The effect of obesity on polycystic ovary syndrome: A systematic review and meta-analysis

Obesity Reviews

Volumn 14, Issue 2, 2013, Pages 95-109

  Lim, S S ^a,b   Norman, R J ^a   Davies, M J ^a   Moran, L J ^a  

^a UNIVERSITY OF ADELAIDE   (Australia)

^b Greater Green Triangle University Department of Rural Health   (Australia)

Author keywords

Central obesity; Obesity; Overweight; Polycystic ovary syndrome

Indexed keywords

ANDROGEN; CHOLESTEROL; GLUCOSE; INSULIN; LIPID; LOW DENSITY LIPOPROTEIN CHOLESTEROL; SEX HORMONE BINDING GLOBULIN; TESTOSTERONE;

ARTICLE; BODY FAT DISTRIBUTION; BODY MASS; BODY WEIGHT; HIRSUTISM; HUMAN; INSULIN RESISTANCE; META ANALYSIS (TOPIC); OBESITY; OVARY POLYCYSTIC DISEASE; REPRODUCTION; SYSTEMATIC REVIEW (TOPIC);

ADULT; BLOOD GLUCOSE; BODY COMPOSITION; BODY MASS INDEX; FEMALE; HUMANS; INSULIN; INSULIN RESISTANCE; LIPIDS; OBESITY; POLYCYSTIC OVARY SYNDROME; REPRODUCTION; SEX HORMONE-BINDING GLOBULIN; TESTOSTERONE;

EID: 84872141370     PISSN: 14677881     EISSN: 1467789X     Source Type: Journal    
DOI: 10.1111/j.1467-789X.2012.01053.x     Document Type: Article

References (141)

