Polikistik Over Sendromlu Hastalarda İnsülin Direnci Ölçüm Metodlarının Değerlendirilmesi
Year 2022,
Volume: 6 Issue: 1, 24 - 31, 30.04.2022
Muhammet Cüneyt Bilginer
,
Damla Tüfekçi
,
Yasemin Emür Günay
,
Oğuzer Usta
,
Hülya Coşkun
,
Ozge Üçüncü
,
İrfan Nuhoğlu
,
Mustafa Koçak
Abstract
Amaç: Bu çalışmada polikistik over sendromlu (PKOS) kadınlarda insülin direnci (IR) ölçüm metodlarının, aynı beden kütle indeksine
sahip PKOS olmayan kadınlarla karşılaştırılması hedeflenmiştir.
Gereç ve Yöntemler: Çalışmamıza PKOS (n=18 normal kilolu ve n=24 hafif kilolu/obez) ve PKOS olmayan (n=18 normal kilolu ve n=24
hafif kilolu/obez) toplam 84 kadın dahil edildi. Lipit düzeyi, glukoz düzeyi ve antropometrik ölçümler kullanılarak trigliserid glukoz
indeksi (TyG), insülin direncinin homeostaz modeliyle değerlendirmesi (HOMA-IR), visseral adipozite indeksi (VAI) hesaplandı. PKOS
olan ve olmayan gruplar arasında ölçüm değerlerinin karşılaştırılmasında Mann-Whitney U test ya da Student t-test kullanıldı. HOMAIR
ile yaş arasındaki ilişki Pearson korelasyon testi, HOMA-IR ile TyG arasındaki ilişki Spearman korelasyon testi ile hesaplandı. p<0.05
anlamlı kabul edildi.
Bulgular: PKOS grubunda PKOS olmayan gruba göre trigliserid düzeyi, insülin, TyG ve HOMA-IR yüksek bulundu (sırasıyla; p= 0.003,
p=0.001, p=0.006, p=0.001). PKOS grubunda HOMA-IR ile yaş arasında negatif korelasyon (r=-0.399, p=0.024), HOMA-IR ile TyG
indeksi arasında pozitif korelasyon (r=0.776, p< 0.001) tespit edildi. Normal kilolu PKOS’lu kadınlarda PKOS olmayanlara göre TyG
indeksi ve HOMA-IR yüksek bulundu. (sırasıyla p=0.002, p=0.003). Ancak hafif kilolu/obez PKOS’lu kadınlarda PKOS olmayanlara göre
fark görülmedi. PKOS hastalarında TyG indeksinin >3.91 olması (%89.5 sensivite, %76.9 spesifite) insulin rezistansını (IR) predikte etti.
Sonuç: PKOS’lu kadınlarda PKOS olmayanlara göre TyG ve HOMA-IR düzeyleri yüksektir. Bu hastalarda insulin rezistansı
değerlendirilmesinde TyG indeksi alternatif bir metod olarak kullanılabilir
Supporting Institution
Yok
References
- Referans-1: Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Aug;132(2):321-336.
- Referans-2: Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev. 2016;37(5):467-520.
- Referans-3: Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020; Oct;30(7):399-404.
- Referans-4: American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol. 2018; Jun;131(6):e157-e171.
- Referans-5: DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol Endocrinol Metab. 1979; 237:E214.
- Referans-6: Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO, Jacques-Camarena O, Rodríguez-Morán M. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010;95:3347-51.
- Referans-7: Vasques AC, Novaes FS, de Oliveira Mda S, Souza JR, Yamanaka A, Pareja JC, Tambascia MA, Saad MJ, Geloneze B. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 2011;93:e98-e100
- Referans-8: Shin K-A. Triglyceride and Glucose (TyG) Index is a Clinical Surrogate Marker for the Diagnosis of Metabolic Syndrome. J Biomedical Science Letters 2017; 23:348-54.
- Referans-9: Kim B, Choi HY, Kim W, Ahn C, Lee J, Kim JG, Kim J, Shin H, Yu JM, Moon S. The cut-off values of surrogate measures for insulin resistance in the Korean population according to the Korean Genome and Epidemiology Study (KOGES). PLoS One 2018;13:e0206994.
- Referans-10: Park K, Ahn CW, Lee SB, Kang S, Nam JS, Lee BK, Kim JH, Park JS. Elevated TyG Index Predicts Progression of Coronary Artery Calcification. Diabetes Care 2019; 42:1569-73.
