CoChat
Sign Up
Cited by 939Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, Diet

Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis

Open access
Lim, S.S., Davies, M.J., Norman, R.J., Moran, L.J.·2012·Human Reproduction Update
DOI 10.1093/humupd/dms030
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND Polycystic ovary syndrome (PCOS) is closely associated with obesity but the prevalence of obesity varies between published studies. The objective of this research was to describe the prevalence of overweight, obesity and central obesity in women with and without PCOS and to assess the confounding effect of ethnicity, geographic regions and the diagnostic criteria of PCOS on the prevalence. METHODS MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and PSYCINFO were searched for studies reporting the prevalence of overweight, obesity or central obesity in women with and without PCOS. Data were presented as prevalence (%) and risk ratio (RR) [95% confidence interval (CI)]. Random-effect models were used to calculate pooled RR. RESULTS This systematic review included 106 studies while the meta-analysis included 35 studies (15129 women). Women with PCOS had increased prevalence of overweight [RR (95% CI): 1.95 (1.52, 2.50)], obesity [2.77 (1.88, 4.10)] and central obesity [1.73 (1.31, 2.30)] compared with women without PCOS. The Caucasian women with PCOS had a greater increase in obesity prevalence than the Asian women with PCOS compared with women without PCOS [10.79 (5.36, 21.70) versus 2.31 (1.33, 4.00), P < 0.001 between subgroups). CONCLUSIONS Women with PCOS had a greater risk of overweight, obesity and central obesity. Although our findings support a positive association between obesity and PCOS, our conclusions are limited by the significant heterogeneity between studies and further studies are now required to determine the source of this heterogeneity. Clinical management of PCOS should include the prevention and management of overweight and obesity.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/humupd/dms030

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 165

  1. Aas AM, Ohrvik J, Malmberg K, Ryden L, Birkeland KI. Insulin-induced weight gain and cardiovascular events in patients with type 2 diabetes. A report from the DIGAMI 2 study. Diab Obes Metab 2009;11:323-329.
  2. Adali E, Yildizhan R, Kurdoglu M, Kolusari A, Edirne T, Sahin HG, Yildizhan B, Kamaci M. The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome. J Int Med Res 2008;36:1188 -1196.
  3. 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.
  4. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome-a new worldwide definition. Lancet 2005;366:1059 -1062.
  5. Al-Ojaimi EH. Pregnancy outcomes after laparoscopic ovarian drilling in women with polycystic ovarian syndrome. Saudi Med J 2006;27:519 -525.
  6. Al-Ruhaily AD, Malabu UH, Sulimani RA. Hirsutism in Saudi females of reproductive age: a hospital-based study. Ann Saudi Med 2008;28:28-32.
  7. Altieri P, Gambineri A, Prontera O, Cionci G, Franchina M, Pasquali R. Maternal polycystic ovary syndrome may be associated with adverse pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2010;149:31-36.
  8. Alvarez-Blasco F, Botella-Carretero JI, San Millan JL, Escobar-Morreale HF. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Arch Intern Med 2006;166:2081 -2086.
  9. Alvarez Blasco F, Luque-Ramirez M, Escobar-Morreale HF. Diet composition and physical activity in overweight and obese premenopausal women with or without polycystic ovary syndrome. Gynecol Endocrinol 2011;27:978 -981.
  10. Amato MC, Galluzzo A, Finocchiaro S, Criscimanna A, Giordano C. The evaluation of metabolic parameters and insulin sensitivity for a more robust diagnosis of the polycystic ovary syndrome. Clin Endocrinol (Oxf) 2008;69:52-60.
  11. Anaforoglu I, Algun E, Incecayir O, Ersoy K. Higher metabolic risk with National Institutes of Health versus Rotterdam diagnostic criteria for polycystic ovarian syndrome in Turkish women. Metab Syndr Relat Disord 2011;9:375 -380.
  12. Ansarin H, Aziz-Jalali MH, Rasi A, Soltani-Arabshahi R. Clinical presentation and etiologic factors of hirsutism in premenopausal Iranian women. Arch Iran Med 2007;10:7 -13.
