The Impact of Obesity on the Metabolic Profile of Patients with Polycystic Ovary Syndrome
PCOS’ta Obezite ve Metabolik Profil
Keywords:
Polycystic ovary syndrome, obesity, insulin resistance, body composition, inflammation, lipid profileAbstract
Objective: The aim of this study was to evaluate the effects of polycystic ovary syndrome (PCOS) and accompanying obesity on various metabolic and biochemical parameters, particularly body composition, insulin resistance (IR), lipid profile, and inflammatory markers.
Methods: A total of 120 women aged 18–40 years were included in the study: 40 obese patients with PCOS, 40 normal-weight (non-obese) patients with PCOS, and 40 healthy controls. The diagnosis of PCOS was established according to the Rotterdam criteria. Participants were classified based on body mass index (BMI) as obese (BMI ≥30 kg/m2) or non-obese (BMI <25 kg/m2). Body composition was assessed using bioelectrical impedance analysis. Serum fasting glucose, insulin, glycated hemoglobin (HbA1c), lipid profile, C-reactive protein (CRP), alanine aminotransferase, aspartate aminotransferase, anti-Müllerian hormone (AMH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone were analyzed. IR was calculated using the homeostatic model assessment of IR (HOMA-IR) method. Statistical comparisons between groups were performed using the Kruskal–Wallis test followed by Dunn’s post-hoc analyses.
Results: Body weight, BMI, total fat mass, and body fat percentage were significantly higher in the obese PCOS group than in the other groups, whereas body water percentage and high-density lipoprotein (HDL) cholesterol levels were significantly lower (p < 0.001). Fasting insulin levels and HOMA-IR were significantly higher in the obese PCOS group than in both the control group and the non-obese PCOS group (p < 0.001). Additionally, HbA1c levels were higher in the obese PCOS group compared with both the control group (p < 0.001) and the non-obese PCOS group (p < 0.01). Similarly, triglyceride (TG), CRP, and ALT levels were higher in the obese PCOS group than in the other groups. AMH levels were higher in the non-obese PCOS group than in the control group. In contrast, no statistically significant differences were found among the groups in LH levels, FSH levels, the LH/FSH ratio, or progesterone levels. Correlation analyses showed that BMI and fat mass were positively associated with indicators of IR and with levels of TG, CRP, and ALT, and negatively associated with HDL cholesterol and body water percentage.
Conclusion: The severity of metabolic impairment in PCOS is closely associated with obesity and increased fat mass. Obesity is one of the main determinants of IR, dyslipidemia, and inflammation. Therefore, improving body composition is of great importance in the management of PCOS to reduce metabolic risk.
References
Aydin K, Cinar N, Aksoy DY, Bozdag G, Yildiz BO. Body composition in lean women with polycystic ovary syndrome: effect of ethinyl estradiol and drospirenone combination. Contraception. 2013;87(3):358–362. doi:10.1016/j.contraception.2012.07.005
Cassar S, Teede HJ, Moran LJ, Joham AE, Harrison CL, Strauss BJ, et al. Polycystic ovary syndrome and anti-Müllerian hormone: role of insulin resistance, androgens, obesity and gonadotrophins. Clin Endocrinol (Oxf). 2014;81(6):899–906. doi:10.1111/cen.12557
Day FR, Hinds DA, Tung JY, Stolk L, Styrkarsdottir U, Saxena R, et al. Causal mechanisms and balancing selection inferred from genetic associations with polycystic ovary syndrome. Nat Commun. 2015;6:8464. doi:10.1038/ncomms9464
Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981–1030. doi:10.1210/er.2011-1034
González F, Kirwan JP, Rote NS, Minium J. Evidence of mononuclear cell preactivation in the fasting state in polycystic ovary syndrome. Am J Obstet Gynecol. 2014;211(6):635.e1–635.e7. doi:10.1016/j.ajog.2014.06.044