1. Ruesten A, Steffen A, Floegel A etal. Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015. Plos ONE 2011; 6: e27455.
2. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. J Am Med Assoc 2010; 303: 235-241.
3. Cameron AJ, Welborn TA, Zimmet PZ etal. Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust 2003; 178: 427-432.
4. Rich-Edwards JW, Goldman MB, Willett WC etal. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol 1994; 171: 171-177.
5. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome; towards a rational approach. In: Dunaif A, Givens JR, Haseltine F (eds). Polycystic Ovary Syndrome. Blackwell Scientific: Boston, MA, 1992, pp. 377-384.
6. Diamanti-Kandarakis E, Kouli CR, Bergiele AT etal. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999; 84: 4006-4011.
7. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998; 83: 3078-3082.
8. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000; 85: 2434-2438.
9. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89: 2745-2749.
10. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25: 544-551.
11. Mehrabian F, Khani B, Kelishadi R, Ghanbari E. The prevalence of polycystic ovary syndrome in Iranian women based on different diagnostic criteria. Endokrynol Pol 2011; 62: 238-242.
12. Hudecova M, Holte J, Olovsson M, Larsson A, Berne C, Sundstrom-Poromaa I. Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: long-term follow-up. Fertil Steril 2011; 96: 1271-1274.
13. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16: 347-363.
14. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999; 84: 165-169.
15. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999; 22: 141-146.
16. Meyer C, McGrath BP, Teede HJ. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab 2005; 90: 5711-5716.
17. de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update 2011; 17: 495-500.
18. Deeks AA, Gibson-Helm ME, Teede HJ. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertil Steril 2010; 93: 2421-2423.
19. Upadhya K, Trent M. Effects of polycystic ovary syndrome on health-related quality of life. Expert Rev Pharmacoecon Outcomes Res 2007; 7: 597-603.
20. Himelein MJ, Thatcher SS. Polycystic ovary syndrome and mental health: a review. Obstet Gynecol Surv 2006; 61: 723-732.
21. Li Y, Yu Ng EH, Stener-Victorin E etal. Polycystic ovary syndrome is associated with negatively variable impacts on domains of health-related quality of life: evidence from a meta-analysis. Fertil Steril 2011; 96: 452-458.
22. Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93: 162-168.
23. Targher G, Solagna E, Tosi F etal. Abnormal serum alanine aminotransferase levels are associated with impaired insulin sensitivity in young women with polycystic ovary syndrome. J Endocrinol Invest 2009; 32: 695-700.
24. Balen AH, Conway GS, Kaltsas G etal. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995; 10: 2107-2111.
25. Liou TH, Yang JH, Hsieh CH, Lee CY, Hsu CS, Hsu MI. Clinical and biochemical presentations of polycystic ovary syndrome among obese and nonobese women. Fertil Steril 2009; 92: 1960-1965.
26. Holte J, Bergh T, Gennarelli G, Wide L. The independent effects of polycystic ovary syndrome and obesity on serum concentrations of gonadotrophins and sex steroids in premenopausal women. Clin Endocrinol (Oxf) 1994; 41: 473-481.
27. Kiddy DS, Sharp PS, White DM etal. Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol (Oxf) 1990; 32: 213-220.
28. Brassard M, AinMelk Y, Baillargeon J-P. Basic infertility including polycystic ovary syndrome. Med Clin North Am 2008; 92: 1163-1192.
29. Holte J, Bergh T, Berne C, Lithell H. Serum lipoprotein lipid profile in women with the polycystic ovary syndrome: relation to anthropometric, endocrine and metabolic variables. Clin Endocrinol (Oxf) 1994; 41: 463-471.
30. Conway GS, Agrawal R, Betteridge DJ, Jacobs HS. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992; 37: 119-125.
31. Kaya C, Cengiz SD, Satiroglu H. Obesity and insulin resistance associated with lower plasma vitamin B 12 in PCOS. Reprod Biomed Online 2009; 19: 721-726, 4092.
32. Ehrmann DA, Liljenquist DR, Kasza K etal. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91: 48-53.
33. Himelein MJ, Thatcher SS. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006; 11: 613-625.
34. Barry JA, Kuczmierczyk AR, Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2011; 26: 2442-2451.
35. Weiner CL, Primeau M, Ehrmann DA. Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med 2004; 66: 356-362.
36. Rasgon NL, Rao RC, Hwang S etal. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003; 74: 299-304.