  13. 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.
  14. 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 2004b;89:2745 -2749.
  15. Azziz R, Marin C, Hoq L, Badamgarav E, Song P. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 2005;90:4650-4658.
  16. Baranowska B, Radzikowska M, Wasilewska-Dziubinska E, Kaplinski A, Roguski K, Plonowski A. Neuropeptide Y, leptin, galanin and insulin in women with polycystic ovary syndrome. Gynecol Endocrinol 1999;13:344 -351.
  17. Barcellos CRG, Rocha MP, Hayashida SAY, Mion D Jr, 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.
  18. 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.
  19. Bernasconi D, Del Monte P, Meozzi M, Randazzo M, Marugo A, Badaracco B, Marugo M. The impact of obesity on hormonal parameters in hirsute and nonhirsute women. Metabolism 1996;45:72 -75.
  20. Beydoun HA, Stadtmauer L, Beydoun MA, Russell H, Zhao Y, Oehninger S. Polycystic ovary syndrome, body mass index and outcomes of assisted reproductive technologies. Reprod Biomed Online 2009;18:856-863.
  21. 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.
  22. Buyalos RP, Geffner ME, Watanabe RM, Bergman RN, Gornbein JA, Judd HL. The influence of luteinizing hormone and insulin on sex steroids and sex hormone-binding globulin in the polycystic ovarian syndrome. Fertil Steril 1993; 60:626-633.
  23. 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.
  24. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996;45:633 -638.
  25. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992;167:1807 -1812.
  26. Carmina E, Chu MC, Longo RA, Rini GB, Lobo RA. Phenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters. J Clin Endocrinol Metab 2005;90:2545 -2549.
  27. Carmina E, Rosato F, Janni A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab 2006;91:2 -6.
  28. 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 2009a; 91:1332-1335.
  29. Carmina E, Guastella E, Longo RA, Rini GB, Lobo RA. Correlates of increased lean muscle mass in women with polycystic ovary syndrome. Eur J Endocrinol 2009b; 161:583 -589.
  30. 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.
  31. Cerda C, Perez-Ayuso RM, Riquelme A, Soza A, Villaseca P, Sir-Petermann T, Espinoza M, Pizarro M, Solis N, Miquel JF et al. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. J Hepatol 2007;47:412-417.
  32. Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, Suh CS, Kim SH, Kim JG, Moon SY. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 2008;23:1924-1931.
  33. Charnvises K, Weerakiet S, Tingthanatikul Y, Wansumrith S, Chanprasertyothin S, Rojanasakul A. Acanthosis nigricans: clinical predictor of abnormal glucose tolerance in Asian women with polycystic ovary syndrome. Gynecol Endocrinol 2005;21:161 -164.
  34. Chen MJ, Chiu HM, Chen CL, Yang WS, Yang YS, Ho HN. Hyperandrogenemia is independently associated with elevated alanine aminotransferase activity in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2010; 95:3332-3341.
  35. Cheung LP, Ma RCW, Lam PM, Lok IH, Haines CJ, So WY, Tong PCY, Cockram CS, Chow CC, Goggins WB. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod 2008; 23:1431-1438.
  36. Chhabra S, Venkatraman S. Menstrual dysfunction in rural young women and the presence of polycystic ovarian syndrome. J Obstet Gynaecol 2010;30:41-45.
  37. Ciampelli M, Fulghesu AM, Cucinelli F, Pavone V, Ronsisvalle E, Guido M, Caruso A, Lanzone A. Impact of insulin and body mass index on metabolic and endocrine variables in polycystic ovary syndrome. Metabolism 1999;48:167-172.
  38. 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.
  39. Ciampelli M, Muzj G, Leoni F, Romualdi D, Belosi C, Cento RM, Lanzone A. Metabolic and endocrine consequences of acute suppression of FFAs by acipimox in polycystic ovary syndrome. J Clin Endocrinol Metab 2001;86:5324 -5329.
  40. 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. Hum Reprod 2002; 17:647-653.
