The DOI matches its Crossref record; 66 of the 67 references it cites were found in a registry or an index; none of the 26 sources its claims cite is checked for support yet.
Prevalence of endocrine disorders in obese patients: systematic review and meta-analysis
Open accessAbstract
Objective: The increasing prevalence of obesity is expected to promote the demand for endocrine testing. To facilitate evidence guided testing, we aimed to assess the prevalence of endocrine disorders in patients with obesity. The review was carried out as part of the Endocrine Work-up for the Obesity Guideline of the European Society of Endocrinology. Design: Systematic review and meta-analysis of the literature. Methods: A search was performed in MEDLINE, EMBASE, Web of Science and COCHRANE Library for original articles assessing the prevalence of hypothyroidism, hypercortisolism, hypogonadism (males) or hyperandrogenism (females) in patients with obesity. Data were pooled in a random-effects logistic regression model and reported with 95% confidence intervals (95% CI). Results: Sixty-eight studies were included, concerning a total of 19.996 patients with obesity. The pooled prevalence of overt (newly diagnosed or already treated) and subclinical hypothyroidism was 14.0% (95% CI: 9.7–18.9) and 14.6% (95% CI: 9.2–20.9), respectively. Pooled prevalence of hypercortisolism was 0.9% (95% CI: 0.3–1.6). Pooled prevalence of hypogonadism when measuring total testosterone or free testosterone was 42.8% (95% CI: 37.6–48.0) and 32.7% (95% CI: 23.1–43.0), respectively. Heterogeneity was high for all analyses. Conclusions: The prevalence of endocrine disorders in patients with obesity is considerable, although the underlying mechanisms are complex. Given the cross-sectional design of the studies included, no formal distinction between endocrine causes and consequences of obesity could be made.
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31 Own result · 19 Not checked yet · 6 Own method · 3 Own interpretation
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mean BMI at the study level was not clearly related to the reported prevalence (P = 0.16)”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypogonadism
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, high prevalence numbers of subclinical hypothyroidism were reported in studies from India (21,39,40,41)”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [21]
- Not checked yetcites [39]
- Not checked yetcites [40]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies restricted to patients with T2DM did show a similar prevalence in a subgroup analysis (11 studies, prevalence 1.1%, 95% CI 0.3-2.1,I 2 70%).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypercortisolism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mean BMI at the study level was not clearly related to the reported prevalence (P = 0.69)”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypercortisolism
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence of overt hypothyroidism from a random-effects model was 14.0%, 95% CI 9.7-18.9%(19 studies, I 2 = 96%, P < 0.01).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies restricted to patients undergoing bariatric surgery showed a prevalence of 12.7%, 95% CI 10.1-15.1 (six studies, I 2 = 72%).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence of hypercortisolism from a random-effects model was 0.9%, 95% CI 0.3-1.6%(22 studies, I 2 = 79%, P < 0.01).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypercortisolism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies restricted to patients undergoing bariatric surgery showed a prevalence of 11.9%, 95% CI 7.4-17.3(five studies, I 2 = 83%).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, both studies using TT and studies using FT showed the same trend of increasing prevalence of hypogonadism with increasing BMI (Fig. 7).”