37. Willett WC, Manson JE, Stampfer MJ etal. Weight, weight change, and coronary heart disease in women. Risk within the 'normal' weight range. JAMA 1995; 273: 461-465.
38. Rudra CB, Sorensen TK, Leisenring WM, Dashow E, Williams MA. Weight characteristics and height in relation to risk of gestational diabetes mellitus. Am J Epidemiol 2007; 165: 302-308.
39. Campbell PJ, Gerich JE. Impact of obesity on insulin action in volunteers with normal glucose tolerance: demonstration of a threshold for the adverse effect of obesity. J Clin Endocrinol Metab 1990; 70: 1114-1118.
40. Pasquali R, Casimirri F, Venturoli S etal. Body fat distribution has weight-independent effects on clinical, hormonal, and metabolic features of women with polycystic ovary syndrome. Metabolism 1994; 43: 706-713.
41. Pasquali R, Casimirri F, Cantobelli S etal. Insulin and androgen relationships with abdominal body fat distribution in women with and without hyperandrogenism. Horm Res 1993; 39: 179-187.
42. Yucel A, Noyan V, Sagsoz N. The association of serum androgens and insulin resistance with fat distribution in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2006; 126: 81-86.
43. Kalra P, Bansal B, Nag P etal. Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome. Fertil Steril 2009; 91 (4 Suppl.): 1437-1440.
44. Bernasconi D, Del Monte P, Meozzi M etal. The impact of obesity on hormonal parameters in hirsute and nonhirsute women. Metabolism 1996; 45: 72-75.
45. Broekmans FJ, Knauff EAH, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BCJM. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006; 113: 1210-1217.
46. World Health Organisation, International Association for the Study of Obesity, International Obesity TaskForce. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Melbourne: Health Communications, Australia Pty Ltd, 2000.
47. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120 (Suppl. 4): S164-S192.
48. World Health Organisation. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation, 1999.
49. Wells GA, Shea B, O'Connell D etal. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. [WWW document]. URL http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed September 2010).
50. Cupisti S, Dittrich R, Binder H, Beckmann MW, Mueller A. Evaluation of biochemical hyperandrogenemia and body mass index in women presenting with amenorrhea. Exp Clin Endocrinol Diabetes 2007; 115: 298-302.
51. Escobar-Morreale HF, Villuendas G, Botella-Carretero JI etal. Adiponectin and resistin in PCOS: a clinical, biochemical and molecular genetic study. Hum Reprod 2006; 21: 2257-2265.
52. Glintborg D, Henriksen JE, Andersen M etal. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004; 82: 1570-1579.
53. Lee H, Oh JY, Sung YA, Chung H, Cho WY. The prevalence and risk factors for glucose intolerance in young Korean women with polycystic ovary syndrome. Endocrine 2009; 36: 326-332.
54. Baglietto L, English DR, Hopper JL etal. Circulating steroid hormone concentrations in postmenopausal women in relation to body size and composition. Breast Cancer Res Treat 2009; 115: 171-179.
55. Pasquali R, Vicennati V, Bertazzo D etal. Determinants of sex hormone-binding globulin blood concentrations in premenopausal and postmenopausal women with different estrogen status. Virgilio-Menopause-Health Group. Metabolism 1997; 46: 5-9.
56. Plymate SR, Matej LA, Jones RE, Friedl KE. Inhibition of sex hormone-binding globulin production in the human hepatoma (Hep G2) cell line by insulin and prolactin. J Clin Endocrinol Metab 1988; 67: 460-464.
57. Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 2006; 113: 1148-1159.
58. Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord 2002; 26: 883-896.
59. Crave JC, Lejeune H, Brebant C, Baret C, Pugeat M. Differential effects of insulin and insulin-like growth factor I on the production of plasma steroid-binding globulins by human hepatoblastoma-derived (Hep G2) cells. J Clin Endocrinol Metab 1995; 80: 1283-1289.
60. Selva DM, Hogeveen KN, Innis SM, Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone-binding globulin gene. J Clin Invest 2007; 117: 3979-3987.
61. Tosi F, Negri C, Brun E etal. Insulin enhances ACTH-stimulated androgen and glucocorticoid metabolism in hyperandrogenic women. Eur J Endocrinol 2011; 164: 197-203.
62. l'Allemand D, Penhoat A, Lebrethon MC etal. Insulin-like growth factors enhance steroidogenic enzyme and corticotropin receptor messenger ribonucleic acid levels and corticotropin steroidogenic responsiveness in cultured human adrenocortical cells. J Clin Endocrinol Metab 1996; 81: 3892-3897.
63. Poretsky L, Cataldo NA, Rosenwaks Z, Giudice LC. The insulin-related ovarian regulatory system in health and disease. Endocr Rev 1999; 20: 535-582.
