Polycystic Ovary Syndrome and Insulin Resistance: Comparative Analysis of Obese and Non-Obese Women in a Tertiary Care Setting Pakistan: Polycystic Ovary Syndrome and Insulin Resistance: Obese and Non-Obese Women

Zara Gul; Gulfreen Waheed

doi:10.54393/pjhs.v6i9.3333

Authors

Zara Gul Department of Obstetrics and Gynaecology, Avicenna Hospital, Lahore, Pakistan
Gulfreen Waheed Department of Obstetrics and Gynaecology, Avicenna Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i9.3333

Keywords:

Insulin Resistance, HOMA-IR, Obesity, Metabolic Risk, Menstrual Irregularity, Hyperandrogenism

Abstract

Polycystic ovarian syndrome is a widespread endocrine disease that is linked to insulin resistance, regardless of obesity. This correlation is especially pertinent to South-Asian groups, where culture and lifestyles could mediate the manifestation of diseases. Objectives: To evaluate the effect of obesity on insulin resistance in women with polycystic ovarian syndrome in a tertiary care setting in Lahore, Pakistan. Methods: An analytical cross-sectional study performed at Avicenna Hospital from May to December 2023. The sample size included 220 women with PCOS, with an equal number of obese and non-obese women. BMI, waist circumference, fasting glucose, and insulin level were measured as clinical and metabolic parameters. IR was assessed on the HOMA-IR with a cut-off of 2.5. Data were analyzed with logistic regression and associated statistical t-tests. All subjects gave written consent before the data collection. Results: Obese women had a much greater BMI, waist circumference, glucose, insulin, and HOMAIR scores (p=0.001). The prevalence of IR was 78% compared to 43% among the obese female versus the non-obese female. BMI was found to predict IR (OR over 3.4 with 95% interval in 2.1-5.5) and fasting glucose (OR over 1.5 with 95% interval in 1.1-2.3). The women were also obese and had an unfavorable lipid profile. Conclusions: Insulin resistance is common in both obese and non-obese women with polycystic ovarian syndrome, but it is higher in the obese group.

References

Fatima M, Amjad S, Ali Sr HS, Ahmed T, Khan S, Raza M et al. Correlation of Subclinical Hypothyroidism with Polycystic Ovary Syndrome (PCOS). Cureus. 2020 May; 12(5). doi: 10.7759/cureus.8142. DOI: https://doi.org/10.7759/cureus.8142

Trakakis E, Pergialiotis V, Hatziagelaki E, Panagopoulos P, Salloum I, Papantoniou N. Subclinical Hypothyroidism Does Not Influence the Metabolic and Hormonal Profile of Women with PCOS. Hormone Molecular Biology and Clinical Investigation. 2017 Sep; 31(3). doi: 10.1515/hmbci-2016-0058. DOI: https://doi.org/10.1515/hmbci-2016-0058

Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F et al. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of Clinical Medicine. 2023 Feb; 12(4): 1454. doi: 10.3390/jcm12041454. DOI: https://doi.org/10.3390/jcm12041454

Cai Y, Zhong L, Guan J, Guo R, Niu B, Ma Y et al. Outcome of in Vitro Fertilization in Women with Subclinical Hypothyroidism. Reproductive Biology and Endocrinology. 2017 May; 15(1): 39. doi: 10.1186/s12958-017-0257-2. DOI: https://doi.org/10.1186/s12958-017-0257-2

Cai J, Zhang Y, Wang Y, Li S, Wang L, Zheng J et al. High Thyroid Stimulating Hormone Level Is Associated with Hyperandrogenism in Euthyroid Polycystic Ovary Syndrome (PCOS) Women, Independent of Age, BMI, and Thyroid Autoimmunity: A Cross-Sectional Analysis. Frontiers in Endocrinology. 2019 Apr; 10: 222. doi: 10.3389/fendo.2019.00222. DOI: https://doi.org/10.3389/fendo.2019.00222

Zhang B, Wang J, Shen S, Liu J, Sun J, Gu T et al. Subclinical Hypothyroidism Is Not a Risk Factor for Polycystic Ovary Syndrome in Obese Women of Reproductive Age. Gynecological Endocrinology. 2018 Oct; 34(10): 875-9. doi: 10.1080/09513590.2018.1462319. DOI: https://doi.org/10.1080/09513590.2018.1462319

Zhao H, Zhang J, Cheng X, Nie X, He B. Insulin Resistance in Polycystic Ovary Syndrome Across Various Tissues: An Updated Review of Pathogenesis, Evaluation, and Treatment. Journal of Ovarian Research. 2023 Jan; 16(1): 9. doi: 10.1186/s13048-022-01091-0. DOI: https://doi.org/10.1186/s13048-022-01091-0

