Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome Basak Yildirim, M.D., a Nuran Sabir, M.D., b and Babur Kaleli, M.D. a Pamukkale University Hospital, Denizli, Turkey Objective: To investigate the relation between intra-abdominal fat distribution and metabolic disorders in nonobese patients with the polycystic ovary syndrome (PCOS). Design: Prospective case– control study. Setting: University-based hospital. Patient(s): Thirty nonobese patients with PCOS and 30 lean women with regular menstrual cycles (controls). All participants had a body mass index 25kg/m 2 . Main Outcome Measure(s): Subcutaneous and intra-abdominal visceral and preperitoneal fat thicknesses were assessed by ultrasonography. Glucose tolerance and insulin sensitivity were evaluated by standard 75-g oral glucose tolerance test and area-under-the-curve analysis. Serum hormones and lipid profile were measured. Result(s): The mean preperitoneal and visceral fat thicknesses were significantly greater in nonobese patients with PCOS. Subcutaneous fat mass was similar between the PCOS and control groups. Nonobese patients with PCOS had glucose intolerance, hyperinsulinemia, and dyslipidemia, manifested by high serum levels of triglyceride, total cholesterol, and high-density lipoprotein (HDL) levels and low serum low-density lipopro- tein (LDL) levels. No correlation existed between subcutaneous fat thickness and the metabolic variables in nonobese patients with PCOS. However, serum triglyceride levels correlated with visceral fat and preperito- neal fat thickness. The mean HDL level correlated negatively with visceral fat and preperitoneal fat thickness. The area under the curve for insulin and mean fasting insulin levels correlated positively with visceral fat thickness. In multiple regression analysis, visceral fat thickness contributed significantly to high serum triglyceride and fasting insulin levels. Conclusion(s): Intra-abdominal preperitoneal and visceral fat accumulation may contribute to the develop- ment of glucose and lipid metabolism disorders in nonobese patients with PCOS. (Fertil Steril 2003;79: 1358 – 64. ©2003 by American Society for Reproductive Medicine.) Key Words: Polycystic ovary syndrome, fat distribution, visceral fat, ultrasonography Polycystic ovary syndrome (PCOS) is con- sidered not only a reproductive endocrinopathy but also a metabolic disorder. It is associated with insulin resistance, hyperinsulinemia, glu- cose intolerance, obesity, and an altered lipid profile (1–3). The reasons for metabolic disorders in PCOS have not been completely elucidated (1– 4). Although obesity is known to be often associated with such metabolic disorders as glucose intolerance and hyperlipidemia, lean women with PCOS also have been found to have hyperinsulinemia and dyslipidemia with higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol and lower levels of high-density lipoprotein (HDL) cholesterol (5– 8). Insulin resistance is found in lean as well as obese patients with PCOS (5– 8). Thus, metabolic disorders in pa- tients with PCOS cannot be explained solely by the presence of obesity. The PCOS and the insulin resistance syn- drome (syndrome X) have similarities. Both are manifested by obesity, peripheral insulin resistance, dyslipidemia, and hyperandro- genism (6). Visceral adipose tissue has a unique anatomy in that it is drained by the portal vein. It is believed to play a major patho- physiologic role in the insulin resistance syn- drome (9). Visceral fat tissue, which delivers Received May 3, 2002; revised and accepted October 22, 2002. Reprint request: Basak Yildirim, M.D., Pamukkale U ¨ niversitesi Tıp Faku ¨ ltesi Hastanesi Bas ¸ hekimlig ˇ i, Doktorlar Caddesi, 20100 Denizli, Turkey (FAX: 90- 258-2410040; E-mail: [email protected]). a Department of Obstetrics and Gynecology, Faculty of Medicine. b Department of Radiology, Faculty of Medicine. FERTILITY AND STERILITY VOL. 79, NO. 6, JUNE 2003 Copyright ©2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. 0015-0282/03/$30.00 doi:10.1016/S0015-0282(03) 00265-6 1358
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