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|Title||Prevalence and Characteristics of the Metabolic Syndrome in Women with Polycystic ovary syndrome in Gaza Strip|
Introduction: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, characterized by chronic anovulation and hyperandrogenism. It affects between 5 to 10% of women of reproductive age, and it is considered one of the most common causes ofinfertility due to anovulation and endocrine disorders in premenopausal women. No single etiologic factor fully accounts for the spectrum of abnormalities in the PCOS. It is characterized by insulinresistance (IR) with compensatory hyperinsulinemia. IRalso plays a role in the metabolic syndrome (MBS) which is defined as a cluster of metabolic abnormalities including abdominal obesity, glucose intolerance, hypertension, dyslipidaemia, and cardiovascular disease(CVD). Objectives: The aim of this study was to determine the prevalence of MBS in women with PCOS compared with age- matched women without PCOS randomly selected from Gaza strip general population as well as its characteristics and predictors. Materials and methods: The target population of this study was one hundred and four consecutive premenopausal Palestinian females that were diagnosed as PCOS, who reside in Gaza strip. The same number of women randomly selected from thegeneral population who had regular menses and an absence of hirsutism matched with age and living place as a control group. Data were collected by a questionnaire interview and by biochemical analysis of blood. For all women in the two study groups serum glucose, total cholesterol, triglyceride, HDL-C, LDL-C, LH, FSH, free testosterone and Insulin hormone were determined in fasting overnight venous blood. Body mass index (BMI), waist circumference and blood pressure were measured. Results: Results showed that the prevalence of MBS and its individual components and markers of insulin resistanceare significantly more common in PCOS compared with those without PCOS as follow: by using European group for the study of insulin resistance (EGIR) MBS definition, a significantly greater proportion of women with PCOS were classified as having MBS 31.7% compared with control 3.8 %, (P=0.000). By using National cholesterol education program-third adult treatment panel (NCEP ATP III) definition the prevalence of the MBS in women with PCOS was 46.2% which is significantly greater than that of the control group 8.7% (P= 0.000), and when we used the International diabetes federation (IDF) definition we found that the MBS was present in 53.8% of PCOS women which is significantly greater than that of the controls 16.3% (P= 0.000). With age, the prevalence of the MBS increased in our study from 37.9% in PCOS women who are ≤ 20 years old to 48.8% in women who are 21-29 years old and then to 76.8% in women who are at least 30 years old, representing a significantly increasing trend (P<0.01). The mean BMI was significantly increased in PCOS women when compared with the control group (28.8 +6.2, 26.3+4.7 Kg/m2 respectively), (P= 0.001). There was significant increasing trend of the MBS in both of cases and controls by increase of BMI, (P= 0.000). The prevalence of the MBS (defined by IDF) in PCOS women from lowest to highest quartile of waist circumference was 0, 31.7, 76.1 and 100%, respectively representing significant increasing trend (P= 0.000). There was significant increasing trend in the proportion of PCOS women with the MBS as related to the fasting insulin levels (P= 0.000). Women in the highest quartile of fasting insulin had nearly 8-fold greater chance of having the MBS than did women in the lowest quartile. The concentration of free testosterone was also significantly (P= 0.024) related to an increasing trend in the proportion of PCOS women with the MBS. All individual components of the MBS and markers of insulin resistance that have been measured showed significant differences between women with PCOS and those without PCOS (P< 0.001) and between PCOS women with MBS and those without MBS (P< 0.05). The most prevalent of MBS components among the PCOS women were waist circumference ≥80 cm (79.8%), followed by low HDL-C < 50 mg/dL (76.9%) and FBS ≥ 100 mg/dL (55.8%). The lowest prevalent components were high blood pressure ≥130/≥85 (17.3%) and Triglyceride ≥ 150 mg/dL (44.2%). Compared with PCOS women who did not meet criteria for the MBS, those with the MBS had significantly higher mean age (27.4 + 1.7 vs. 23.2 + 1.5, P=0.000) and more hyperandrogenic. The best predictors of MBS were triglyceride ≥150 mg/dL (93.5%), blood pressure ≥130/≥85 (83.3%) and then FBS ≥100 mg/dL (74.1%). A history of type II DM (DM2) was present in 2.9% of PCOS women and in 1% of women without PCOS (a difference that was not statistically significant (P=0.123). Whereas a history of DM2 in immediate family members was present in 43.3% of women with PCOS compared with 26.9% of the controls (a difference that was statistically significant P=0.01). Primary infertility, secondary infertility, hirsutism and hirsutism in immediate family members were found in 69.1, 11.7, 48.1 and 29.8%, respectively of the PCOS women. 73.1% of these women were suffered from psychiatric disorder related to the clinical symptoms accompanied with the syndrome. Women with PCOS were similar in age of menarche to those without the PCOS (P=0.592). However, these two groups of women differed significantly in the presence of acanthosis nigricans, acne, seborrhea, male pattern hair loss, android body type and hypertension (P< 0.05), The prevalence of miscarriage did not differ significantly between PCOS women and controls (32.7% vs. 31.7%, respectively, P=0.500). PCOS women with the MBS tended to present significantly more often with symptoms of hirsutism, acanthosis nigricans, psychiatric disorder, hypertension, android body type and secondary infertility compared with those without MBS (P< 0.05). Insulin resistance in both obese and non obese women with PCOS appears to be significantly more common compared with those without PCOS (P<0.01). Hyperinsulinemia was significantly associated with hyperandrogenism (P=0.000) and hypertension (P<0.01) in women with PCOS. The triglyceride/HDL-C ratio negatively correlates with quantitative insulin sensitivity check index in women with PCOS (P= 0.000). Conclusion: The MBS and its individual components and markers of insulin resistanceare significantly more common in women with PCOS compared with those without PCOS. The risk of the MBS in PCOS women, particularly in the highest quartile of fasting insulin levels increased nearly to 8- fold greater chance than did women in the lowest quartile. Insulin resistance had a likely a central role and a key pathologic factor in the pathogenesis of both PCOS and MBS.
|Publisher||الجامعة الإسلامية - غزة|
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