  41. Cosar E, Ucok K, Akgun L, Koken G, Sahin FK, Arioz DT, Bas O. Body fat composition and distribution in women with polycystic ovary syndrome. Gynecol Endocrinol 2008;24:428-432.
  42. 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.
  43. Cupisti S, Dittrich R, Binder H, Kajaia N, Hoffmann I, Maltaris T, Beckmann MW, Mueller A. 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.
  44. 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.
  45. 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.
  46. de Vries L, Karasik A, Landau Z, Phillip M, Kiviti S, Goldberg-Stern H. Endocrine effects of valproate in adolescent girls with epilepsy. Epilepsia 2007;48:470-477.
  47. Deeks AA, Gibson-Helm ME, Teede HJ. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertil Steril 2010;93:2421 -2423.
  48. Dewailly D, Contestin M, Gallo C, Catteau-Jonard S. Metabolic syndrome in young women with the polycystic ovary syndrome: revisiting the threshold for an abnormally decreased high-density lipoprotein cholesterol serum level. BJOG 2010;117:175-180.
  49. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI. 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.
  50. Dokras A, Bochner M, Hollinrake E, Markham S, VanVoorhis B, Jagasia DH. Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol 2005;106:131-137.
  51. Echiburu B, Perez-Bravo F, Maliqueo M, Sanchez F, Crisosto N, Sir-Petermann T. Polymorphism T -. C (-34 base pairs) of gene CYP17 promoter in women with polycystic ovary syndrome is associated with increased body weight and insulin resistance: a preliminary study. Metabolism 2008;57:1765 -1771.
  52. Economou F, Xyrafis X, Livadas S, Androulakis II, Argyrakopoulou G, Christakou CD, Kandaraki E, Palioura E, Diamanti-Kandarakis E. 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.
  53. Eden JA, Warren P. A review of 1019 consecutive cases of polycystic ovary syndrome demonstrated by ultrasound. Australas Radiol 1999;43:41-46.
  54. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-634.
  55. Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN, Aronoff S, Bernstein R, Bodenner D, Braithwaite S et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:48-53.
  56. Elsenbruch S, Benson S, Hahn S, Tan S, Mann K, Pleger K, Kimmig R, Janssen OE. Determinants of emotional distress in women with polycystic ovary syndrome. Hum Reprod 2006;21:1092-1099.
  57. Espinos-Gomez JJ, Corcoy R, Calaf J. Prevalence and predictors of abnormal glucose metabolism in Mediterranean women with polycystic ovary syndrome. Gynecol Endocrinol 2009;25:199 -204.
  58. 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.
  59. Farid ur R, Sohail I, Hayat Z, Niazi NA. Etiology of hirsutism. Is there a correlation between menstrual regularity, body mass index and severity of hirsutism with the cause? J Pak Assoc Dermatol 2010;20:4 -9.
  60. Ferk P, Teran N, Gersak K. The (TAAAA)n microsatellite polymorphism in the SHBG gene influences serum SHBG levels in women with polycystic ovary syndrome. Hum Reprod 2007;22:1031 -1036.
  61. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999 -2008. J Am Med Asso 2010;303:235 -241.
  62. Fox R. Prevalence of a positive family history of type 2 diabetes in women with polycystic ovarian disease. Gynecol Endocrinol 1999;13:390-393.
  63. Fulghesu AM, Cucinelli F, Pavone V, Murgia F, Guido M, Caruso A, Mancuso S, Lanzone A. Changes in luteinizing hormone and insulin secretion in polycystic ovarian syndrome. Hum Reprod 1999;14:611 -617.
  64. Gambarin-Gelwan M, Kinkhabwala SV, Schiano TD, Bodian C, Yeh H, Futterweit W. Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Clin Gastroenterol Hepatol 2007;5:496 -501.
  65. Gambineri A, Pelusi C, Manicardi E, Vicennati V, Cacciari M, Morselli-Labate AM, Pagotto U, Pasquali R. Glucose intolerance in a large cohort of Mediterranean women with polycystic ovary syndrome: phenotype and associated factors. Diabetes 2004;53:2353 -2358.
