Correlation of subclinic atherosclerosis, proinflammatory status, and insulin resistance with anthropometric measurements in polycystic ovary syndrome

Year 2022, , 182 - 187, 26.09.2022

Davut Sakız , Murat Çalapkulu , Muhammed Erkam Sencar , Bekir Ucan , İlknur Öztürk Ünsal , Mustafa Özbek , Erman Çakal

https://doi.org/10.47582/jompac.1144152

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is the most frequently encountered endocrinopathy in women of reproductive age. Visceral obesity, cardiovascular complications, insulin resistance, and proinflammatory status are frequently seen in PCOS patients. Many anthropometric measurements are used to evaluate visceral obesity. The aim of this study was to evaluate the correlations of anthropometric measurements with cardiovascular risk, insulin resistance and proinflammatory status in PCOS patients.
Material and Method: This retrospective study included 68 PCOS patients and 83 healthy females. Anthropometric measurements were evaluated of waist circumference, hip circumference, waist/hip ratio, body mass index (BMI), visceral adiposity index (VAI), lipid accumulation product (LAP), body adiposity index (BAI), abdominal volume index (AVI), body roundness index (BRI), and a body shape index (ABSI) of all the participants. Carotid intima media thickness (CIMT) for subclinical atherosclerosis cardiovascular risk evaluation, HOMA for insulin resistance assessment, and hsCRP levels for proinflammatory status assessment were determined as the main outcome measure. Correlations of anthropometric measurements with each other and with the main outcome measures were evaluated.
Results: HOMA and CIMT were significantly higher in PCOS patients. Abdominal obesity indicators such as waist circumference, hip circumference, waist-to-hip ratio, BMI, LAP, BAI, BRI, AVI, VAI and ABSI were significantly higher in the PCOS group. There was no significant difference between the groups in respect of hsCRP levels (p=0.317). When the correlations of anthropometric measurements with PCOS status were evaluated, it was seen that all measurements were correlated. The highest correlation with CIMT was obtained in BMI measurement, and the highest correlation with HOMA was obtained in BRI measurement. The anthropometric measurements were not found to be correlated with proinflammatory status in PCOS patients.
Conclusion: It was observed that anthropometric measurements may be functional in predicting PCOS-related subclinical atherosclerosis and insulin resistance. Visceral adiposity was found to be predictive for insulin resistance and subclinical atherosclerosis in PCOS patients.

Keywords

Adiposity, insulin resistance, carotid intima media thickness, CIMT

Supporting Institution

None

Polikistik over sendromu hastalarında subklinik ateroskleroz, proinflamatuvar durum ve insülin direncinin antropometrik ölçümlerle korelasyonu

Abstract

Amaç: Polikistik over sendromu (PKOS) doğurganlık çağındaki kadınlarda sık görülen bir endokrinopatidir. PKOS hastalarında visseral obezite, kardiyovasküler bozukluklar, insülin direnci, proinflamatuvar durum sıklıkla görülebilmektedir. Visseral obezitenin değerlendirilmesi amacıyla bir çok antropometrik ölçüm kullanılmaktadır. Amacımız antropometrik ölçümlerinin kardiyovasküler risk, insülin direnci ve proinflamatuvar durum ile korelasyonlarını değerlendirmektir.
Gereç ve Yöntem: Bu retrospektif çalışmaya 68 PKOS ve 83 kontrol katılımcı alındı. Tüm katılımcıların bel çevresi, kalça çevresi, bel/kalça oranı, vücut kitle indeksi (VKI), visseral yağlanma indeksi (VAI), lipid birikim ürünü (LAP), vücut yağlanma indeksi (BAI), abdominal hacim indeksi (AVI), vücut yuvarlaklık indeksi (BRI) ve vücut şekli indeksi (ABSI) gibi antropometrik ölçümleri yapıldı. Ana sonuç ölçütü olarak kardiyovasküler risk ve subklinik ateroskleroz değerlendirmesi için karotis intima media kalınlığı (KIMK), insülin direnci değerlendirmesi için HOMA-IR, proinflamatuvar durum değerlendirmesi amaçlı hsCRP düzeyleri belirlendi. Antropometrik ölçümlerin birbirleri ve ana sonuç ölçütleri ile korelasyonları değerlendirildi.
Bulgular: HOMA-IR ve KIMK, PCOS hastalarında anlamlı olarak daha yüksekti. PCOS grubunda bel çevresi, kalça çevresi, bel kalça oranı, LAP, BAI, BRI, AVI, VAI ve ABSI gibi abdominal obezite göstergeleri anlamlı olarak daha yüksekti. hsCRP düzeyleri arasında anlamlı farklılık yoktu (p=0,317). Antropometrik ölçümlerin PCOS olma durumu, KIMK, hsCRP ve HOMA ile korelasyonları değerlendirildiğinde tüm ölçümlerin korele olduğu görüldü. KIMK ile en yüksek korelasyon VKI ölçümü, HOMA ile en yüksek korelasyon BRI ölçümünde elde edildi. Antropometrik ölçümlerin PKOS hastalarında CRP ile korelasyon göstermediği tespit edildi.
Sonuç: Antropometrik ölçümlerin PKOS ilişkili subklinik ateroskleroz ve insülin direncini öngörmede işlevsel olabileceği görülmüştür. PCOS hastalarında visseral adipozitenin subklinik ateroskleroz ve insülin direncini için prediktif olduğu görülmüştür.

