Polikistikover sendromlu hastalarda visseral adiposite indeksi ve lipid birikim ürünlerinin metabolik, antropometrik ve hormonal parametrelerle ilişkisi

Öz

Amaç: Polikistik over sendromu (PKOS) üreme çağında en sık görülen endokrinopati olup santral obezite, glukoz intoleransı, dislipidemi ve hipertansiyon ile ilişkilidir. Visseral adipozite indeksi (VAI) ve lipid birikim ürünleri (LAP) insülin duyarlılığı dışında kardiyovasküler ve serebrovasküler olaylar ile de ilişkili olduğu saptanmıştır. Bizler de, bu çalışmamızda PKOS ve kontrol grubu hastalarımızda VAI ve LAP ile metabolik, antropometrik ve hormonal parametreler arasındaki ilişkileri değerlendirdik. Yöntemler: Çalışmaya 18-35 yaş aralığında 106’sı Rotterdam kriterlerine göre PKOS grubunda olmak üzere toplam 172 hasta dahil edildi. Diabetes mellitus, Cushing sendromu, hiperprolaktinemi, konjenital adrenal hiperplazi, hipertansiyon ve tiroid bozukluğu olan hastalar çalışmaya dahil edilmedi. LAP ve VAI indekslerinin hesaplanması için HDL ve trigliserid düzeylerine bakıldı. Bulgular: PKOS’lu hasta grubunda LAP ile HDL-C (r=-0,644) arasında anlamlı negatif korelasyon saptanırken, trigliserid (r=0,706) ve kalça çevresi (r=0,872) arasında pozitif korelasyon saptandı. Yine VAI ile bel çevresi (r=0,625) ve HOMA-IR (r=0,462) arasında pozitif korelasyon saptandı. Sonuç: Bu çalışmada PKOS hasta grubunda VAI’nın insülin direncini belirlemede yararlı bir indeks olduğu sonucuna varıldı.

Anahtar Kelimeler

• Polikistik over sendromu
• Visseral adipozite indeksi
• Lipid birikim ürünleri

The relation of visceral adiposity index and lipid accumulation product with metabolic, anthropometric, and hormonal parameters in patients with polycystic ovary syndrome

Öz

Aim: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age and is associated with glucose intolerance, central obesity, hypertension, and dyslipidemia. The Visceral Adiposity Index (VAI) and Lipid Accumulation Product (LAP) are effective indices for predicting insulin resistance are associated with cardiovascular and cerebrovascular events. In this study, we aimed to investigate the relationship of VAI and LAP with metabolic, anthropometric, and hormonal parameters in PCOS patients. Methods: A total of 106 patients with PCOS who were diagnosed according to the Rotterdam criteria and 66 healthy controls without PCOS aged 18-35 years were included in this prospective, case-control study. Patients with diabetes mellitus, Cushing syndrome, hyperprolactinemia, congenital adrenal hyperplasia, hypertension, or thyroid disorder were excluded. The VAI and LAP were calculated based on the high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels. Results: There was a negative, significant correlation between LAP and HDL-C (r=-0.644), a positive, significant correlation between TG (r=0.706) and hip circumference (r=0.872), and a positive, significant correlation between VAI and waist circumference (r=0.625) in the PCOS group. There was also a positive, significant correlation between HOMA-IR and VAI in the PCOS group (r=0.462). Conclusion: Our study results suggest that VAI seems to be a more useful index for predicting insulin resistance in PCOS patients.

Anahtar Kelimeler

• Lipid accumulation product
• polycystic ovary syndrome
• Visceral adiposity index

Kaynakça

1. 1. Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370:685–97.
2. 2. Escobar-Morreale HF, San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18:266-72.
3. 3. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Hector F. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95:2038–49.
4. 4. Yildrim B, Sabir N, Kaleli B. Relationship of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome. Fertil Steril. 2003;79:1358–64.
5. 5. Kalkhoff RK, Hartz AH, Rupley D, Kissebah AH, Kelber S. Relationship of body fat distribution to blood pressure, carbohydrate tolerance, and plasma lipids in healthy obese women. J Lab Clin Med. 1983;102:621–7.
6. 6. Fernandez-Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev.2003;24:278–301.
7. 7. Chan DC, Barrett HP, Watts GF. Dyslipidemia in visceral obesity: mechanisms, implications, and therapy. Am J Cardiovasc Drugs. 2004;4:227–46.
8. 8. Bjorntorp P. Visceral obesity: a civilization syndrome. Obes Res. 1993:1;206–22.

