Adipose Tissue Has Aberrant Morphology and Function in PCOS: Enlarged Adipocytes and Low Serum Adiponectin, but Not Circulating Sex Steroids, Are Strongly Associated with Insulin Resistance
Abstract
CONTEXT: Comprehensive characterization of the adipose tissue in women with polycystic ovary syndrome (PCOS), over a wide range of body mass indices (BMIs), is lacking. Mechanisms behind insulin resistance in PCOS are unclear. OBJECTIVE: To characterize the adipose tissue of women with PCOS and controls matched pair-wise for age and BMI, and to identify factors, among adipose tissue characteristics and serum sex steroids, that are associated with insulin sensitivity in PCOS. DESIGN/OUTCOME MEASURES: Seventy-four PCOS women and 31 controls were included. BMI was 18-47 (PCOS) and 19-41 kg/m(2) (controls). Anthropometric variables, volumes of subcutaneous/visceral adipose tissue (magnetic resonance imaging; MRI), and insulin sensitivity (clamp) were investigated. Adipose tissue biopsies were obtained to determine adipocyte size, lipoprotein lipase (LPL) activity, and macrophage density. Circulating testosterone, free testosterone, free 17β-estradiol, SHBG, glycerol, adiponectin, and serum amyloid A were measured/calculated. RESULTS: Comparison of 31 pairs revealed lower insulin sensitivity, hyperandrogenemia, and higher free 17β-estradiol in PCOS. Abdominal adipose tissue volumes/distribution did not differ in the groups, but PCOS women had higher waist-to-hip ratio, enlarged adipocytes, reduced adiponectin, and lower LPL activity. In regression analysis, adipocyte size, adiponectin, and waist circumference were the factors most strongly associated with insulin sensitivity in PCOS (R(2)=0.681, P < 0.001). CONCLUSIONS: In PCOS, adipose tissue has aberrant morphology/function. Increased waist-to-hip ratio indicates abdominal/visceral fat accumulation, but this is not supported by MRI. Enlarged adipocytes and reduced serum adiponectin, together with a large waistline, rather than androgen excess, may be central factors in the pathogenesis/maintenance of insulin resistance in PCOS.
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In PCOS, hypertrophic adipocytes are associated with metabolic disorders.
“In PCOS, hypertrophic adipocytes are associated with metabolic disorders [37].”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [37]
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Coagulation and Fibrinolytic Disturbances in Women with Polycystic Ovary Syndrome
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Adipocyte biology in polycystic ovary syndrome
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Mitochondrial dysfunction: An emerging link in the pathophysiology of polycystic ovary syndrome
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Western-style diet, sex steroids and metabolism
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Androgens and the Regulation of Adiposity and Body Fat Distribution in Humans
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Puberty and its disorders in the female
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Metabolic Evidence of Diminished Lipid Oxidation in Women With Polycystic Ovary Syndrome
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Polycystic ovary syndrome as a plausible evolutionary outcome of metabolic adaptation
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- Authors
- Mannerås-Holm, L., Leonhardt, H., Kullberg, J., Jennische, E., Odén, A., Holm, G., Hellström, M., Lönn, L., Olivecrona, G., Stener-Victorin, E., & Lönn, M.
- Affiliations
- University of Gothenburg (SE)
- Sahlgrenska University Hospital (SE)
- Uppsala University Hospital (SE)
- Chalmers University of Technology (SE)
- Rigshospitalet (DK)
- Umeå University (SE)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2011-02
- Volume
- 96
- Issue
- 2
- Pages
- E304-E311
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2090371418
- Cited by
- 369
- References
- 49
- Citations by year
- 2026: 18 · 2025: 23 · 2024: 20 · 2023: 20 · 2022: 41 · 2021: 24 · 2020: 29 · 2019: 20 · 2018: 31 · 2017: 22 · 2016: 25 · 2015: 28 · 2014: 20 · 2013: 22 · 2012: 14
- FWCI
- 17.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Chalmers Publication Library (Chalmers University of Technology) (submittedVersion)
- Chalmers Research (Chalmers University of Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- polycystic ovary syndrome, insulin resistance, adipose tissue, adipocyte size, adiponectin, lipoprotein lipase, visceral adipose tissue, subcutaneous adipose tissue, waist-to-hip ratio, hyperandrogenemia, sex steroids, serum amyloid A, macrophage density, insulin sensitivity
- MeSH terms
- Adipose Tissue, Adult, Amyloid, Body Height, Body Weight, Female, Glycerol, Humans, Immunohistochemistry, Insulin Resistance, Lipoprotein Lipase, Macrophages, Polycystic Ovary Syndrome, Sex Hormone-Binding Globulin, Gonadal Steroid Hormones, Body Mass Index, Adipocytes, Cell Size, Waist-Hip Ratio, Adiponectin, Waist Circumference
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