  66. 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.
  67. Gennarelli G, Holte J, Wide L, Berne C, Lithell H. Is there a role for leptin in the endocrine and metabolic aberrations of polycystic ovary syndrome? Hum Reprod 1998;13:535-541.
  68. Georgopoulos NA, Saltamavros AD, Vervita V, Karkoulias K, Adonakis G, Decavalas G, Kourounis G, Markou KB, Kyriazopoulou V. Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertil Steril 2009; 92:250-255.
  69. Glintborg D, Henriksen JE, Andersen M, Hagen C, Hangaard J, Rasmussen PE, Schousboe K, Hermann AP. 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.
  70. Glueck CJ, Wang P, Fontaine R, Tracy T, Sieve-Smith L. Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome (PCOS). J Adolescent Health 2001;29:160 -169.
  71. Glueck CJ, Iyengar S, Goldenberg N, Smith LS, Wang P. Idiopathic intracranial hypertension: Associations with coagulation disorders and polycystic-ovary syndrome. J Lab Clin Med 2003a;142:35 -45.
  72. Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism 2003b;52:908-915.
  73. Glueck CJ, Wang P, Bornovali S, Goldenberg N, Sieve L. Polycystic ovary syndrome, the G1691A factor V Leiden mutation, and plasminogen activator inhibitor activity: associations with recurrent pregnancy loss. Metabolism 2003c; 52:1627-1632.
  74. Glueck CJ, Goldenberg N, Wang P, Loftspring M, Sherman A. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Hum Reprod 2004;19:510-521.
  75. Glueck CJ, Aregawi D, Goldenberg N, Golnik KC, Sieve L, Wang P. Idiopathic intracranial hypertension, polycystic-ovary syndrome, and thrombophilia. J Lab Clin Med 2005a;145:72-82.
  76. Glueck CJ, Dharashivkar S, Wang P, Zhu B, Gartside PS, Tracy T, Sieve L. Obesity and extreme obesity, manifest by ages 20 -24 years, continuing through 32 -41 years in women, should alert physicians to the diagnostic likelihood of polycystic ovary syndrome as a reversible underlying endocrinopathy. Eur J Obstet Gynecol Reprod Biol 2005b;122:206 -212.
  77. Glueck CJ, Aregawi D, Winiarska M, Agloria M, Luo G, Sieve L, Wang P. Metformin-diet ameliorates coronary heart disease risk factors and facilitates resumption of regular menses in adolescents with polycystic ovary syndrome. J Pediatr Endocrinol 2006a;19:831 -842.
  78. Glueck CJ, Morrison JA, Friedman LA, Goldenberg N, Stroop DM, Wang P. Obesity, free testosterone, and cardiovascular risk factors in adolescents with polycystic ovary syndrome and regularly cycling adolescents. Metabolism 2006b; 55:508-514.
  79. Glueck CJ, Morrison JA, Wang P. Insulin resistance, obesity, hypofibrinolysis, hyperandrogenism, and coronary heart disease risk factors in 25 pre-perimenarchal girls age<¼14 years, 13 with precocious puberty, 23 with a first-degree relative with polycystic ovary syndrome. J Pediatr Endocr Met 2008a;21:973 -984.
  80. Glueck CJ, Pranikoff J, Aregawi D, Wang P. Prevention of gestational diabetes by metformin plus diet in patients with polycystic ovary syndrome. Fertil Steril 2008b;89:625-634.
  81. Glueck CJ, Morrison JA, Goldenberg N, Wang P. Coronary heart disease risk factors in adult premenopausal white women with polycystic ovary syndrome compared with a healthy female population. Metabolism 2009;58:714 -721.
  82. 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.
  83. Gul OB, Somunkiran A, Yucel O, Demirci F, Ozdemir I. The effect of ethinyl estradiol-cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome. Arch Gynecol Obstet 2008;277:25-30.