64. Willis D, Mason H, Gilling-Smith C, Franks S. Modulation by insulin of follicle-stimulating hormone and luteinizing hormone actions in human granulosa cells of normal and polycystic ovaries. J Clin Endocrinol Metab 1996; 81: 302-309.
65. Azziz R. Reproductive endocrinologic alterations in female asymptomatic obesity. Fertil Steril 1989; 52: 703-725.
66. Marsden PJ, Murdoch AP, Taylor R. Tissue insulin sensitivity and body weight in polycystic ovary syndrome. Clin Endocrinol (Oxf) 2001; 55: 191-199.
67. Hahn S, Tan S, Sack S etal. Prevalence of the metabolic syndrome in German women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2007; 115: 130-135.
68. Goverde AJ, van Koert AJB, Eijkemans MJ etal. Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod 2009; 24: 710-717.
69. Ferrannini E, Natali A, Bell P, Cavallo-Perin P, Lalic N, Mingrone G. Insulin resistance and hypersecretion in obesity. European Group for the Study of Insulin Resistance (EGIR). J Clin Invest 1997; 100: 1166-1173.
70. Kahn SE, Prigeon RL, Schwartz RS etal. Obesity, body fat distribution, insulin sensitivity and Islet beta-cell function as explanations for metabolic diversity. J Nutr 2001; 131: 354S-360S.
71. Dunaif A, Xia J, Book CB, Schenker E, Tang Z. Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle. A potential mechanism for insulin resistance in the polycystic ovary syndrome. J Clin Invest 1995; 96: 801-810.
72. Corbould A, Kim YB, Youngren JF etal. Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. Am J Physiol Endocrinol Metab 2005; 288: E1047-E1054.
73. Buffington CK, Kitabchi AE. Evidence for a defect in insulin metabolism in hyperandrogenic women with polycystic ovarian syndrome. Metabolism 1994; 43: 1367-1372.
74. Morin-Papunen LC, Vauhkonen I, Koivunen RM, Ruokonen A, Tapanainen JS. Insulin sensitivity, insulin secretion, and metabolic and hormonal parameters in healthy women and women with polycystic ovarian syndrome. Hum Reprod 2000; 15: 1266-1274.
75. Morales AJ, Laughlin GA, Butzow T, Maheshwari H, Baumann G, Yen SSC. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Metab 1996; 81: 2854-2864.
76. Cupisti S, Kajaia N, Dittrich R, Duezenli H, Beckmann MW, Mueller A. Body mass index and ovarian function are associated with endocrine and metabolic abnormalities in women with hyperandrogenic syndrome. Eur J Endocrinol 2008; 158: 711-719.
77. Buyalos RP, Pekonen F, Halme JK, Judd HL, Rutanen EM. The relationship between circulating androgens, obesity, and hyperinsulinemia on serum insulin-like growth factor binding protein-1 in the polycystic ovarian syndrome. Am J Obstet Gynecol 1995; 172: 932-939.
78. Ferris WF, Crowther NJ. Once fat was fat and that was that: our changing perspectives on adipose tissue. Cardiovasc J Afr 2011; 22: 147-154.
79. Hotamisligil GS, Peraldi P, Budavari A, Ellis R, White MF, Spiegelman BM. IRS-1-mediated inhibition of insulin receptor tyrosine kinase activity in TNF-alpha- and obesity-induced insulin resistance. Science 1996; 271: 665-668.
80. Mitrou P, Lambadiari V, Maratou E etal. Skeletal muscle insulin resistance in morbid obesity: the role of interleukin-6 and leptin. Exp Clin Endocrinol Diabetes 2011; 119: 484-489.
81. Bastard JP, Maachi M, Lagathu C etal. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 2006; 17: 4-12.
82. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989; 38: 1165-1174.
83. Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992; 41: 1257-1266.
84. Dunaif A, Finegood DT. Beta-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome. J Clin Endocrinol Metab 1996; 81: 942-947.
85. Attaoua R, Ait El Mkadem S, Radian S etal. FTO gene associates to metabolic syndrome in women with polycystic ovary syndrome. Biochem Biophys Res Commun 2008; 373: 230-234.
86. Weyer C, Tataranni PA, Bogardus C, Pratley RE. Insulin resistance and insulin secretory dysfunction are independent predictors of worsening of glucose tolerance during each stage of type 2 diabetes development. Diabetes Care 2001; 24: 89-94.
87. Lundgren H, Bengtsson C, Blohme G, Lapidus L, Waldenstrom J. Fasting serum insulin concentration and early insulin response as risk determinants for developing diabetes. Diabet Med 1990; 7: 407-413.
88. Haffner SM, Stern MP, Mitchell BD, Hazuda HP, Patterson JK. Incidence of type II diabetes in Mexican Americans predicted by fasting insulin and glucose levels, obesity, and body-fat distribution. Diabetes 1990; 39: 283-288.
89. Lillioja S, Mott DM, Spraul M etal. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N Engl J Med 1993; 329: 1988-1992.
90. Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril 2011; 95: 1073-1079.
91. Rosenzweig JL, Ferrannini E, Grundy SM etal. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: 3671-3689.
92. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001; 111: 607-613.
93. Demirel F, Bideci A, Cinaz P etal. Serum leptin, oxidized low density lipoprotein and plasma asymmetric dimethylarginine levels and their relationship with dyslipidaemia in adolescent girls with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2007; 67: 129-134.
94. Erel CT, Senturk LM, Kaleli S, Gezer A, Baysal B, Tasan E. Is serum leptin level regulated by thyroid functions, lipid metabolism and insulin resistance in polycystic ovary syndrome? Gynecol Endocrinol 2003; 17: 223-229.
95. Ashton WD, Nanchahal K, Wood DA. Body mass index and metabolic risk factors for coronary heart disease in women. Eur Heart J 2001; 22: 46-55.
96. Robins SJ, Lyass A, Zachariah JP, Massaro JM, Vasan RS. Insulin resistance and the relationship of a dyslipidemia to coronary heart disease: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2011; 31: 1208-1214.
97. Robinson S, Henderson AD, Gelding SV etal. Dyslipidaemia is associated with insulin resistance in women with polycystic ovaries. Clin Endocrinol (Oxf) 1996; 44: 277-284.
98. Slowinska-Srzednicka J, Zgliczynski S, Wierzbicki M etal. The role of hyperinsulinemia in the development of lipid disturbances in nonobese and obese women with the polycystic ovary syndrome. J Endocrinol Invest 1991; 14: 569-575.
99. Castelo-Branco C, Steinvarcel F, Osorio A, Ros C, Balasch J. Atherogenic metabolic profile in PCOS patients: role of obesity and hyperandrogenism. Gynecol Endocrinol 2010; 26: 736-742.
100. Essah PA, Nestler JE, Carmina E. Differences in dyslipidemia between American and Italian women with polycystic ovary syndrome. J Endocrinol Invest 2008; 31: 35-41.
101. Carmina E, Bucchieri S, Mansueto P, Rini G, Ferin M, Lobo RA. Circulating levels of adipose products and differences in fat distribution in the ovulatory and anovulatory phenotypes of polycystic ovary syndrome. Fertil Steril 2009; 91 (4 Suppl.): 1332-1335.
102. Cosar E, Ucok K, Akgun L etal. Body fat composition and distribution in women with polycystic ovary syndrome. Gynecol Endocrinol 2008; 24: 428-432.
103. Strowitzki T, Halser B, Demant T. Body fat distribution, insulin sensitivity, ovarian dysfunction and serum lipoproteins in patients with polycystic ovary syndrome. Gynecol Endocrinol 2002; 16: 45-51.
104. Godoy-Matos AF, Vaisman F, Pedrosa AP, Farias MLF, Mendonca LMC, Pinheiro MFMC. Central-to-peripheral fat ratio, but not peripheral body fat, is related to insulin resistance and androgen markers in polycystic ovary syndrome. Gynecol Endocrinol 2009; 25: 793-798.
105. Svendsen PF, Nilas L, Norgaard K, Jensen JEB, Madsbad S. Obesity, body composition and metabolic disturbances in polycystic ovary syndrome. Hum Reprod 2008; 23: 2113-2121.
106. Karabulut A, Yaylali GF, Demirlenk S, Sevket O, Acun A. Evaluation of body fat distribution in PCOS and its association with carotid atherosclerosis and insulin resistance. Gynecol Endocrinol 2012; 28: 111-114.
107. Barber TM, Golding SJ, Alvey C etal. Global adiposity rather than abnormal regional fat distribution characterizes women with polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93: 999-1004.
108. Faloia E, Canibus P, Gatti C etal. Body composition, fat distribution and metabolic characteristics in lean and obese women with polycystic ovary syndrome. J Endocrinol Invest 2004; 27: 424-429.
109. Lord J, Thomas R, Fox B, Acharya U, Wilkin T. The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome. BJOG 2006; 113: 1203-1209.
110. Penaforte FRO, Japur CC, Diez-Garcia RW, Chiarello PG. Upper trunk fat assessment and its relationship with metabolic and biochemical variables and body fat in polycystic ovary syndrome. J Hum Nutr Diet 2010; 24: 39-46.
111. Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and visceral fat in midlife women: the Study of Women's Health Across the Nation (SWAN) fat patterning study. Obesity (Silver Spring) 2010; 18: 604-610.
112. Sinha A, Formica C, Tsalamandris C etal. Effects of insulin on body composition in patients with insulin-dependent and non-insulin-dependent diabetes. Diabet Med 1996; 13: 40-46.
113. Jean Hailes Foundation for Women's Health. Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Melbourne: Jean Hailes Foundation for Women's Health on behalf of the PCOS Australian Alliance, 2011.
114. Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011; (2): CD007506.
115. Thomson RL, Buckley JD, Lim SS etal. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil Steril 2010; 94: 1812-1816.
116. Holte J, Bergh T, Berne C, Wide L, Lithell H. Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 1995; 80: 2586-2593.
