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Polycystic ovary syndrome

Link between obesity and PCOS exaggerated, study claims

Bias results from patients who self-refer for care
Dr Ricardo Azziz

Women who actively seek treatment for the polycystic ovary syndrome (PCOS) tend to be heavier than those identified through screening of the general population, and according to researchers this could be exaggerating the relationship between obesity and PCOS.

"The findings indicate that while obesity is a major problem for everyone who has it, we should treat obesity as obesity and probably not try to link obesity as a sign of PCOS," said Dr Ricardo Azziz, reproductive endocrinologist at the Medical College of Georgia at Georgia Regents University. “"What is surprising to us is that the rate of obesity in women with PCOS who we found in the general population is nowhere near as high as we expected from studying women with PCOS who did seek care."

Reporting their findings in the Journal of Clinical Endocrinology & Metabolism, the authors note that obesity has been considered a hallmark of the condition since it was first described in 1932 and that the on-going association likely is perpetuated by a bias resulting from patients who self-refer for care.

The researchers examined looked at what have long been considered indicators of the disease, including obesity, high testosterone levels and excess body hair, in women actively seeking care for PCOS as well as those identified with PCOS through a general pre-employment health screening.

Two-hundred and ninety-two PCOS patients identified at a tertiary care outpatient facility (referral PCOS) and 64 PCOS women (unselected PCOS) identified through the screening of a population of 668 seeking a pre-employment physical.

Among the women undergoing a pre-employment physical 563 did not demonstrate features of the disorder (unselected controls). All PCOS subjects met the NIH 1990 criteria for the disorder.

The referral PCOS subjects had greater mean body mass index (BMI) and hirsutism score, and higher degrees of hyperandrogenemia; were more likely to be non-Hispanic White (83.90%); and demonstrated a more severe PCOS subphenotype, than unselected PCOS or unselected controls.

The unselected PCOS subjects had a prevalence of obesity and severe obesity and a mean BMI similar to those of the general population from which they were derived.

However, obesity rates in patients actively seeking treatment were about 2.5 times higher than in women identified with PCOS through the screening of the general population.

"A lot of patients believe PCOS leads to obesity and we really don't have strong data to support that. In fact, our evidence suggests that is not the case," said Azziz. "We do know that the more fat you have, the more metabolic dysfunction you have, regardless of whether you have PCOS."

He said that there is growing evidence that also suggests that, regardless of how much they have, the fat in women with PCOS behaves differently.

Azziz and his colleagues recently reported in the journal Diabetes, that differences in the fat of women with PCOS revealed that several tiny RNA molecules, called microRNA, were overexpressed in the fat of those who also were insulin-resistant, resulting in decreased expression of GLUT4, a key protein that regulates fat's use of glucose for energy.

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