  84. Hahn S, Janssen OE, Tan S, Pleger K, Mann K, Schedlowski M, Kimmig R, Benson S, Balamitsa E, Elsenbruch S. Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome. Eur J Endocrinol 2005;153:853 -860.
  85. Hahn S, Frey UH, Siffert W, Tan S, Mann K, Janssen OE. The CC genotype of the GNAS T393C polymorphism is associated with obesity and insulin resistance in women with polycystic ovary syndrome. Eur J Endocrinol 2006;155:763 -770.
  86. Hahn S, Tan S, Sack S, Kimmig R, Quadbeck B, Mann K, Janssen OE. Prevalence of the metabolic syndrome in German women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2007;115:130 -135.
  87. Haq F, Aftab O, Rizvi J. Clinical, biochemical and ultrasonographic features of infertile women with polycystic ovarian syndrome. J Coll Physicians Surg Pak 2007;17:76 -80.
  88. Hashemipour M, Faghihimani S, Zolfaghary B, Hovsepian S, Ahmadi F, Haghighi S. Prevalence of polycystic ovary syndrome in girls aged 14 -18 years in Isfahan, Iran. Horm Res 2004;62:278-282.
  89. Hickey M, Doherty DA, Atkinson H, Sloboda DM, Franks S, Norman RJ, Hart R. Clinical, ultrasound and biochemical features of polycystic ovary syndrome in adolescents: implications for diagnosis. Hum Reprod 2011;26:1469 -1477.
  90. Hirschberg AL, Naessen S, Stridsberg M, Bystrom B, Holte J. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol 2004;19:79-87.
  91. 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.
  92. Homburg R, Orvieto R, Bar-Hava I, Ben-Rafael Z. Serum levels of insulin-like growth factor-1, IGF binding protein-1 and insulin and the response to human menopausal gonadotrophins in women with polycystic ovary syndrome. Hum Reprod 1996;11:716-719.
  93. Hsu MI, Liou TH, Chou SY, Chang CY, Hsu CS. Diagnostic criteria for polycystic ovary syndrome in Taiwanese Chinese women: comparison between Rotterdam 2003 and NIH 1990. Fertil Steril 2007;88:727 -729.
  94. Jahanfar S, Eden JA. Idiopathic hirsutism or polycystic ovary syndrome? Aust N Z J Obstet Gynaecol 1993;33:414 -416.
  95. 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 2010;18:604-610.
  96. Kiddy DS, Sharp PS, White DM, Scanlon MF, Mason HD, Bray CS, Polson DW, Reed MJ, Franks S. 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.
  97. Kirchengast S, Huber J. Body composition characteristics, sex hormone levels and circadian gonadotropin fluctuations in infertile young women. Coll Antropol 1999;23:407 -423.
  98. 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.
  99. Kraschnewski JL, Keyserling TC, Bangdiwala SI, Gizlice Z, Garcia BA, Johnston LF, Gustafson A, Petrovic L, Glasgow RE, Samuel-Hodge CD. Optimized probability sampling of study sites to improve generalizability in a multisite intervention trial. Prev Chronic Dis 2010;7:A10.
  100. Laitinen J, Taponen S, Martikainen H, Pouta A, Millwood I, Hartikainen AL, Ruokonen A, Sovio U, McCarthy MI, Franks S et al. Body size from birth to Obesity and central obesity in PCOS adulthood as a predictor of self-reported polycystic ovary syndrome symptoms. Int J Obes (Lond) 2003;27:710-715.
  101. Lam PM, Tam WH, Cheung LP. Higher metabolic risk in Chinese women fulfilling the NIH diagnostic criteria for polycystic ovarian syndrome. Fertil Steril 2009; 91:1493-1495.
  102. Langan D, Higgins JP, Gregory W, Sutton AJ. Graphical augmentations to the funnel plot assess the impact of additional evidence on a meta-analysis. J Clin Epidemiol 2012;65:511 -519.
  103. 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.
  104. Li Y, Yu Ng EH, Stener-Victorin E, Hou L, Wu T, Han F, Wu X. 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.
  105. Lim SS, Norman RJ, Clifton PM, Noakes M. Hyperandrogenemia, psychological distress, and food cravings in young women. Physiol Behav 2009;98:276-280.