117. Jakubowicz DJ, Nestler JE. 17alpha-hydroxyprogesterone responses to leuprolide and serum androgens in obese women with and without polycystic ovary syndrome after dietary weight loss. J Clin Endocrinol Metab 1997; 82: 556-560.
118. Moran LJ, Noakes M, Clifton PM, Tomlinson L, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88: 812-819.
119. Moran LJ, Noakes M, Clifton PM, Wittert GA, Williams G, Norman RJ. Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome. Am J Clin Nutr 2006; 84: 77-87.
120. Kiddy DS, Hamilton-Fairley D, Bush A etal. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992; 36: 105-111.
121. Tolino A, Gambardella V, Caccavale C etal. Evaluation of ovarian functionality after a dietary treatment in obese women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2005; 119: 87-93.
122. Knowler WC, Barrett-Connor E, Fowler SE etal. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.
123. Sheehan TJ, DuBrava S, DeChello LM, Fang Z. Rates of weight change for black and white Americans over a twenty year period. Int J Obes Relat Metab Disord 2003; 27: 498-504.
124. Adali E, Yildizhan R, Kurdoglu M, Bugdayci G, Kolusari A, Sahin HG. Increased plasma thrombin-activatable fibrinolysis inhibitor levels in young obese women with polycystic ovary syndrome. Fertil Steril 2010; 94: 666-672.
125. Barcellos CRG, Rocha MP, Hayashida SAY, Mion Jr D, Lage SG, Marcondes JAM. Impact of body mass index on blood pressure levels in patients with polycystic ovary syndrome. Arq Bras Endocrinol Metabol 2007; 51: 1104-1109.
126. Cheung LP, Ma RCW, Lam PM et al. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Human Reprod 2008; 23: 1431-1438.
127. Ciampelli M, Guido M, Cucinelli F, Cinque B, Barini A, Lanzone A. Hypothalamic-pituitary-adrenal axis sensitivity to opioids in women with polycystic ovary syndrome. Fertil Steril 2000; 73: 712-717.
128. Ciampelli M, Muzj G, Leoni F et al. Metabolic and endocrine consequences of acute suppression of FFAs by acipimox in polycystic ovary syndrome. J Clin Endocrinol Metab 2001; 86: 5324-5329.
129. Ciampelli M, Leoni F, Lattanzi F, Guido M, Apa R, Lanzone A. A pilot study of the long-term effects of acipimox in polycystic ovarian syndrome. Human Reprod 2002; 17: 647-653.
130. Cupisti S, Dittrich R, Binder H, Beckmann MW, Mueller A. Evaluation of biochemical hyperandrogenemia and body mass index in women presenting with amenorrhea. Exp Clin Endocrinol Diabetes 2007a; 115: 298-302.
131. Cupisti S, Dittrich R, Binder H et al. Influence of body mass index on measured and calculated androgen parameters in adult women with Hirsutism and PCOS. Exp Clin Endocrinol Diabetes 2007b; 115: 380-386.
132. Economou F, Xyrafis X, Livadas S et al. In overweight/obese but not in normal-weight women, polycystic ovary syndrome is associated with elevated liver enzymes compared to controls. Hormones 2009; 8: 199-206.
133. Gennarelli G, Holte J, Stridsberg M, Niklasson F, Berne C, Backstrom T. The counterregulatory response to hypoglycaemia in women with the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1997; 46: 167-174.
134. Marcondes JA, Minanni SL, Luthold WW et al. The effects of spironolactone on testosterone fractions and sex-hormone binding globulin binding capacity in hirsute women. J Endocrinol Invest 1995; 18: 431-435.
135. Martinez-Guisasola J, Guerrero M, Alonso F, Diaz F, Cordero J, Ferrer J. Plasma beta-endorphin levels in obese and non-obese patients with polycystic ovary disease. Gynecol Endocrinol 2001; 15: 14-22.
136. Mozzanega B, Mioni R, Granzotto M et al. Obesity reduces the expression of GLUT4 in the endometrium of normoinsulinemic women affected by the polycystic ovary syndrome. Ann N Y Acad Sci 2004; 1034: 364-374.
137. Mukherjee S, Shaikh N, Khavale S et al. Genetic variation in exon 17 of INSR is associated with insulin resistance and hyperandrogenemia among lean Indian women with polycystic ovary syndrome. Eur J Endocrinol 2009; 160: 855-862.
138. Sharifi F, Hajihosseini R, Mazloomi S, Amirmogaddami H, Nazem H. Decreased adiponectin levels in polycystic ovary syndrome, independent of body mass index. Metab Syndr Relat Disord 2010; 8: 47-52.
139. Siddiqui IA, Tamimi W, Tamim H, Aleisa N, Adham M. A study on clinical and sonographic features in obese and nonobese patients with polycystic ovary syndrome. Arch Gynecol Obstet 2010; 281: 467-471.
140. Spranger J, Mohlig M, Wegewitz U et al. Adiponectin is independently associated with insulin sensitivity in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2004; 61:738-746.
141. Yildizhan R, Kurdoglu M, Adali E et al. Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Arch Gynecol Obstet 2009; 280: 559-563.