Document Type : Original Article
Authors
1 Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 School of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
3 Alzahra Hospital, Infertility and IVF Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Keywords
Polycystic ovary syndrome (PCOS) as the most
common endocrinopathy among reproductiveaged
women is a major health and economic burden
(
This ovarian dysfunction syndrome encompasses
a broad spectrum of clinical signs and symptoms.
Clinical manifestations include menstrual irregularities,
hyperandrogenism and infertility (
MetS is a combination of cardiovascular risk factors,
including dyslipidemia, impaired fasting glucose
levels, abdominal obesity and high blood pressure.
Insulin resistance, as a major defect in MetS,
appears to be a common linkage between these coexisting
abnormalities (
This cross-sectional study was conducted on 200
women aged 20-40 years old who were diagnosed
with PCOS by a gynecologist, according to Rotterdam
criteria (
MetS was defined using the definition of the NCEP
ATP III (
Body weight was measured to the nearest 0.1 kg using
a calibrated Seca Scale (SECA 707; HH, Modena,
Italy), with the participants barefoot and wearing
light clothing. Standing height was measured to the
nearest 0.1 cm using a mounted tape. The participants
were barefoot with arms hanging freely at their sides.
Body mass index (BMI) was calculated as weight in
kilograms divided by the square of height in meters
(kg/m2). According to the World Health Organization
categories, persons who have a BMI between 25.0
and 29.9 are classified as overweight and those who
have a BMI of 30.0 or higher are classified as obese
(
Systolic and diastolic blood pressures (SBP and DBP) were measured twice in the right arm in a sitting position after a 10 minute rest period, using a mercury sphygmomanometer the average of the two measurements was used for analysis.
Blood samples were collected after a 12-hour overnight fast. Serum glucose was measured by an enzymatic colorimetric method. Serum total cholesterol and TG were determined by using commercially available enzymatic reagents (Pars Azmoon, Tehran, Iran) adapted to an autoanalyzer (model Alcyon 300 Abbott, USA and Germany). High-density lipoprotein cholesterol was determined after precipitation of the apolipoprotein B–containing lipoproteins with phosphotungstic acids. Low-density lipoprotein cholesterol (LDL-C) was indirectly measured by using the Friedewald formula (LDL=total cholesterol - HDL - TG/5).
All data were collected in a cross-sectional survey. Continuous variables were presented as mean and standard deviation (SD), while categorical variables were presented as frequency (number) and percentage. Trend chi-square analysis was used for comparison of categorical variables and percentages of study variables among BMI and age categories. P<0.05 was considered significant. Statistical analysis was performed with SPSS software version 16.0.
In this study patients’ mean ± SD for age was 26.18 ± 4.27 years, BMI was 27.12 ± 2.34kg/m2 and WC was 91.08 ± 8.5cm. The overall prevalence for overweight was 71% (142 out of 200) whereas obese patients comprised 10.5% (21 out of 200)of the study population. The frequency of MetS as determined by NCEP ATP III was 39.5% (79/200). A considerable proportion (96.7%) of women without MetS (n=121) fulfilled two criteria whereas 3.3% (4/121) fulfilled one criteria for MetS. Approximately 70% of patients with MetS had three criteria and 30% had four MetS criteria.
Age-stratified frequency of metabolic syndrome (MetS) in women with PCOS
10 (12.6) | 30 (49.1) | 39 (65.0) | 79 (39.5) | |
69 (87.4) | 31(50.8) | 21(35.0) | 121 (60.5) | |
Frequency of MetS differed across age groups (trend Chi-square test; p=0.03).
According to table 1, the frequency of MetS
increased with age, from 12.6% in women aged
20-26 years to 65.0% in those aged 34-40 years
(p=0.03). The frequency of MetS was also significantly
associated with BMI (p<0.0001;
Compared with the normal BMI group, overweight
and obese women had a 7.7-fold and 16-
fold increased risk for MetS, respectively. High WC
and high blood pressure were also more prevalent
in the overweight and obese groups (p<0.0001).
The most prevalent isolated abnormality of MetS
in women with PCOS was a HDL-C level below
50 mg/dLwhich was observed in 99.5% (199 out
of 200) subjects. Other abnormalities included
increased serum TG in 98% (196 out of 200), increased
WC in 65% (130 out of 200) and hypertension
in 34% (68 out of 200). There were no
elevated fasting glucose concentrations observed
(
Percentage of metabolic syndrome (MetS) components according to NCEP ATP III criteria in women with PCOS
Body mass index group-stratified frequency of metabolic syndrome and its components in women with PCOS
BMI (kg/m2) | ||||
---|---|---|---|---|
<25 (n=37) | 25-29.9 (n=142) | ≥30 (n=21) | P valuea | |
2 (5.4%) | 59 (41.5%) | 18 (85.7%) | <0.0001 | |
0 (0%) | 48 (33.8%) | 20 (95.2%) | <0.0001 | |
33 (89.2%) | 142 (100%) | 21 (100%) | 0.15 | |
36 (97.3%) | 142 (100%) | 21 (100%) | 0.19 | |
8 (21.6%) | 101 (71.1%) | 21 (100%) | <0.0001 | |
0 (0%) | 0 (0%) | 0 (0%) | ||
HDL-C; High-density lipoprotein cholesterol and a; Trend Chi-square test.
Today, many researches are focused on metabolic
complications in the field of PCOS, among women.
An economic assessment has reported that 40% of
the economic costs of PCOS can be attributed to
type 2 diabetes mellitus in the USA (
In this study, the occurrence of low HDL-C was
the most frequent component of MetS in women
with PCOS, followed by increased serum TG and
increased WC. Similar results have been reported
in other studies. It has been mentioned that dyslipidemia
is the most common metabolic abnormality
in PCOS, with a prevalence as high as 70% according
to NCEP criteria (
In the current study we have observed an approximately
two-fold increase in the prevalence of
MetS in obese women with PCOS compared with
non-obese women. Since most of the women with
PCOS (38-88%) are overweight or obese, therefore
there is little doubt that adiposity plays an
important role in development and maintenance
of PCOS and strongly influences the severity of
both its clinical and endocrine characteristics in
numerous women (
The current study had some limitations: the relatively small sample size and use of only one diagnostic criterion for MetS (NCEPATPIII definition). In addition, the results might be influenced by the manner in which PCOS and MetS were diagnosed. The lack of a standard definition for MetS in women with PCOS is unfortunate and makes comparison with other studies difficult. We have only included cross-sectional measurements; prospective data from this study will be available in the future to conclusively determine an association between PCOS and CVD in Iranian women.
In the present study, although 39.5% of all participants had MetS, the majority of those without MetS had at least one criterion by the time of recruitment into this study. Despite the fact that these participants were not diagnosed with MetS by that time, these participants already were at risk for CVD. Therefore in the absence of intervention, they might develop MetS in the future, as the authors found that the frequency of MetS in this population increased with age. The lower frequency of MetS in the younger population and the increasing frequency of this syndrome with increasing age and BMI would be valuable information for the development and implementation of effective management strategies for Iranian women with PCOS.