  106. 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.
  107. 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.
  108. Luque-Ramirez M, Alvarez-Blasco F, Uriol Rivera MG, Escobar-Morreale HF. Serum uric acid concentration as non-classic cardiovascular risk factor in women with polycystic ovary syndrome: effect of treatment with ethinyl-estradiol plus cyproterone acetate versus metformin. Hum Reprod 2008;23:1594 -1601.
  109. 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.
  110. Marcondes JA, Minanni SL, Luthold WW, Lera ´rio AC, Nery M, Mendonc ¸a BB, Wajchenberg BL, Kirschner MA. The effects of spironolactone on testosterone fractions and sex-hormone binding globulin binding capacity in hirsute women. J Endocrinol Invest 1995;18:431 -435.
  111. Marcondes JAM, Hayashida SAY, Barcellos CRG, Rocha MP, Maciel GAR, Baracat EC. Metabolic syndrome in women with polycystic ovary syndrome: prevalence, characteristics and predictors. Arq Bras Endocrinol Metabol 2007; 51:972-979.
  112. Marsden PJ, Murdoch AP, Taylor R. Tissue insulin sensitivity and body weight in polycystic ovary syndrome. Clin Endocrinol (Oxf) 2001;55:191-199.
  113. 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.
  114. 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.
  115. 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.
  116. Mohlig M, Floter A, Spranger J, Weickert MO, Schill T, Schlosser HW, Brabant G, Pfeiffer AF, Selbig J, Schofl C. Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling. Diabetologia 2006;49:2572 -2579.
  117. Moran LJ, Noakes M, Clifton PM, Wittert GA, Tomlinson L, Galletly C, Luscombe ND, Norman RJ. Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. J Clin Endocrinol Metab 2004;89:3337 -3344.
  118. Moran LJ, Noakes M, Clifton PM, Wittert GA, Le Roux CW, Ghatei MA, Bloom SR, Norman RJ. Postprandial ghrelin, cholecystokinin, peptide YY, and appetite before and after weight loss in overweight women with and without polycystic ovary syndrome. Am J Clin Nutr 2007;86:1603-1610.
  119. Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 2009;92:1966 -1982.
  120. 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.
  121. Moran LJ, Cameron JD, Strauss BJ, Teede HJ. Vascular function in the diagnostic categories of polycystic ovary syndrome. Hum Reprod 2011a;26:2192 -2199.
  122. Mozzanega B, Mioni R, Granzotto M, Chiarelli S, Xamin N, Zuliani L, Sicolo N, Marchesoni D, Vettor R. 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.
  123. Mubarak MF, Arora S, Williams R. Laparoscopic ovarian drilling for women with anovulatory polycystic ovarian syndrome: a district general hospital experience. Gynecol Surg 2006;3:115-117.
  124. Mukherjee S, Shaikh N, Khavale S, Shinde G, Meherji P, Shah N, Maitra A. 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.
  125. Nacul AP, Andrade CD, Schwarz P, de Bittencourt PIH Jr, Spritzer PM. Nitric oxide and fibrinogen in polycystic ovary syndrome: associations with insulin resistance and obesity. Eur J Obstet Gynecol Reprod Biol 2007;133:191-196.
  126. National Cholesterol Education Program NH, Lung, and Blood Institute (NHLBI). Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). J Am Med Assoc 2001;285:2486 -2497.
  127. Ni RM, Mo Y, Chen X, Zhong J, Liu W, Yang D. Low prevalence of the metabolic syndrome but high occurrence of various metabolic disorders in Chinese women with polycystic ovary syndrome. Eur J Endocrinol 2009;161:411 -418.
  128. Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod 2001;16:1995 -1998.
  129. Pasquali R, Casimirri F, Cantobelli S, Morselli Labate AM, Venturoli S, Paradisi R, Zannarini L. Insulin and androgen relationships with abdominal body fat distribution in women with and without hyperandrogenism. Horm Res 1993; 39:179-187.
