Abstract
Insulin resistance (IR) is an independent risk factor for cardiovascular disease and
is a prevalent metabolic disturbance among women with polycystic ovary syndrome (PCOS).
Central adiposity, a marker of IR and an accurate anthropometric method to estimate
truncal adiposity, may represent a key clinical tool for IR screening in subpopulations
at higher metabolic and cardiovascular risk, such as women with PCOS. The aims of
the present study were (1) to investigate the influence of androgens on IR and central
obesity in overweight or obese hirsute women with or without PCOS and (2) to test
the reliability of the sum of trunk skinfolds (subscapular, suprailiac, and abdominal)
to estimate truncal adiposity. This observational, cross-sectional study included
37 hirsute patients with body mass index of 25 kg/m2 or greater and aged between 14 and 41 years. Twenty-four had PCOS, and 13 had ovulatory
cycles, normal androgen levels, and isolated hirsutism, named idiopathic hirsutism
(IH). Nutritional, anthropometric, clinical, and laboratory evaluations were performed.
Body composition was assessed by measurement of waist circumference and skinfold thickness
and by dual-energy x-ray absorptiometry (DXA). Both groups presented similar ages,
body mass index, and hirsutism score. The PCOS group had higher androgen levels, homeostasis
model assessment (HOMA) index, and fasting insulin levels. Free androgen index was
positively associated with HOMA, independent of truncal adiposity (r = 0.441, P = .009). Strong correlations were also observed between truncal adiposity measured
by DXA and both the sum of trunk skinfolds (r = 0.863, P = .0001) and waist circumference in hirsute patients (r = 0.947, P = .0001). In our study, IR (HOMA index ≥3.8) was associated with truncal obesity,
with a more androgenic profile, and with an unfavorable lipid profile. In conclusion,
hirsutism per se appears not to be a risk for IR and related cardiovascular disease
unless there is presence of central adiposity and/or abnormal androgen profile as
observed in patients with PCOS. Waist circumference and the sum of trunk skinfolds
represent accurate methods to estimate truncal adiposity, but waist circumference
measurement seems to be the simplest method of clinical screening for IR in hirsute
women.
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Article info
Publication history
Accepted:
March 29,
2007
Received:
May 5,
2006
Identification
Copyright
© 2007 Published by Elsevier Inc.
