P324 - ECE_2476 - The impact of waist to height ratio in the assessment of women with polycystic ovary syndrome. Evidence from a large European cohort
TL;DR
It is suggested that WHtR captures a distinct aspect of PCOS pathophysiology as it integrates both metabolic and androgenic interaction in PCOS and emerges as a pragmatic anthropometric marker for early metabolic risk stratification in PCOS.
Abstract
Women suffering from PCOS display a variety of metabolic and hormonal abnormalities. Waist to height ratio (WHtR,), is considered as a valuable predictor of cardiovascular risk and central obesity. To assess the association of WHtR with metabolic/hormonal profile in PCOS. Data from 2201 PCOS women, mean age 25.0 years (21-29), BMI 24.7 kg/m2 (21.3-30.80) were analyzed. Participants were classified into three WHtR categories according to the established cut-offs (A: <0.50, B: 0.50-0.59, C: ≥0.60). Findings are presented before and after adjustment for age and BMI. A gradual statistically significant increase was observed among subgroups regarding HOMA-IR [A: 1.5 (0.9-2.3), B: 2.7 (1.6-4.0), C: 4.2 (2.6-6.3)] and the existence of impaired glucose tolerance (IGT) [A: 7.3%, B: 12.4%, C: 24.0%], (P for trend <.001). The relationship of HOMA-IR with WHtR remained statistically significant (P < .001) even after adjustment for age and BMI. These subgroups were also associated with a progressively adverse lipid profile, characterized by higher triglyceride [A: 78 (58-102), B: 89 (67-111), C: 96 (75-142)mg/dl] and LDL cholesterol levels [A: 108 (86-133), B: 114 (94-139), C: 118.0 (98-133)mg/dl] and lower HDL cholesterol concentrations [A: 51(43-61), B: 51 (42-57), C: 45 (40-54)mg/dl], with strong linear trends across WHtR strata. Notably, the associations with triglycerides and HDL cholesterol persisted after adjustment for age and BMI (P < .001). Considering, hormonal profile, subgroups based on WHtR categories were associated with a progressive increase in free androgen index (FAI) [A: 4.97 (3.07-7.66), B: 7.49 (4.54-11.11), C: 9.38 (6.00-13.90)] and the prevalence of hirsutism [A: 55.5%, B: 61.8%, C: 69.3%] (P for trend <.001). Total testosterone levels showed a modest, but significant increase across WHtR strata, whereas DHEAS, D4 and 17OP concentrations did not differ significantly. Gonadotropins exhibited an inverse association with WHtR, with lower LH and FSH levels observed in higher WHtR categories, while TSH showed only a weak trend. In multivariate analyses, sugbroups were strongly associated with increased FAI values in a graded manner, and these associations remained statistically significant after adjustment for age and BMI (P < .001). Multivariate analysis showed that WHtR constitutes a solid denominator of insulin resistance, dyslipidemia and hyperandrogenemia even after adjustment of age and BMI. These findings suggest that WHtR captures a distinct aspect of PCOS pathophysiology as it integrates both metabolic and androgenic interaction in PCOS and emerges as a pragmatic anthropometric marker for early metabolic risk stratification in PCOS.