  130. Pasquali R, Casimirri F, Venturoli S, Antonio M, Morselli L, Reho S, Pezzoli A, Paradisi R. Body fat distribution has weight-independent effects on clinical, hormonal, and metabolic features of women with polycystic ovary syndrome. Metabolism 1994;43:706 -713.
  131. Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 2006;113:1148-1159.
  132. Patel AA, Bloomgarden ZT, Futterweit W. Premicroalbuminuria in women with polycystic ovary syndrome: A metabolic risk marker. Endocr Pract 2008; 14:193-200.
  133. Peppard HR, Marfori J, Iuorno MJ, Nestler JE. Prevalence of polycystic ovary syndrome among premenopausal women with type 2 diabetes. Diabet Care 2001;24:1050 -1052.
  134. 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.
  135. Reynolds K, Gu D, Whelton PK, Wu X, Duan X, Mo J, He J. Prevalence and risk factors of overweight and obesity in China. Obesity 2007;15:10-18.
  136. Rucker G, Schwarzer G, Carpenter J. Arcsine test for publication bias in meta-analyses with binary outcomes. Stat Med 2008;27:746 -763.
  137. Sahin Y, Kelestimur F. 17-Hydroxyprogesterone response to buserelin testing in the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1993;39:151 -155.
  138. San Millan JL, Alvarez-Blasco F, Luque-Ramirez M, Botella-Carretero JI, Escobar-Morreale HF. The PON1-108C/T polymorphism, and not the polycystic ovary syndrome, is an important determinant of reduced serum paraoxonase activity in premenopausal women. Hum Reprod 2006;21:3157-3161.
  139. Schwimmer JB, Khorram O, Chiu V, Schwimmer WB. Abnormal aminotransferase activity in women with polycystic ovary syndrome. Fertil Steril 2005;83:494-497.
  140. 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.
  141. Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A. Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril 2007;88:1389 -1395.
  142. 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.
  143. Silfen ME, Denburg MR, Manibo AM, Lobo RA, Jaffe R, Ferin M, Levine LS, Oberfield SE. Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. J Clin Endocrinol Metab 2003;88:4682-4688.
  144. Sinha A, Formica C, Tsalamandris C, Panagiotopoulos S, Hendrich E, DeLuise M, Seeman E, Jerums G. Effects of insulin on body composition in patients with insulin-dependent and non-insulin-dependent diabetes. Diabet Med 1996; 13:40-46.
  145. Spranger J, Mohlig M, Wegewitz U, Ristow M, Pfeiffer AFH, Schill T, Schlosser HW, Brabant G, Schofl C. Adiponectin is independently associated with insulin sensitivity in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2004; 61:738-746.
  146. 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.
  147. 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.
  148. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011;378:804-814.
  149. Targher G, Solagna E, Tosi F, Castello R, Spiazzi G, Zoppini G, Muggeo M, Day CP, Moghetti P. 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.
  150. Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol 2011;9:39.
  151. Telli MH, Yildirim M, Noyan V. Serum leptin levels in patients with polycystic ovary syndrome. Fertil Steril 2002;77:932 -935.
  152. Tirosh A, Shai I, Afek A, Dubnov-Raz G, Ayalon N, Gordon B, Derazne E, Tzur D, Shamis A, Vinker S et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. New Engl J Med 2011;364:1315 -1325.
  153. Tousignant B, Faraj M, Conus F, Garrel D, Brochu M, Rabasa-Lhoret R, Coderre L. Body fat distribution modulates insulin sensitivity in post-menopausal overweight and obese women: a MONET study. Int J Obes (Lond) 2008;32: 1626 -1632.
  154. Tropeano G, Liberale I, Vuolo IP, Barini A, Caroli G, Carfagna P, Menini E. Effects of ovary suppression by a long-acting GnRH-agonist on circulating GH, insulin-like growth factor I and insulin levels in women with polycystic ovary syndrome. J Endocrinol Invest 1997;20:220 -224.
