Polikistik Over Sendromlu Hastalarda Yeni Antropometrik Ölçümlerin Kardiyometabolik Risk ve İnsülin Rezistansını Belirlemedeki Önemi

Abstract

Amaç: Polikistik Over Sendromunda (PKOS) abdominal obezite sıklıkla görülmektedir. Abdominal obezitenin değerlendirilmesi PKOS’lu hastalarda metabolik ve kardiyovasküler disfonksiyon açısından önemlidir. Bu çalışmada PKOS’lu hastalarda yeni antropometrik ölçümleri ve kardiyovasküler risk ve insülin rezistansı ile ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya 62 PKOS’lu hasta ve 38 sağlıklı kontrol dahil edildi. Hastaların klinik bulguları, serum hormon düzeyleri ve overlerin ultrasonik bulguları değerlendirildi. Antropometrik ölçümler, HOMA-IR düzeyleri ve karotis intima media kalınlıkları (KIMK) değerlendirildi. Bulgular: Abdominal obezite belirteci olan bel çevresi, LAP, BAI, BRI, VAI, AVI ve WHtR PKOS’lu hastalarda anlamlı olarak yüksekti (p<0,01). HOMA-IR ve KIMK PKOS’lu hastalarda anlamlı olarak yüksek tespit edildi (p<0,01). Antropometrik ölçümler ile KIMK ve insülin rezistansı arasında istatistiksel olarak anlamlı korelasyon tespit edildi. Antropometrik öçlümler PKOS belirteci olarak da anlamlı bulundu. Sonuçlar: BKI ve Bel/Boy oranı gibi antropometrik ölçümler bazı kısıtlılıklara sahip olsa da obezite değerlendirmesinde kullanışlıdır. PKOS’lu hastalarda bel çevresi gibi yeni antropomterik ölçümler abdominal obezite ve metabolik/kardiyovasküler risklerin belirlenmesinde daha kullanışlıdır.

Keywords

• Polikistik Over Sendromu
• Ateroskleroz
• Antropometri
• Karotis İntima Media Kalınlığı
• Abdominal Obezite

The Importance of New Anthropometric Measurements in Detecting Cardio Metabolic Risk and Insulin Resistance in Patients with Polycystic Ovary Syndrome: Single Center Experience

Abstract

Objective: Abdominal obesity is frequently seen in Polycystic Ovary Syndrome (PCOS). The evaluation of abdominal obesity might be important according to metabolic and cardiovascular dysfunctions in patients with PCOS. We aimed to evaluate the new anthropometric measurements in patients with polycystic ovary syndrome (PCOS) and their relationship with cardiovascular risk and insulin resistance. Methods: We included 62 patients with PCOS and 38 healthy individuals as control. The clinical examinations, serum hormone levels and ultrasonographic findings of overs were evaluated. Anthropometric Measurements, HOMA-IR values and Carotid intima-media thickness (CIMT) measurements were evaluated. Results: The predictors of abdominal obesity as waist circumference, LAP, BAI, BRI, VAI, AVI, WHtR were significantly higher in patient with PCOS (p<0.01). HOMA-IR and CIMT were also significantly higher in patients with PCOS compared with controls (p<0.01). We found significant correlations between anthropometric measurements and CIMT and insulin resistance. Anthropometric measurements were also valuable in prediction of PCOS. Conclusion: Some of the measurements as BMI and waist/height ratio are used in evaluation of obesity. However, they had some limitations in prediction of obesity. We believe that recently used anthropometric measurements as waist circumference might be more useful predictors in evaluation of abdominal obesity and metabolic/cardiovascular risks in patients with PCOS.

Keywords

• Polycystic ovary syndrome
• Atherosclerosis
• Anthropometry
• Carotid intima-media thickness
• Abdominal obesity

References

1. 1. Salehi M, Bravo-Vera R, Sheikh A, Gouller A, Poretsky L. Obesity in polycystic ovary syndrome: Two disease or one? Turk JEM. 2003;4:149-157.
2. 2. Legro RS. Polycystic ovary syndrome and cardiovascular disease: A premature association? Endocr Rev. 2003;24:302- 312.
3. 3. Lemieux S, Prud’homme D, Nadeau A, Tremblay A, Bouchard C, Despres JP. Seven-year changes in body fat and visceral adipose tissue in women. Association with indexes of plasma glucose-insulin homeostasis. Diabetes Care. 1996;19:983-991.
4. 4. Dos Santos RE, 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 nonobese postmenopausal women. Gynecol Endocrinol. 2005;21:295-301.
5. 5. 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 I diabetes in clinical practice. J Clin Lipidol. 2018;12:734-740.
6. 6. Feng J, He S, Chen X. Body adiposity indexand body roundness index in identifying insulin resistance among adults without diabetes. Am J Med Sci. 2019;357:116-123.
7. 7. Chen S, Chen Y, Liu X, Li M, Wu B, Li Y, Liang Y, Shao X, Holthöfer H, Zou H. Insulin resistance and metabolic syndrome in normal-weight individuals. Endocrine. 2014;46:496-504.
8. 8. Kahn HS. The lipid accumulation product is better than BMI for identifying diabetes: A population-based comparison. Diabetes Care. 2006;29:151-153.