- Referans-11: Brończyk-Puzoń A, Jagielski P, Kulik-Kupka K, Koszowska A, Nowak J, Zubelewicz-Szkodzińska B. Usefulness of a new anthropometric indicator - VAI (Visceral Adiposity Index) in the evaluation of metabolic and hormonal disorders in women with polycystic ovarysyndrome. Adv Clin Exp Med 2017;26(5):825-828.
- Referans-12: Zheng SH, Li XL. Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS. Gynecol Endocrinol. 2016;32(3):177-183.
- Referans-13: Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society (AES). 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 Nov;21(11):1291-300.
- Referans-14: World Health Organization. WHO fact sheet on overweight and obesity. Updated October 2017. http://www.who.int/mediacentre/factsheets/fs311/en/. Date of access: 8 December 2017.
- Referans-15: Sasaki A, Emi Y, Matsuda M, Sharula, Kamada Y, Chekir C, Hiramatsu Y, Nakatsuka M. Increased arterial stiffness in mildly-hypertensive women with polycystic ovary syndrome. J Obstet Gynaecol Res. 2011;37(5):402-411.
- Referans-16: Amato MC, Verghi M, Galluzzo A, Giordano C. The oligomenorrhoic phenotypes of polycystic ovary syndrome are characterized by a high visceral adiposity index: a likely condition of cardiometabolic risk. Hum Reprod 2011;26:1486–94.
- Referans-17: Millan J, Pinto X, Munoz A, Zuniga M, Rubies-Prat J, Pallardo LF, Masana L, Mangas A, Hernandez-Mijares A, Gonzalez-Santos P, Ascaso JF, Pedro-Botet J. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vascular health and risk management 2009; 5: 757–765
- Referans-18: McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, Simon J, Krauss RM. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005; 96: 399–404
- Referans-19: Yildizhan B, Anik Ilhan G, Pekin T. The impact of insulin resistance on clinical, hormonal and metabolic parameters in lean women with polycystic ovarysyndrome. J Obstet Gynaecol. 2016;36:893–896.
- Referans-20: Dickerson EH, Cho LW, Maguiness SD, Killick SL, Robinson J, Atkin SL. Insulin resistance and free androgen index correlate with the outcome of controlled ovarian hyperstimulation in non-PCOS women undergoing IVF. Hum Reprod. 2010 Feb;25(2):504-9.
- 21. Ungera G, Benozzia SF, Perruzzab F, Pennacchiottia GL.
Triglycerides and glucose index: A useful indicator of insulin
resistance. Endocrinol Nutr. 2014;61(10):533-540
- 22. Hackbart KS, Cunha PM, Meyer RK, Wiltbank MC. Effect
of glucocorticoid-induced insulin resistance on follicle
development and ovulation. Biol Reprod. 2013;88:153.
- 23. Belani M, Purohit N, Pillai P, Gupta S. Modulation of
steroidogenic pathway in rat granulosa cells with subclinical
Cd exposure and insulin resistance: An impact on female
fertility. Biomed Res Int. 2014;2014:460251.
- 24. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence,
phenotype and cardiometabolic risk of polycystic ovary
syndrome under different diagnostic criteria. Hum Reprod.
2012;27(10):3067-3073.
- 25. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E,
Ben-Ami Shor D, Tzur D, Afek A, Shamiss A, Haklai Z, Kark JD.
Body-mass index in 2.3 million adolescents and cardiovascular
death in adulthood. N Engl J Med. 2016;374(25):2430-2440.
- 26. Carmina E, Lobo RA. Is there really increased cardiovascular
morbidity in women with polycystic ovary syndrome? J
Womens Health (Larchmt). 2018;27(11):1385-1388.
- 27. Dumesic DA, Akopians AL, Madrigal VK, Ramirez E,
Margolis DJ, Sarma MK, Thomas AM, Grogan TR, Haykal
R, Schooler TA, Okeya BL, Abbott DH, Chazenbalk GD.
Hyperandrogenism accompanies increased intra-abdominal
fat storage in normal weight polycystic ovary syndrome
women. J Clin Endocrinol Metab. 2016;101(11):4178-4188.
- 28. Lath R, Shendye R, Jibhkate A. Insulin resistance and lipid
profile in polycystic ovary syndrome. Asian J Biomed Pharm
Sci. 2015;5:30.
- 29. Matos LN, Giorelli GDV, Dias CB. Correlation of
anthropometric indicators for identifying insulin sensitivity
and resistance. Sao Paulo Medical Journal. 2011;129:30-35.