9. 9. Huang X, Wang Q, Liu T, Pei T, Liu D, Zhu H, et al. Body fat indices as effective predictors of insulin resistance in obese/non-obese polycystic ovary syndrome women in the Southwest of China. Endocrine. 2019 Jul;65(1):81-5.
10. 10. Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85:1–10.
11. 11. Borruel S, Moltó JF, Alpañés M, Fernández-Durán E, Álvarez-Blasco F, Luque-Ramírez M, et al. Surrogate Markers of Visceral Adiposity in Young Adults: Waist Circumference and Body Mass Index Are More Accurate than Waist Hip Ratio, Model of Adipose Distribution and Visceral Adiposity Index. PLoS One. 2014;9(12):e114112.
12. 12. Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M. et al. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33:920–2.
13. 13. Kahn HS. The "lipid accumulation product" performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC cardiovascular disorders. 2005;5:26.
14. 14. Oh JY, Sung YA, Lee HJ. The Visceral Adiposity Index as a Predictor of Insulin Resistance in Young Women with Polycystic Ovary Syndrome. Obesity (Silver Spring). 2013;21(8):1690-4.
15. 15. 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 population-based study. Eur J Endocrinol. 2014 Aug;171(2):199-207.
16. 16. Amato MC, Giordano C, Pitrone M, Galluzzo A. Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis. 2011;10:183.
17. 17. Amato MC, Pizzolanti G, Torregrossa V, Misiano G, Milano S, Giordano C. Visceral adiposity index (VAI) is predictive of an altered adipokine profile in patients with type 2 diabetes. PLoS One. 2014;9:9196–9.
18. 18. Amato MC, Magistro A, Gambino G, Vesco R, Giordano C. Visceral adiposity index and DHEAS are useful markers of diabetes risk in women with polycystic ovary syndrome. Eur J Endocrinol. 2015;172:79–88.
19. 19. Abe T, Kawakami Y, Sugita M, Yoshikawa K, FukunagaT.Use of B-mode ultrasound for visceral fat mass evaluation: comparisons with magnetic resonance imaging. Appl Human Sci. 1995;14:133–9.
20. 20. Galluzzo A, Amato MC, Giordano C. Insulin resistance and polycystic ovary syndrome. Nutr Metab Cardiovasc Dis. 2008;18:511-8.
21. 21. Taksali SE, Caprio S, Dziura J, Dufour S, Calí AM, Goodman TR, et al. High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype. Diabetes. 2008;57:367-71.
22. 22. Neeland IJ, Turer AT, Ayers CR, Powell-Wiley TM, Vega GL, Farzaneh-Far R, et al. Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. JAMA 2012;308:1150–9.
23. 23. Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity,diabetes, and vascular diseases. Eur Heart J. 2008;29:2959–71.
24. 24. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition: a consensus statement from the International Diabetes Federation. Diabet Med. 2006;23:469-80.
25. 25. Oh JY, Sung YA, Lee HJ, Oh JY, Chung HW, Park H. Optimal waist circumference for prediction of metabolic syndrome in young Korean women with polycystic ovary syndrome. Obesity. 2010;18(3):593–7.
26. 26. Mario FM, Graff SK, Spritzer PM. Adiposity Indexes as Phenotype-Specific Markers of Preclinical Metabolic Alterations and Cardiovascular Risk in Polycystic Ovary Syndrome: A Cross-Sectional Study. Exp Clin Endocrinol Diabetes. 2017 May;125(5):307-15.
27. 27. Abruzzese GA, Cerrrone GE, Gamez JM, Graffigna MN, Belli S, Lioy G, et al. 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.Met Res. 2017 Jan;49(1):23-9.
28. 28. Agrawal H, Aggarwal K, Jain A. Visceral Adiposity Index: Simple Tool for Assessing Cardiometabolic Risk in Women with Polycystic Ovary Syndrome. Indian J Endocrinol Metab. 2019;23(2):232–7.
29. 29. Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23:57–63.
30. 30. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, et al. Insulin resistance as estimated by homeostasis model assessment predicts incident symptomatic cardiovascular disease in Caucasian subjects from the general population: the Bruneck study. Diabetes Care. 2007;30:318–24.
31. 31. Jamil AS, Alalaf SK, Al-Tawil NG, Al-Shawaf T, et al. A case-control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. Reprod Health. 2015;12:7.
32. 32. Daan NM, Louwers YV, Koster MP, Eijkemans MJC, Rijke YB, Lentjes WG, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril. 2014;102:1444–51.