A new study presented this week at the European Congress of Endocrinology details genetic and observational associations between obesity and markers of body composition on the likelihood of developing polycystic ovary syndrome (PCOS) later in life.
Presented Monday at the European Congress of Endocrinology 2022, results of the study demonstrate increased BMI, body fat percentage, fasting insulin, and sex-hormone-binding globulin (SHBG), were all associated with an increased likelihood of developing PCOS.
A diagnostic challenge
PCOS is a common endocrine condition, however, many cases go undiagnosed. According to a 2016 study (Bozdag et al, Human Reproduction, 2016) the condition affects up to 10% of women of childbearing age. PCOS impacts how women’s ovaries work and can manifest itself as irregular periods, high levels of “male” hormones, and enlarged ovaries with fluid-filled sacs surrounding the eggs (https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/Accessed May 24, 2022).
The condition can lead to diabetes, infertility, poorer quality of life, and pregnancy complications. Research surrounding risk factors for development of PCOS have come into the spotlight of endocrine research efforts in recent years.
Looking for linkage
This newly released study, conducted by Laurence Dobbie, MBChB, and colleagues from the Royal Liverpool University Hospital in the United Kingdom, was launched with the goal of investigating whether obesity and diabetes markers were associated with an increased likelihood of PCOS development.
The study included a genetic analysis, termed Mendelian randomization, of over 110,000 women. In epidemiology, Mendelian randomization is a method using measured variation in genes to interrogate the causal effect of an exposure on an outcome. The team also pooled data from 63 other studies, via meta-analysis, to assess how overweight and obesity affect the chance of developing PCOS.
More than double the odds
Their analysis revealed significant associations between body composition metrics and the odds of developing PCOS. With every standard deviation (SD) increase in BMI, which correlated to a BMI increase of 4.8 kg/m2, the odds of PCOS more than doubled (OR, 2.76 [95% CI, 2.27-3.35]). Similar trends were observed with risk of PCOS and SD increases in body fat percentage (OR, 3.05 [95% CI, 2.24 – 4.15]), whole-body fat mass (OR, 2.53 [95% CI, 2.04-3.14]), fasting insulin (OR, 6.98 [95% CI, 2.02-24.13]), and SHBG (OR, 0.74 [95% CI, 0.64-0.87]).
Single SD increases for body fat percentage, whole-body fat mass, fasting insulin, and SHBG were 8.5%, 9.6 kg, 0.79 pmol/L, and 28 nmol/L, respectively. Investigators noted that their research further indicated that genetically determined childhood body size also increased odds of PCOS after adjustment for adult body size (OR, 2.56 [95% CI, 1.57-4.20]).
Early years are decisive
In their meta-analysis, investigators found that women with overweight (OR, 3.80 [95% 2.87-5.03]), women with obesity (OR, 4.99 [95% CI, 3.74-6.67]), and women with central obesity (OR, 2.93 [95% CI, 2.08-4.12]) all had increased likelihood of developing PCOS. (Central obesity was defined via waist circumference/waist-hip ratio.) Additionally, results suggested that the presence of overweight (OR, 5.32) or obesity (OR, 7.86) in adolescence was associated with greater odds of PCOS than overweight (OR, 3.57) or obesity (OR, 4.66) in adulthood.
Interestingly, the analysis also showed that girls with overweight who go on to have a normal adult body weight are still more likely to develop PCOS.
“This study shows that obesity during childhood and teenage years are key factors in the development of PCOS,” stated Dobbie in a statement from the society. “This opens a way to support women’s health by investing in nutritional and weight management programs for younger people. This also has the potential to prevent the condition’s consequences which include poorer quality of life, infertility, diabetes, and pregnancy complications.
“Future research should focus on developing new ways to help women affected by PCOS manage their weight.”
The study, “Body Composition during Childhood, Adolescence and Adulthood influences the odds of developing Polycystic Ovary Syndrome: A Mendelian Randomization Study with a Systematic Review and Meta-analysis,” was presented on May 23 at the 2022 annual meeting of the European Congress of Endocrinology.
Clinicians’ Bonus: More To Know
PCOS clinical tool for you
A consortium of PCOS experts have collaborated to develop a 4-page, downloadable PCOS tool to assist healthcare providers in the delivery of evidence-based care for the condition. The work product of clinicians from The American Society for Reproductive Medicine, the Centre for Research Excellence in Polycystic Ovary Syndrome, European Society of Human Reproduction and Embryology, as well as Monash University, the evidence-based “PCOS GP Tool” features concise, comprehensive information ranging from PCOS assessment (including a 3-step diagnostic algorithm) to Rotterdam diagnostic criteria; metabolic features and risk factors to be aware of and to monitor; lifestyle and emotional well-being goals and management guidance, and more. Download the “PCOS GP Tool” here.
And a PCOS app for your patients
Developed by leading PCOS experts from around the world and co-designed with women with the condition, the app’s developers from Monash Center for Health Research and Implementation (MCHRI) and Monash University state that AskPCOS is “the first app dedicated to the condition of PCOS that is based on the best available evidence.” The app’s information “is informed by the National Health and Medical Research Council (NHMRC)-approved, evidence-based guidelines, community preference, and multidisciplinary clinical expertise in PCOS and was developed to help women with PCOS find good quality, trustworthy information.”
AskPCOS is designed for patients who think they may have PCOS, those who already have a diagnosis, and for those individuals supporting women with PCOS. It offers a range of innovative features including:
- a self-diagnostic quiz
- easy to understand information on PCOS
- a question-prompt list to assist the patient when talking to health professionals and
- a symptoms tracker to help the patient better understand the condition and her body.
Clinical experts in PCOS at MCHRI and Monash University provide the AskPCOS app, which is designed to be informative and educational, but is not intended to provide specific medical advice nor to replace individual health practitioner advice. Find the AskPCOS app here.
Quick video bonus on patients’ PCOS perspectives
In this insightful ~2-minute video, Endocrinologist and Professor of Women’s Health Helena Teede, MBBS, FRACP, PhD, FAAHMS, highlights research on the frustration and poor experience women so often have in obtaining both a correct diagnosis of PCOS and effective management of their condition, and outlines how the International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS) was developed. Prof Teede is Director of the Monash Centre for Health Research Implementation, School of Public Health, co-director of the Monash Institute of Medical Engineering at Monash University, and at Monash Health, and Executive Director of Monash Partners Academic Health Sciences Centre.
The contents of this feature are not provided or reviewed by NPWH.