- 30. Ramezani Tehrani F, Minooee S, Azizi F. Comparison of various
adiposity indexes in women with polycystic ovary syndrome
and normo-ovulatory non-hirsute women: A populationbased
study. Eur J Endocrinol. 2014;171(2):199-207.
- 31. Abruzzese GA, Cerrrone GE, Gamez JM, Graffigna MN, Belli
S, Lioy G, Mormandi E, Otero P, Levalle OA, Motta AB. Lipid
accumulation product (LAP) and visceral adiposity index
(VAI) as markers of insulin resistance and metabolic associated
disturbances in young argentine women with polycystic ovary
syndrome. Horm Metab Res. 2017;49(1):23-29.
- 32. Dawood A, Alkafrawy N, Saleh S, Noreldin R, Zewain S. The
relationship between IL-18 and atherosclerotic cardiovascular
risk in Egyptian lean women with polycystic ovary syndrome.
Gynecol Endocrinol. 2018;34:294-297.
- 33. Morciano A, Romani F, Sagnella F, Scarinci E, Palla C, Moro
F, Tropea A, Policola C, Della Casa S, Guido M, Lanzone A,
Apa R. Assessment of insulin resistance in lean women with
polycystic ovary syndrome. Fertil Steril. 2014;102:250-256.
- 34. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto
P, Orio F, Di Fede G, Rini G. Abdominal fat quantity and
distribution in women with polycystic ovary syndrome and
extent of its relation to insulin resistance. J Clin Endocrinol
Metab. 2007;92:2500-2505.
- 35. Vilmann LS, Thisted E, Baker JL, Holm JC. Development of
obesity and polycystic ovary syndrome in adolescents. Horm
Res Paediatr. 2012;78:269-278.
- 36. Fang H, Berg E, Cheng X, Shen W. How to best assess
abdominal obesity. Curr Opin Clin Nutr Metab Care. 2018;
21(5):360-365.
- 37. Bray GA, DeLany JP, Volaufova J, Harsha DW, Champagne
C. Prediction of body fat in 12-y-old African American and
white children: Evaluation of methods. Am J Clin Nutr.
2002;76(5):980-990.
- 38. Jeanes YM, Reeves S. Metabolic consequences of obesity and
insulin resistance in polycystic ovary syndrome: Diagnostic
and methodological challenges. Nutr Res Rev. 2017;30(1):97-
105.
- 39. Bil E, Dilbaz B, Cirik DA, Ozelci R, Ozkaya E, Dilbaz S.
Metabolic syndrome and metabolic risk profile according to
polycystic ovary syndrome phenotype. J Obstet Gynaecol Res.
2016; 42:837-843.
Evaluation of Insulin Resistance Measurement Methods in Patients with Polycystic Ovary Syndrome
Year 2022,
Volume: 6 Issue: 1, 24 - 31, 30.04.2022
Muhammet Cüneyt Bilginer
,
Damla Tüfekçi
,
Yasemin Emür Günay
,
Oğuzer Usta
,
Hülya Coşkun
,
Ozge Üçüncü
,
İrfan Nuhoğlu
,
Mustafa Koçak
Abstract
Aim: This study aims to compare insulin resistance (IR) measurement methods in women with and without polycystic ovary syndrome
(PCOS) who have the same body mass index.
Material and Methods: There were 84 women with PCOS and non-PCOS (n=18 normal weight and n=24 overweight/obese in both
groups). Triglyceride glucose index (TyG), assessment of insulin resistance with homeostasis model (HOMA-IR), visceral adiposity
index (VAI) were calculated using lipid level, glucose level and anthropometric measurements. Mann-Whitney U or Student's t-test
was used to compare measurements between the groups. The relationship between HOMA-IR and age was calculated with the Pearson
correlation test, and the relationship between HOMA-IR and TyG was calculated with the Spearman correlation test. p<0.05 was
considered significant.
Results: Triglyceride levels, insulin, TyG, and HOMA-IR were higher in the PCOS group than in the non-PCOS group (p=0.003, p=0.001,
p=0.006, p=0.001, respectively). In the PCOS group, there was a negative correlation between HOMA-IR and age (r=-0.399, p=0.024),
and a positive correlation between HOMA-IR and TyG index (r=0.776, p<0.001). TyG index and HOMA-IR were higher in normal
weight PCOS women than non-PCOS (p=0.002, p=0.003, respectively), however there was no difference in overweight/obese PCOS
women and non-PCOS. In PCOS patients, a TyG index >3.91 (89.5% sensitivity, 76.9% specificity) predicted insulin resistance (IR).