Keywords

Adipozite, insülin direnci, karotis intima media kalınlığı, KIMK

References

• Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American association of clinical endocrinologists, american college of endocrinology, and androgen excess and pcos society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - Part 1. Endocr Pract 2015; 21: 1291–300.
• Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181–91.
• Shaw LJ, Merz CNB, Azziz R, et al. Postmenopausal women with a history of ırregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the national ınstitutes of health—national heart, lung, and blood ınstitute sponsored women’s ıschemia syndrome evaluation. J Clin Endocrinol Metab. 2008; 93: 1276.
• Shim U, Oh J-Y, Lee HJ, Hong YS, Sung Y-A. Long menstrual cycle ıs associated with type 2 diabetes mellitus in korean women. Diabetes Metab J 2011; 35: 384.
• Duleba AJ, Dokras A. Is PCOS an inflammatory process? Fertil Steril 2012; 97: 7.
• Escobar-Morreale HF, Millán JLS. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab 2007; 18: 266–72.
• Legro RS. Obesity and PCOS: Implications for Diagnosis and Treatment. Semin Reprod Med 201; 30: 496.
• Elffers TW, de Mutsert R, Lamb HJ, et al. Body fat distribution, in particular visceral fat, is associated with cardiometabolic risk factors in obese women. He M, editor. PLoS One [Internet] 2017; 12: e0185403.
• Zheng S-H, Li X-L. Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS. Gynecol Endocrino 201; 32: 177–83.
• Eickemberg M, Amorim LDAF, Almeida M da CC de, et al. Indicators of abdominal adiposity and carotid ıntima-media thickness:results from the longitudinal study of adult health (ELSA-Brazil). Arq Bras Cardiol 2019; 112: 220.
• Santos RE dos, Aldrighi JM, Lanz JR, Ferezin PC, Marone MMS. Relationship of body fat distribution by waist circumference, dual-energy x-ray absorptiometry and ultrasonography to insulin resistance by homeostasis model assessment and lipid profile in obese and non-obese postmenopausal women. Gynecologic Endocrinol 2009; 21: 295–301.
• Aydoğdu A, Haymana C, Tapan S, et al. Polikistik over sendromu olgularinda artmiş visseral adipozite indeksi; Inflamasyon, insülin direnci ve hiperandrojenite arasindaki ilişki. Gulhane Med J 2015; 57: 107–10.
• Gönülalan G, Saçkan F. The ımportance of new anthropometric measurements in detecting cardio metabolic risk and ınsulin resistance in patients with polycystic ovary syndrome: single center experience. Turkish J Diabetes Obes 2021; 5: 25–32.
• Akbaş F, Usta Atmaca H, Değirmencioğlu Ş. Evaluation of the relationship between metabolic syndrome, visceral adiposity index and lipid accumulation product in patients with obesity. J Acad Res Med 2021; 11: 56–61.
• Kahn HS. The “lipid accumulation product” performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC Cardiovasc Disord 2005; 5: 26.
• Kahn HS. The lipid accumulation product ıs better than BMI for identifying diabetes. Diabetes Care 2006; 29: 151–3.
• Chen S, Chen Y, Liu X, et al. Insulin resistance and metabolic syndrome in normal-weight individuals. Endocrine 2014; 46: 496–504.
• Feng J, He S, Chen X. Body adiposity ındex and body roundness ındex in ıdentifying ınsulin resistance among adults without diabetes. Am J Med Sci 2019; 357: 116–23.
• Uruska A, Zozulinska-Ziolkiewicz D, Niedzwiecki P, Pietrzak M, Wierusz-Wysocka B. TG/HDL-C ratio and visceral adiposity index may be useful in assessment of insulin resistance in adults with type 1 diabetes in clinical practice. J Clin Lipidol 2018; 12: 734–40.
• Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19–25.
• Tsigos C, Hainer V, Basdevant A, et al. management of obesity in adults: european clinical practice guidelines. Obes Facts 2008; 1: 106–16.
• Thomas DM, Bredlau C, Bosy-Westphal A, et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity 2013; 21: 2264–71.
• Bergman RN, Stefanovski D, Buchanan TA, et al. A better index of body adiposity. Obesity (Silver Spring) 2011; 19: 1083.
• Amato MC, Giordano C, Galia M, et al. Visceral adiposity index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 2010; 33: 920–2.
• Peters SA, Grobbee DE, Bots ML. Carotid intima–media thickness: a suitable alternative for cardiovascular risk as outcome? Eur J Cardiovasc Prev Rehabil 2011; 18: 167–74.
• Icli A, Cure E, Uslu AU, et al. The relationship between atherogenic index and carotid artery atherosclerosis in familial mediterranean fever. Angiology 2017; 68: 315–21.
• Altin C, Erol V, Aydin E, et al. Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study. Nutr Metab Cardiovasc Dis 2018; 28: 501–9.
• Moon HU, Ha KH, Han SJ, Kim HJ, Kim DJ. The association of adiponectin and visceral fat with insulin resistance and β-cell dysfunction. J Korean Med Sci 2019; 34: 1.
• Neeland IJ, Ross R, Després JP, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol 2019; 7: 715–25.
• Spritzer PM, Lecke SB, Satler F, Morsch DM. Adipose tissue dysfunction, adipokines, and low-grade chronic inflammation in polycystic ovary syndrome. Reproduction 2015; 149: R219–27.