9. 9. 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.
10. 10. Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19-25.
11. 11. Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus- Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B, Obesity Management Task Force of the European Association for the Study of Obesity. Management of obesity in adults: European clinical practice guidelines. Obesity Facts. 2008;1:106-116.
12. 12. Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A, AlkaMeSy Study Group. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33:920-922.
13. 13. Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RM. A better index of body adiposity. Obesity (Silver Spring). 2011;19:1083- 1089.
14. 14. Thomas DM, Bredlau C, Bosy-Westphal A, Mueller M, Shen W, Gallagher D, Maeda Y, McDougall A, Peterson CM, Ravussin E, Heymsfield SB. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring). 2013;21:2264-2271.
15. 15. Arslan M, Atmaca A, Ayvaz G, et al. (Türkiye Endokrinoloji ve Metabolizma Derneği Metabolik Sendrom Çalışma Grubu). Metabolik Sendrom Klavuzu 2009. (Accessed at http:// http:// temd.org.tr/admin/uploads/tbl_yayinlar/metabolik_sendrom. pdf)
16. 16. Goldzieher J, Green J. The polycystic ovary. I. Clinical and histologic features. J Clin Endocrinol Metab. 1962;22:325-338.
17. 17. Spritzer PM, Lecke SB, Satler F, Morsch DM. Adipose tissue dysfunction, adipokines, and low-grade chronic inflammation in polycystic ovary syndrome. Reproduction. 2015;149: 219- 227.
18. 18. Jain S, Khera R, Corrales-Medina VF, Townsend RR, Chirinos JA. Inflammation and arterial stiffness in humans. Atherosclerosis. 2014;237:381-390.
19. 19. Peters SAE, Grobbee DE, Bots ML. Carotid intima-media thickness: A suitable alternative for cardiovascular risk as outcome? Eur J Cardio Prevention and Rehab. 2011;18:167- 174.
20. 20. Altin C, Erol V, Aydin E, Yilmaz M, Tekindal M.A, Sade LE, Gülay H, Müderrisoğlu H. Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study. Nutr Metab Cardiovasc Dis. 2018;28:501-509.
21. 21. Altin C, Yilmaz M, Ozsoy HM, Gezmis E, Balci S, Tekindal MA, Sade LE, Muderrisoglu H. Assessment of epicardial fat and carotid intima media thickness in gestational hypertension. J Obstet Gynaecol Res. 2018;44:1072-1079.
22. 22. Bozkırlı E, Bakıner O, Ertörer E, Anafaroğlu İ, Tütüncü NB, Demirağ NG. Insulin resistance in non-obese polycystic ovary syndrome subjects and relation with family history of diabetes mellitus. Turk JEM. 2015;19:55-59.
23. 23. Anan F, Masaki T, Umeno Y, Iwao T, Yonemochi H, Eshima N, Saikawa T, Yoshimatsu H. Correlations of visceral fat accumulation and atherosclerosis in Japanese patients with type 2 diabetes mellitus. Metabolism. 2008;57:280-284.
24. 24. Gastaldelli A, Miyazaki Y, Pettiti M, Matsuda M, Mahankali S, Santini E, DeFronzo RA, Ferrannini E. Metabolic effects of visceral fat accumulation in type 2 diabetes. J Clin Endocrinol Metab. 2002;87:5098-5103.
25. 25. Shen S, Lu Y, Dang Y, Qi H, Shen Z, Wu L, Li F, Yang C, Qiang D, Yang Y, Shui K, Bao Y. Effect of aerobic exercise on the atherogenic index of plasma in middle-aged Chinese men with various body weights. Int J Cardiol. 2017;230:1-5.
26. 26. Elffers TW, de Mutsert R, Lamb HJ, de Roos A, Willems van Dijk K, Rosendaal FR, Jukema JW, Trompet S. Body fat distribution, in particular visceral fat, is associated with cardiometabolic risk factors in obese women. PLoS One. 2017;12:e0185403
27. 27. Barbalho SM, Oshiiwa M, Sato Fontana LC, Ribeiro Finalli EF, Paiva Filho ME, Machado Spada AP. Metabolic syndrome and atherogenic indices in school children: A worrying panorama in Brazil. Diabetes Metab Syndr. 2017;11:397-401.
28. 28. Liu PJ, Ma F, Lou HP, Zhu YN. Body roundness index and body adiposity index: Two new anthropometric indices to identify metabolic syndrome among Chinese postmenopausal women. Climacteric. 2016;19:433-439.
29. 29. Johnson W, Chumlea WC, Czerwinski SA, Demerath EW. Concordance of the recently published body adiposity index with measured body fat percent in European-American adults. Obesity (Silver Spring). 2012;20:900-903.
30. 30. Li G, Wu HK, Wu XW, Cao Z, Tu YC, Ma Y, Li BN, Peng QY, Cheng J, Wu B, Zhou Z. The feasibility of two anthropometric indices to identify metabolic syndrome, insulin resistance and inflammatory factors in obese and overweight adults. Nutrition. 2019;57:194-201.
31. 31. Maessen MF, Eijsvogels TM, Verheggen RJ, Hopman MTE, Verbeek ALM, de Vegt F. Entering a new era of body indices: the feasibility of a body shape index and body roundness index to identify cardiovascular health status. PLoS One. 2014;9:e107212.