Bedaiwy MA, Abdel-Rahman MY, Tan J, AbdelHafez FF, Abdelkareem AO, Henry D et al. Clinical, Hormonal, and Metabolic Parameters in Women with Subclinical Hypothyroidism and Polycystic Ovary Syndrome: A Cross-Sectional Study. Journal of Women's Health. 2018 May; 27(5): 659-64. doi: 10.1089/jwh.2017.6584. DOI: https://doi.org/10.1089/jwh.2017.6584

Su P, Chen C, Sun Y. Physiopathology of Polycystic Ovary Syndrome in Endocrinology, Metabolism and Inflammation. Journal of Ovarian Research. 2025 Feb; 18(1): 34. doi: 10.1186/s13048-025-01621-6. DOI: https://doi.org/10.1186/s13048-025-01621-6

Sami A, Iftekhar MF, Rauf MA, Sher A. Subclinical Hypothyroidism among Local Adult Obese Population. Pakistan Journal of Medical Sciences. 2018 Jul; 34(4): 980. doi: 10.12669/pjms.344.14127. DOI: https://doi.org/10.12669/pjms.344.14127

Nayak PK, Mitra S, Sahoo J, Mahapatra E, Agrawal S, Lone Z. Relationship of Subclinical Hypothyroidism and Obesity in Polycystic Ovarian Syndrome Patients. Journal of Family Medicine and Primary Care. 2020 Jan; 9(1): 147-50. doi: 10.4103/jfmpc.jfmpc_654_19. DOI: https://doi.org/10.4103/jfmpc.jfmpc_654_19

Shi D, Du J, Kang H, Feng L, Liu F. The Effect of Subclinical Hypothyroidism on Hormonal and Metabolic Profiles and Ovarian Morphology in Patients with Polycystic Ovary Syndrome: A Cross-Sectional Study. Gynecological Endocrinology. 2024 Dec; 40(1): 2358219. doi: 10.1080/09513590.2024.2358219. DOI: https://doi.org/10.1080/09513590.2024.2358219

Melmed S, Koeing R, Rosen C, Auchus R, Goldfine A. Williams Textbook of Endocrinology. 14th ed. Philadelphia: Elsevier Health Sciences. 2019. doi: 10.33029/9704-4951-6-PEND-1-848. DOI: https://doi.org/10.33029/9704-4951-6-PEND-1-848

Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The Age of Adolescence. The Lancet Child and Adolescent Health. 2018 Mar; 2(3): 223-8. doi: 10.1016/S2352-4642(18)30022-1. DOI: https://doi.org/10.1016/S2352-4642(18)30022-1

Khan SH, Shahid R, Aslam S, Manzoor R, Anwar R, Chaudhry T. How Significant Are Insulin Resistance Parameters in Subjects with Polycystic Ovarian Syndrome (PCOS)? A Cross-Sectional Study. Pakistan Armed Forces Medical Journal. 2024 Feb; 74(1): 36. doi: 10.51253/pafmj.v74i6.8627. DOI: https://doi.org/10.51253/pafmj.v74i6.8627

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Obese and Non-Obese Polycystic Ovarian Syndrome: Comparison of Clinical, Metabolic, Hormonal Parameters, and Their Differential Response to Clomiphene. Indian Journal of Endocrinology and Metabolism. 2019 Mar; 23(2): 257-62. doi: 10.4103/ijem.IJEM_637_18. DOI: https://doi.org/10.4103/ijem.IJEM_637_18

Ara F, Shoaib M, Naz R, Ghilzai S, Qadar S, Jan S. Dealing with Insulin Resistance among Polycystic Ovarian Syndrome Patient. Journal of Population Therapeutics and Clinical Pharmacology. 2024; 31(6): 3159-3165. doi: 10.53555/jptcp.v31i6.7319. DOI: https://doi.org/10.53555/jptcp.v31i6.7319

Uppal SS, Naveed AK, Majeed A, Shafiq M, Namoos K, Baig S. Complications of Obesity in Polycystic Ovary Syndrome: Insulin Resistance and Inflammation. Pakistan Journal of Medicine and Dentistry. 2021; 10(2): 16-21.

Tabassum R, Imtiaz F, Sharafat S, Nusrat U. Prevalence and Clinical Profile of Insulin Resistance in Young Women of Poly Cystic Ovary Syndrome: A Study from Pakistan. Pakistan Journal of Medical Sciences. 2013 Apr; 29(2): 593. doi: 10.12669/pjms.292.3180. DOI: https://doi.org/10.12669/pjms.292.3180

Afridi S, Saifullah S, Falah SF, Naz F, Ahmad S, Shaukat A. Assessing the Effects of Metformin on Lipid Metabolism in Women with PCOS: Metformin on Lipid Metabolism in PCOS. Pakistan Journal of Health Sciences. 2025 May: 104-9. doi: 10.54393/pjhs.v6i5.2980. DOI: https://doi.org/10.54393/pjhs.v6i5.2980