Conclusion: TyG and HOMA-IR levels are higher in women with PCOS than non-PCOS. The TyG index can be used as an alternative
method in evaluating insulin resistance among these patients.
References
- Referans-1: Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Aug;132(2):321-336.
- Referans-2: Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev. 2016;37(5):467-520.
- Referans-3: Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020; Oct;30(7):399-404.
- Referans-4: American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol. 2018; Jun;131(6):e157-e171.
- Referans-5: DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol Endocrinol Metab. 1979; 237:E214.
- Referans-6: Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO, Jacques-Camarena O, Rodríguez-Morán M. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010;95:3347-51.
- Referans-7: Vasques AC, Novaes FS, de Oliveira Mda S, Souza JR, Yamanaka A, Pareja JC, Tambascia MA, Saad MJ, Geloneze B. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 2011;93:e98-e100
- Referans-8: Shin K-A. Triglyceride and Glucose (TyG) Index is a Clinical Surrogate Marker for the Diagnosis of Metabolic Syndrome. J Biomedical Science Letters 2017; 23:348-54.
- Referans-9: Kim B, Choi HY, Kim W, Ahn C, Lee J, Kim JG, Kim J, Shin H, Yu JM, Moon S. The cut-off values of surrogate measures for insulin resistance in the Korean population according to the Korean Genome and Epidemiology Study (KOGES). PLoS One 2018;13:e0206994.
- Referans-10: Park K, Ahn CW, Lee SB, Kang S, Nam JS, Lee BK, Kim JH, Park JS. Elevated TyG Index Predicts Progression of Coronary Artery Calcification. Diabetes Care 2019; 42:1569-73.
- Referans-11: Brończyk-Puzoń A, Jagielski P, Kulik-Kupka K, Koszowska A, Nowak J, Zubelewicz-Szkodzińska B. Usefulness of a new anthropometric indicator - VAI (Visceral Adiposity Index) in the evaluation of metabolic and hormonal disorders in women with polycystic ovarysyndrome. Adv Clin Exp Med 2017;26(5):825-828.
- Referans-12: Zheng SH, Li XL. Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS. Gynecol Endocrinol. 2016;32(3):177-183.
- Referans-13: Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society (AES). 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 Nov;21(11):1291-300.
- Referans-14: World Health Organization. WHO fact sheet on overweight and obesity. Updated October 2017. http://www.who.int/mediacentre/factsheets/fs311/en/. Date of access: 8 December 2017.
- Referans-15: Sasaki A, Emi Y, Matsuda M, Sharula, Kamada Y, Chekir C, Hiramatsu Y, Nakatsuka M. Increased arterial stiffness in mildly-hypertensive women with polycystic ovary syndrome. J Obstet Gynaecol Res. 2011;37(5):402-411.
- Referans-16: Amato MC, Verghi M, Galluzzo A, Giordano C. The oligomenorrhoic phenotypes of polycystic ovary syndrome are characterized by a high visceral adiposity index: a likely condition of cardiometabolic risk. Hum Reprod 2011;26:1486–94.
- Referans-17: Millan J, Pinto X, Munoz A, Zuniga M, Rubies-Prat J, Pallardo LF, Masana L, Mangas A, Hernandez-Mijares A, Gonzalez-Santos P, Ascaso JF, Pedro-Botet J. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vascular health and risk management 2009; 5: 757–765
- Referans-18: McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, Simon J, Krauss RM. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005; 96: 399–404
- Referans-19: Yildizhan B, Anik Ilhan G, Pekin T. The impact of insulin resistance on clinical, hormonal and metabolic parameters in lean women with polycystic ovarysyndrome. J Obstet Gynaecol. 2016;36:893–896.
- Referans-20: Dickerson EH, Cho LW, Maguiness SD, Killick SL, Robinson J, Atkin SL. Insulin resistance and free androgen index correlate with the outcome of controlled ovarian hyperstimulation in non-PCOS women undergoing IVF. Hum Reprod. 2010 Feb;25(2):504-9.
- 21. Ungera G, Benozzia SF, Perruzzab F, Pennacchiottia GL.
Triglycerides and glucose index: A useful indicator of insulin
resistance. Endocrinol Nutr. 2014;61(10):533-540
- 22. Hackbart KS, Cunha PM, Meyer RK, Wiltbank MC. Effect
of glucocorticoid-induced insulin resistance on follicle
development and ovulation. Biol Reprod. 2013;88:153.
