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Hyperandrogenism tied to intra-abdominal fat in normal-weight PCOS
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In normal-weight women with polycystic ovary syndrome, hyperandrogenism is associated with intra-abdominal fat and increased number of small subcutaneous abdominal adipocytes, study data show.
The increased subcutaneous abdominal adipocytes may restrict subcutaneous adipose storage, which may lead to the promotion of metabolic dysfunction through lipotoxicity, according to the researchers.
Daniel A. Dumesic, MD, professor in the department of obstetrics and gynecology and division chief of reproductive endocrinology and infertility at the University of California, Los Angeles, and colleagues evaluated six normal-weight women with PCOS and 14 age- and BMI-matched ovulatory women with normal androgen levels (controls) to determine differences in adipose structure and function and their relation to hyperandrogenism and hyperinsulinemia.
Circulating hormone and metabolic measurements were collected for all participants, and frequently sampled intravenous glucose tolerance testing was conducted. Participants also had body DXA, abdominal MRI and a subcutaneous abdominal fat biopsy performed.
Despite similar fasting glucose levels between the two groups, fasting insulin levels were greater in the PCOS group compared with controls before the frequently sampled IV glucose test. Serum androgen levels were positively related to fasting serum levels in all participants.
The two groups had similar total body mass on DXA. The PCOS group had higher android fat mass and percent android fat relative to total body fat compared with controls. Circulating levels of total testosterone (P = .004), free testosterone (P = .005), androstenedione (P = .028) and fasting insulin (P = .035) were positively correlated with android fat mass in all participants.
The two groups had similar subcutaneous abdominal fat mass as shown by MRI. Intra-abdominal fat was greater in the PCOS group compared with controls (P = .03).
BMI and subcutaneous abdominal fat mass were positively correlated in both groups. Android fat mass, percent android fat mass, circulating levels of androgens, fasting insulin, log triglycerides, non-HDL and total cholesterol were all correlated with intra-abdominal fat mass.
The PCOS group demonstrated a significant shift toward smaller subcutaneous abdominal adipocytes compared with controls.
“The major clinical implication of our paper is that preferential abdominal fat deposition occurs in normal weight PCOS women and is detectable by state-of-the-art radiographic imaging, but not necessarily by physical examination,” Dumesic told Endocrine Today. “This type of ‘android fat’ distribution in young, normal-appearing PCOS women is positively linked through androgen excess with increased intra-abdominal fat mass and subtle changes in subcutaneous abdominal fat cells that could predispose to insulin resistance.” – by Amber Cox
For more information:
Daniel Dumesic, MD, can be reached at ddumesic@mednet.ucla.edu.
Disclosure: The researchers report no relevant financial disclosures.
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