Body fat distribution has weight-independent effects on clinical, hormonal, and metabolic features of women with polycystic ovary syndrome

This study was performed to investigate whether different patterns of body fat distribution may have distinct effects on the clinical, hormonal, and metabolic features of women with clinical hyperandrogenism such as polycystic ovary syndrome (PCOS). Ninety-seven consecutive women with PCOS were included in the study after assessment of gynecological and obesity history and careful clinical examination. Women were divided into three tertile groups based on the waist to hip ratio (WHR). Those with peripheral body fat distribution (P-BFD) had a WHR of less than 0.80, those with intermediate body fat distribution (I-BFD) had a WHR of 0.81 to 0.90, and those with abdominal body fat distribution (A-BFD) had a WHR exceeding 0.90. Baseline blood and urine samples were obtained for several hormone and lipid determinations, and the response of glucose, insulin, and C-peptide to a glucose oral challenge (75 g) was investigated. In the PCOS group, WHR values were higher than those used to define P-BFD and A-BFD in the normal female population. As WHR values increased, a significantly greater prevalence of obesity and acanthosis nigricans and a lower prevalence of acne was present. No significant differences were present in any of the other clinical features between the three groups. Ovarian morphology and volumes were similar in all groups. After adjusting for age and body mass index, we found that increasing WHR values led to (1) a progressive and significant increase of luteinizing hormone (LH), androstenedione, and estrone concentrations; (2) higher levels of fasting and glucose-stimulated insulin, whereas no difference was present in fasting and stimulated glucose and C-peptide concentrations; (3) significantly higher levels of triglycerides, very-low-density lipoprotein (VLDL) cholesterol, and apolipoprotein B and lower values of high-density lipoprotein (HDL) cholesterol without any difference in total cholesterol and apolipoprotein A-I. In addition, women with A-BFD had significantly higher diastolic blood pressure levels than the other two groups. This study therefore demonstrates that among women with PCOS, those with A-BFD have different clinical, hormonal, and metabolic features when compared with women with P-BFD, and that these differences were independent of individual body weight.