González F, Kirwan JP, Rote NS, Minium J. Glucose ingestion stimulates atherothrombotic inflammation in polycystic ovary syndrome. Am J Physiol Endocrinol Metab. 2013;304(4):E375–E383. doi:10.1152/ajpendo.00491.2012
Huddleston HG, Quinn MM, Kao C, Lenhart N, Rosen MP, Cedars MI. Women with polycystic ovary syndrome demonstrate worsening markers of cardiovascular risk over the short term despite declining hyperandrogenaemia. Clin Endocrinol (Oxf). 2017;87(6):775–782. doi:10.1111/cen.13497
Isayeva AS, Vovchenko MM, Petyunina OV. Sedentary lifestyle attenuates positive metabolic effect of regular physical exercise. J Endocrinol Metab. 2022;12(2):59–65. doi:10.14740/jem797
Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab. 2014;18(3):317–324. doi:10.4103/2230-8210.131162
Kim JJ. Obesity and polycystic ovary syndrome. J Obes Metab Syndr. 2024;33(4):239-245. doi:10.7570/jomes24035
Kiyak Caglayan E, Engin-Ustun Y, Gocmen AY, Polat MF, Aktulay A. Serum sirtuin 1 levels in patients with polycystic ovary syndrome. J Obstet Gynaecol. 2015;35(6):608–611. doi:10.3109/01443615.2014.990428
Koleva-Tyutyundzhieva D, Ilieva-Gerova M, Deneva T, Orbetzova M. Metabolic and inflammatory adipokine profiles in PCOS: a focus on adiposity, insulin resistance, and atherogenic risk. Int J Mol Sci. 2025;26(19):9702. doi:10.3390/ijms26199702
Liang Y, Ming Q, Liang J, Zhang Y, Zhang H, Shen T. Gut microbiota dysbiosis in polycystic ovary syndrome: association with obesity. Can J Physiol Pharmacol. 2020;98(11):803–809. doi:10.1139/cjpp-2019-0413
Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618–637. doi:10.1093/humupd/dms030
Moon H, Ha K, Han S, Kim H, Kim D. The association of adiponectin and visceral fat with insulin resistance and β-cell dysfunction. Journal of Korean Medical Science. 2019;34(1):e7.
doi:10.3346/jkms.2019.34.e7
Patwari P, Batra N, Sen K, Saha A, Kumari B, Basu M, et al. Nonobese PCOS compared to obese PCOS have similar clinical presentation, hormonal profile, and insulin resistance. Clin Endocrinol (Oxf). 2025;103(4):567–579. doi:10.1111/cen.15302
Rattan S, Flaws JA. The epigenetic impacts of endocrine disruptors on female reproduction across generations. Biol Reprod. 2019;101(3):635–644. doi:10.1093/biolre/ioz081
Sarray S, Almawi WY. Levels of CD40L and other inflammatory biomarkers in obese and non-obese women with polycystic ovary syndrome. Am J Reprod Immunol. 2016;76(4):285–291. doi:10.1111/aji.12549
Siddiqui S, Mateen S, Ahmad R, Moin S. A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). J Assist Reprod Genet. 2022;39(11):2439–2473. doi:10.1007/s10815-022-02625-7
Silveira EA, Mendonça CR, Delpino FM, Souza GVE, Rosa LPS, Oliveira C, et al. Sedentary behavior, physical inactivity, abdominal obesity and obesity in adults and older adults. Clin Nutr ESPEN. 2022;50:63–73. doi:10.1016/j.clnesp.2022.06.001
Tay CT, Loxton D, Bahri Khomami M, Teede H, Harrison CL, Joham AE. High prevalence of medical conditions and unhealthy lifestyle behaviours in women with PCOS during preconception. Hum Reprod. 2023;38(11):2267–2276. doi:10.1093/humrep/dead190
Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469. doi:10.1210/clinem/dgad463
Türkiye Endokrinoloji ve Metabolizma Derneği. Obezite tanı ve tedavi kılavuzu. Ankara: TEMD; 2019.
Usta A, Avci E, Bulbul CB, Kadi H, Adali E. The monocyte count to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome. Reprod Biol Endocrinol. 2018;16(1):34. doi:10.1186/s12958-018-0351-0
World Health Organization. Obesity and overweight. Geneva: WHO; 2025.
World Health Organization. Polycystic ovary syndrome. Geneva: WHO; 2025 Feb 7.
Yildizhan R, Ilhan GA, Yildizhan B, Kolusari A, Adali E, Bugdayci G. Serum retinol-binding protein 4, leptin, and plasma asymmetric dimethylarginine levels in obese and nonobese young women with polycystic ovary syndrome. Fertil Steril. 2011;96(1):246–250. doi:10.1016/j.fertnstert.2011.04.073