- 23. Belani M, Purohit N, Pillai P, Gupta S. Modulation of
steroidogenic pathway in rat granulosa cells with subclinical
Cd exposure and insulin resistance: An impact on female
fertility. Biomed Res Int. 2014;2014:460251.
- 24. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence,
phenotype and cardiometabolic risk of polycystic ovary
syndrome under different diagnostic criteria. Hum Reprod.
2012;27(10):3067-3073.
- 25. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E,
Ben-Ami Shor D, Tzur D, Afek A, Shamiss A, Haklai Z, Kark JD.
Body-mass index in 2.3 million adolescents and cardiovascular
death in adulthood. N Engl J Med. 2016;374(25):2430-2440.
- 26. Carmina E, Lobo RA. Is there really increased cardiovascular
morbidity in women with polycystic ovary syndrome? J
Womens Health (Larchmt). 2018;27(11):1385-1388.
- 27. Dumesic DA, Akopians AL, Madrigal VK, Ramirez E,
Margolis DJ, Sarma MK, Thomas AM, Grogan TR, Haykal
R, Schooler TA, Okeya BL, Abbott DH, Chazenbalk GD.
Hyperandrogenism accompanies increased intra-abdominal
fat storage in normal weight polycystic ovary syndrome
women. J Clin Endocrinol Metab. 2016;101(11):4178-4188.
- 28. Lath R, Shendye R, Jibhkate A. Insulin resistance and lipid
profile in polycystic ovary syndrome. Asian J Biomed Pharm
Sci. 2015;5:30.
- 29. Matos LN, Giorelli GDV, Dias CB. Correlation of
anthropometric indicators for identifying insulin sensitivity
and resistance. Sao Paulo Medical Journal. 2011;129:30-35.
- 30. Ramezani Tehrani F, Minooee S, Azizi F. Comparison of various
adiposity indexes in women with polycystic ovary syndrome
and normo-ovulatory non-hirsute women: A populationbased
study. Eur J Endocrinol. 2014;171(2):199-207.
- 31. Abruzzese GA, Cerrrone GE, Gamez JM, Graffigna MN, Belli
S, Lioy G, Mormandi E, Otero P, Levalle OA, Motta AB. Lipid
accumulation product (LAP) and visceral adiposity index
(VAI) as markers of insulin resistance and metabolic associated
disturbances in young argentine women with polycystic ovary
syndrome. Horm Metab Res. 2017;49(1):23-29.
- 32. Dawood A, Alkafrawy N, Saleh S, Noreldin R, Zewain S. The
relationship between IL-18 and atherosclerotic cardiovascular
risk in Egyptian lean women with polycystic ovary syndrome.
Gynecol Endocrinol. 2018;34:294-297.
- 33. Morciano A, Romani F, Sagnella F, Scarinci E, Palla C, Moro
F, Tropea A, Policola C, Della Casa S, Guido M, Lanzone A,
Apa R. Assessment of insulin resistance in lean women with
polycystic ovary syndrome. Fertil Steril. 2014;102:250-256.
- 34. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto
P, Orio F, Di Fede G, Rini G. Abdominal fat quantity and
distribution in women with polycystic ovary syndrome and
extent of its relation to insulin resistance. J Clin Endocrinol
Metab. 2007;92:2500-2505.
- 35. Vilmann LS, Thisted E, Baker JL, Holm JC. Development of
obesity and polycystic ovary syndrome in adolescents. Horm
Res Paediatr. 2012;78:269-278.
- 36. Fang H, Berg E, Cheng X, Shen W. How to best assess
abdominal obesity. Curr Opin Clin Nutr Metab Care. 2018;
21(5):360-365.
- 37. Bray GA, DeLany JP, Volaufova J, Harsha DW, Champagne
C. Prediction of body fat in 12-y-old African American and
white children: Evaluation of methods. Am J Clin Nutr.
2002;76(5):980-990.
- 38. Jeanes YM, Reeves S. Metabolic consequences of obesity and
insulin resistance in polycystic ovary syndrome: Diagnostic
and methodological challenges. Nutr Res Rev. 2017;30(1):97-
105.
- 39. Bil E, Dilbaz B, Cirik DA, Ozelci R, Ozkaya E, Dilbaz S.
Metabolic syndrome and metabolic risk profile according to
polycystic ovary syndrome phenotype. J Obstet Gynaecol Res.
2016; 42:837-843.