  155. Upadhya K, Trent M. Effects of polycystic ovary syndrome on health-related quality of life. Expert Rev Pharmacoecon Outcomes Res 2007;7:597-603.
  156. Villaseca P, Hormaza P, Cardenas I, Oestreicher E, Arteaga E. Ethinylestradiol/ cyproterone acetate in polycystic ovary syndrome: lipid and carbohydrate changes. Eur J Contracept Reprod Health Care 2004;9:155-165.
  157. Villuendas G, Botella-Carretero JI, Roldan B, Sancho J, Escobar-Morreale HF, San Millan JL. Polymorphisms in the insulin receptor substrate-1 (IRS-1) gene and the insulin receptor substrate-2 (IRS-2) gene influence glucose homeostasis and body mass index in women with polycystic ovary syndrome and non-hyperandrogenic controls. Hum Reprod 2005;20:3184 -3191.
  158. Vrbikova J, Dvorakova K, Grimmichova T, Hill M, Stanicka S, Cibula D, Bendlova B, Starka L, Vondra K. Prevalence of insulin resistance and prediction of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovary syndrome. Clin Chem Lab Med 2007;45:639-644.
  159. Wang K, Zhao Y, Shi Y, Wang L, Chen ZJ. No association of the Arg51Gln and Leu72Met polymorphisms of the ghrelin gene and polycystic ovary syndrome. Hum Reprod 2009;24:485-490.
  160. Weerakiet S, Srisombut C, Bunnag P, Sangtong S, Chuangsoongnoen N, Rojanasakul A. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome. Int J Gynaecol Obstet 2001;75:177 -184.
  161. Weerakiet S, Bunnag P, Phakdeekitcharoen B, Wansumrith S, Chanprasertyothin S, Jultanmas R, Thakkinstian A. Prevalence of the metabolic syndrome in Asian women with polycystic ovary syndrome: using the International Diabetes Federation criteria. Gynecol Endocrinol 2007;23:153 -160.
  162. Wehr E, ller R, Horejsi R, Giuliani A, Kopera D, Schweighofer N, Groselj-Strele A, Pieber TR, Obermayer-Pietsch B. Subcutaneous adipose tissue topography and metabolic disturbances in polycystic ovary syndrome. Wien Klin Wochenschr 2009;121:262-269.
  163. Welt CK, Gudmundsson JA, Arason G, Adams J, Palsdottir H, Gudlaugsdottir G, Ingadottir G, Crowley WF. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab 2006;91:4842 -4848.
  164. Yildizhan R, Kurdoglu M, Adali E, Kolusari A, Yildizhan B, Sahin HG, Kamaci M. Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Arch Gynecol Obstet 2009;280:559-563.
  165. 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.

Cited by

Sorted by citations

Authors
Lim, S. S., Davies, M. J., Norman, R. J., & Moran, L. J.
Affiliations
The University of Adelaide (AU)
ORCID
Venue
Human Reproduction Update
Publisher
Oxford University Press (OUP)
Published
2012-07-04
Volume
18
Issue
6
Pages
618-637
ISSN
  • 1355-4786 (ISSN-L)
  • 1460-2369
DOI
10.1093/humupd/dms030
OpenAlex
W2112553362
Cited by
939
References
23
Citations by year
2026: 79 · 2025: 113 · 2024: 94 · 2023: 102 · 2022: 91 · 2021: 92 · 2020: 72 · 2019: 47 · 2018: 54 · 2017: 50 · 2016: 43 · 2015: 47 · 2014: 33 · 2013: 17 · 2012: 3
FWCI
4.34
Type
journal article
Language
en
Open access
Locations
  • Human Reproduction Update (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Own your potential (DEAKIN) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
polycystic ovary syndrome, obesity, overweight, abdominal obesity, prevalence, ethnicity, Asian women, white women, PCOS diagnostic criteria, confounding factors
MeSH terms
Adolescent, Adult, Age Factors, Female, Humans, Obesity, Polycystic Ovary Syndrome, Prevalence, Overweight, Obesity, Abdominal

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review