Insulin resistance in obesity and polycystic ovary syndrome: systematic review and meta-analysis of observational studies

Abstract

We aimed at investigating whether insulin resistance (IR)/sensitivity are impaired in obese/non-obese polycystic ovary syndrome (PCOS) and obese/non-obese healthy controls. A comprehensive literature search was performed for observational, English language studies. Meta-analysis was performed with the random effects model according to the heterogeneity. Eligible studies, involving 3037 women in four groups of: 1-obese, PCOS; 2-non-obese, PCOS, 3-obese, non-PCOS and 4-Non-obese, non-PCOS were included. Based on the insulin resistance index (HOMA-IR) analysis, the pooled mean (95% Conf. Interval) of HOMA IR in groups 1-4 were 4.38 (3.84, 4.92), 2.68 (2.16, 3.20), 2.44 (2.06, 2.82) and 1.34 (1.06, 1.63), respectively. Meta-analysis showed that group 1 (obese, PCOS patients) statistically have the highest IR and group 4 (non-obese, non-PCOS women) have the highest insulin sensitivity. Group 2 (non-obese, PCOS patients) and group 3 (obese, non-PCOS women) were between this range and they had lower IR than group 1 (obese, PCOS) and lower insulin sensitivity than group 4 (non-obese, non-PCOS). So, there were statistical differences between all groups except between groups 2 and 3. Insulin sensitivity indexes (quickie and ISI), also confirm the IR index (HOMA-IR) results. Based on different IR/sensitivity indexes, we found no evidence of any different effects of BMI ≥ 30 kg/m(2) on IR/sensitivity. In conclusion, PCOS status intensifies the adverse effects of obesity on IR, it has to be appropriately addressed in primary and secondary preventive cares and treatments provided for these women.

Association between uterine leiomyoma and metabolic syndrome in parous premenopausal women

“…First, IR has been proposed to underlie pathophysiologic pathways connecting obesity, diabetes, HTN, dyslipidemia, and atherosclerosis. [22] Second, insulin has been observed to promote mitosis, vascular smooth muscle proliferation (in rats), and the growth of UL cells in tissue culture. [23] Tyrosine kinases signaling pathways are signal transduction process of cell proliferation, differentiation, migration, metabolism, and programed cell apoptosis, contributing to normal cellular communication and maintenance of homeostasis.…”

Comorbidities and complications of polycystic ovary syndrome: An overview of systematic reviews

“…The study characteristics and PICO framework of the included systematic reviews are summarized in Table 1. The country of origin of the authors included China (n = 5), 18,26,30,35,36 USA (n = 4), 23,37-39 United Kingdom (UK) (n = 4), 27,[40][41][42] Australia (n = 4), 2,23,41,43 Iran (n = 4), 19,29,44,45 Greece (n = 2), 17,46 the Netherlands (n = 2), 11,42 Sweden (n = 1) 30 and Switzerland (n = 1). 47 N = 9 reviews included all study types.…”

“…47 N = 9 reviews included all study types. 2,18,27,38,40,[42][43][44]48 N = 5 reviews included observational studies only 11,17,19,41,46 ; n = 2 included cohort and case-control studies only 26,47 ; and n = 2 reviews explicitly included cross-sectional studies only. 37,49 N = 1 review included cohort, case-control or cross-sectional studies 45 and n = 1 included peer-reviewed primary articles.…”

“…14 However, those who do become pregnant are at an increased risk of pregnancy and foetal complications regardless of the mode of conception. 17,18 PCOS has metabolic implications including IR, 19 dyslipidaemia 20,21 and abnormal glucose metabolism. 22,23 Moreover, women with PCOS also show a propensity for excess weight gain which exacerbates these symptoms.…”

The risk of metabolic syndrome in polycystic ovary syndrome: A systematic review and meta‐analysis

“…The dysmetabolic aspect of PCOS has gained more attention in recent decades. Several features of metabolic disturbances, insulin resistance and hyperinsulinaemia particularly have been observed in most women with PCOS . Therefore, obesity and visceral obesity are very common among women with PCOS, which is associated with metabolic syndrome (MetS) .…”