The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome

Abstract

Objective To establish whether visceral fat mass is the most significant variable correlating with insulin resistance and other metabolic parameters in women with polycystic ovary syndrome (PCOS).Design Prospective cross-sectional trial.Setting Reproductive medicine clinic.Population Forty women with anovulatory PCOS.Methods Measurements were taken at recruitment, and analysis was performed to define correlations between the outcome measures and the explanatory variables.Main outcome measures Visceral and subcutaneous fat by computed tomography scan, insulin resistance, anthropometric measures, markers of the metabolic syndrome and androgens.Results Strong linear correlation of visceral fat to insulin resistance (r = 0.68, P < 0.001) was observed. There were also statistically significant correlations with fasting insulin (r = 0.73, P < 0.001), homeostasis model assessment b-cell function (r = 0.50, P = 0.007), triglycerides (r = 0.45, P = 0.003), high-density lipoprotein cholesterol (r = -0.42, P = 0.007), urate (r = 0.47, P = 0.002), Sex hormone binding globulin (r = -0.39, P = 0.01) and luteinising hormone (r = -0.32, P = 0.02). There were no significant correlations of testosterone with fat distribution or metabolic parameters. Insulin resistance showed closest correlation to visceral fat mass (r = 0.68, P < 0.001), then to waist circumference (r = 0.62, P < 0.001), with the weakest correlation being waist:hip ratio (r = 0.36, P = 0.01). The best regression model for predicting insulin resistance is with visceral fat mass and triglycerides as the explanatory variables (r = 0.72, P < 0.001).Conclusions Visceral fat is the most significant variable correlating with metabolic dysfunction in women with PCOS. Our data support the hypothesis that visceral fat either causes insulin resistance or is a very early effect of it. It also implies that reducing visceral fat should reduce insulin resistance which may account for the observations that exercise and weight loss appear to be more effective interventions than pharmacological treatments. The best anthropometric measure of insulin resistance is waist circumference.Keywords Fat distribution, insulin resistance, metabolic syndrome, polycystic ovary syndrome, visceral fat.Please cite this paper as: Lord J, Thomas R, Fox B, Acharya U, Wilkin T. The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome.

Correlates of increased lean muscle mass in women with polycystic ovary syndrome

“…These and other studies have shown that increased abdominal fat is an important determinant of increased cardiovascular and metabolic disease (4,5). Most studies have shown that increased abdominal fat is present not only in the majority of women with PCOS who are obese but also occurs in overweight and normoweight women with the syndrome (1,2).…”

“…In recent years, many studies have focused on fat quantity and distribution in women with polycystic ovary syndrome (PCOS) (1)(2)(3)(4). These and other studies have shown that increased abdominal fat is an important determinant of increased cardiovascular and metabolic disease (4,5).…”

Avaliação do risco cardiovascular por meio do índice LAP em pacientes não obesas com síndrome dos ovários policísticos

“…Não há dúvidas de que mulheres com SOP apresentam elevada prevalência de obesidade central (5,8,(9)(10)(11)13,14). Estudos apontam que 50% a 60% dessas pacientes apresentam obesidade abdominal, independente do IMC (21,22).…”

“…Entre os fatores de risco cardiovascular comuns na SOP, a obesidade central tem merecido destacada atenção (5,(8)(9)(10)(11)(12)(13)(14), em virtude do fato de que a distribuição visceral de gordura está relacionada com a RI (13,14), aspecto intimamente associado à fisiopatologia da SOP (15). Além disso, parece não haver dúvidas quanto à relação entre marcadores de obesidade do tipo androide e fatores de risco relacionados ao sistema cardiovascular nesse subgrupo da população feminina (5,8,11,12,14).…”

Use of ethnic specific BMI and waist cut-offs for prevention of diabetes and cardiovascular disease

“…Whereas BMI provides a marker of overall adiposity, WC is a better marker of abdominal adiposity, and is the best correlate of visceral fat mass (12). Higher levels of WC are strongly associated with cardiovascular disease.…”