.192 in non-obese subjects with PCO+HA+O compared to those with PCO+O, whereas the risk of MetS was not different in obese patients. Multivariate logistic regression analysis showed that high free androgen index and low sex hormone-binding globulin were significantly associated with MetS in non-obese women with PCOS, with odds ratios of 4.234 (95% CI, 1.893–9.474) and 4.612 (95% CI, 1.978–10.750), respectively. However, no associations were detected between MetS and SHBG and FAI in obese PCOS subjects. Conclusions Our results indicate that HA and its associated parameters (FAI and SHBG) are significantly associated with MetS in non-obese PCOS subjects, whereas this association was not observed in obese subjects.


[1]  Ehrmann DA (2005) Polycystic ovary syndrome. N Engl J Med 352: 1223–1236. doi: 10.1056/nejmra041536
[2]  Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, et al. (1998) Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 83: 3078–3082. doi: 10.1210/jcem.83.9.5090
[3]  Asunción M, Calvo RM, San Millán JL, Sancho J, Avila S, et al. (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 85: 2434–2438. doi: 10.1210/jcem.85.7.6682
[4]  Teede H, Deeks A, Moran L (2010) Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 8: 41. doi: 10.1186/1741-7015-8-41
[5]  Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19: 41–47. doi: 10.1093/humrep/deh098
[6]  Yilmaz M, Isaoglu U, Delibas IB, Kadanali S (2011) Anthropometric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. J Obstet Gynaecol Res 37: 1020–1026. doi: 10.1111/j.1447-0756.2010.01478.x
[7]  Kandaraki E, Christakou C, Diamanti-Kandarakis E (2009) Metabolic syndrome and polycystic ovary syndrome and vice versa. Arq Bras Endocrinol Metabol 53: 227–237. doi: 10.1590/s0004-27302009000200014
[8]  Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, et al. (2005) American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112: 2735–2752. doi: 10.1161/circulationaha.105.169404
[9]  Essah PA, Nestler JE (2006) The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest 29: 270–280. doi: 10.1007/bf03345554
[10]  Holte J (1996) Disturbances in insulin secretion and sensitivity in women with the polycystic ovary syndrome. Baillieres Clin Endocrinol Metab 10: 221–247. doi: 10.1016/s0950-351x(96)80085-1
[11]  Apridonidze T, Essah PA, Iuorno MJ, Nestler JE (2005) Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 90: 1929–1935. doi: 10.1210/jc.2004-1045
[12]  Weerakiet S, Bunnag P, Phakdeekitcharoen B, Wansumrith S, Chanprasertyothin S, et al. (2007) Prevalence of the metabolic syndrome in Asian women with polycystic ovary syndrome: using the International Diabetes Federation criteria. Gynecol Endocrinol 23: 153–160. doi: 10.1080/09513590701214158
[13]  Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L (2003) Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism 52: 908–915. doi: 10.1016/s0026-0495(03)00104-5
[14]  Park HR, Choi Y, Lee HJ, Oh JY, Hong YS, et al.. (2007) The metabolic syndrome in young Korean women with polycystic ovary syndrome. Diabetes Res Clin Pract (Suppl 1): S243–S246.
[15]  Oh JY, Hong YS, Sung YA, Barrett-Connor E (2004) Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care 27: 2027–2032. doi: 10.2337/diacare.27.8.2027
[16]  Christakou CD, Diamanti-Kandarakis E (2008) Role of androgen excess on metabolic aberrations and cardiovascular risk in women with polycystic ovary syndrome. Women's Health (Lond Engl) 4: 583–594. doi: 10.2217/17455057.4.6.583
[17]  Cussons AJ, Watts GF, Burke V, Shaw JE, Zimmet PZ, et al. (2008) Cardiometabolic risk in polycystic ovary syndrome: a comparison of different approaches to defining the metabolic syndrome. Hum Reprod 23: 2352–2358. doi: 10.1093/humrep/den263
[18]  Kim JJ, Chae SJ, Choi YM, Hwang SS, Hwang Kr, et al. (2011) Assessment of hirsutism among Korean women: results of a randomly selected sample of women seeking pre-employment physical check-up. Hum Reprod 26: 214–220. doi: 10.1093/humrep/deq303
[19]  Coviello AD, Legro RS, Dunaif A (2006) Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab 91: 492–497. doi: 10.1210/jc.2005-1666
[20]  Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, et al. (2008) Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 23: 1924–1931. doi: 10.1093/humrep/den239
[21]  Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, et al. (2012) Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 97: 28–38. doi: 10.1016/j.fertnstert.2011.09.024
[22]  Mehrabian F, Khani B, Kelishadi R, Kermani N (2011) The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females. J Res Med Sci 16: 763–769.
[23]  Dieudonne MN, Pecquery R, Boumediene A, Leneveu MC, Giudicelli Y (1998) Androgen receptors in human preadipocytes and adipocytes: regional specificities and regulation by sex steroids. Am J Physiol 274: C1645–C1652.
[24]  Fruzzetti F, Perini D, Lazzarini V, Parrini D, Genazzani AR (2009) Hyperandrogenemia influences the prevalence of the metabolic syndrome abnormalities in adolescents with the polycystic ovary syndrome. Gynecol Endocrinol 25: 335–343. doi: 10.1080/09513590802630146
[25]  Escobar-Morreale HF, San Millan JL (2007) Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab 18: 266–272. doi: 10.1016/j.tem.2007.07.003
[26]  Korhonen S, Hippel?inen M, Vanhala M, Heinonen S, Niskanen L (2003) The androgenic sex hormone profile is an essential feature of metabolic syndrome in premenopausal women: a controlled community-based study. Fertil Steril 79: 1327–1334. doi: 10.1016/s0015-0282(03)00347-9
[27]  Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, et al. (2009) The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 91: 456–488. doi: 10.1016/j.fertnstert.2008.06.035


comments powered by Disqus