§ Prevalence of endocrine disorders in obese patients > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence of hypogonadism when FT was measured was 32.7%, 95% CI 23.1-43.0%(11 studies, I 2 = 96%, P < 0.01).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypogonadism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Six included studies in our review assessed hypogonadism by TT.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“BMI was not positively correlated with the prevalence of subclinical hypothyroidism in a metaregression (P = 0.50).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“in fact, two studies with a relatively low mean BMI (34 and 37 kg/m 2 respectively) reported high prevalences of 32.9 and 43.7%”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence of hypogonadism when TT was measured was 42.8%, 95% CI 37.6-48.0%(13 studies, I 2 = 89%, P < 0.01).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypogonadism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
In the paper
“Importantly, only one study met our biochemical pre-definition of hypogonadism, by using two separate measurements of testosterone (33).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [33]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence of subclinical hypothyroidism from a random-effects model was 14.6%, 95% CI 9.2-20.9%(19 studies, I 2 = 97%, P < 0.01).”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The reported prevalence in this study was 22.6%.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“BMI was not positively correlated with the prevalence of overt hypothyroidism in a meta-regression”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hypothyroidism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our literature search did not identify studies exclusively investigating prevalence of biochemical hyperandrogenism in women with obesity; only three studies investigating prevalence of PCOS were included.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All three studies used the presence of clinical and/or biochemical hyperandrogenism as an essential criterion for diagnosing PCOS, but we were unable to stratify results for biochemical hyperandrogenism only.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“This is in line with our review: prevalence of PCOS in obese women is almost similar to the general population of reproductiveaged women (9.1-25% vs 6-20%, dependent on which criteria are used to define PCOS) (7).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [7]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our literature search did not identify studies exclusively investigating prevalence of biochemical hyperandrogenism in women with obesity; only three studies investigating prevalence of PCOS were included.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Firstly, elevated leptin concentrations in obese men may inhibit the production of testosterone by Leydig cells (56).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [56]
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Insulin resistance can induce decreased sex-hormone-binding globulin (SHBG) production of the liver, which in turn leads to a larger amount of TT available for conversion to estradiol in fat tissue.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Importantly, treatment of hypothyroid patients with thyroxine until clinically euthyroid did not change BMI (47,48).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [47]
- Not checked yetcites [48]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The lower levels of adiponectin seen in obesity can also lead to increased hepatogenous glucose production and insulin resistance (58).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [58]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, given the cross-sectional design of the studies included, no formal distinction between endocrine causes and consequences of obesity could be made.”
§ Prevalence of endocrine disorders in obese patients > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All three studies defined PCOS as the presence of clinical and/or biochemical hyperandrogenism (measured by FT) and ovulatory dysfunction.”
§ Prevalence of endocrine disorders in obese patients > Risk of bias
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“This reverse relationship between obesity and hypothyroidism is further supported by the fact that several studies observed a significant decrease of TSH levels after weight loss resulting from bariatric surgery (10,14,16).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [10]
- Not checked yetcites [14]
- Not checked yetcites [16]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All three studies used the presence of clinical and/or biochemical hyperandrogenism as an essential criterion for diagnosing PCOS, but we were unable to stratify results for biochemical hyperandrogenism only.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Since day-to-day variations in serum testosterone concentrations can be large, it is important to confirm low testosterone concentrations with repeat measurement (6).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [6]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To conclude, the prevalence of endocrine disorders in patients with obesity is considerable, although the underlying mechanisms are complex.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“However, visceral fat mass quantified by imaging did not differ in women with PCOS compared with BMI-matched control women (70, 71).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [70]
- Not checked yetcites [71]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 20
- Probably not a substantial claim. 10
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In our review though, imaging was negative in none of the obese patients with proven hypercortisolism (although two patients refused further investigation of the source of hypercortisolism); they were all diagnosed with a pituitary or adrenal source of hypercortisolism.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twenty-seven studies concerning (subclinical) hypothyroidism were included, published between 1987 and 2018.A total of 7446 patients with obesity were included, of whom at least 1288 males and 5256 females (3 studies did not differentiate gender).”
§ Prevalence of endocrine disorders in obese patients > Study characteristics
plainn = 7,446- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It should be noted that the male-to-female ratio in our review is 1:4”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eighteen included studies, published from 1994 to 2016, reported on prevalence of male hypogonadism (Supplementary data 4).They comprised a total of 4546 obese male patients, with a mean age ranging from 27.9 to 61.9 years.Mean BMI ranged from 24.8 to 50.3 kg/m 2 .”
§ Prevalence of endocrine disorders in obese patients > Study characteristics
plainn = 4,546- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 22 study groups contained a total of 5819 patients: 1888 males and 3931 females, with a mean age ranging from 37.8 to 60.9 years.Mean BMI ranged from 29.8 to 51.5 kg/m 2 .”
§ Prevalence of endocrine disorders in obese patients > Study characteristics
plainn = 5,819- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All three included studies concerning hyperandrogenism investigated prevalence of polycystic ovary syndrome (PCOS) in a total of 2185 premenopausal obese women”
- Also stated in: § Study characteristics · plain
“with a reported mean age of 37 years (Supplementary data 5).Mean BMI was not reported.Studies were published from 2006 to 2015.”
§ Prevalence of endocrine disorders in obese patients > Study characteristics
plainn = 2,185- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Also stated in: § Study characteristics · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies reported cut-off levels for TT but none reported exact values of low TT levels.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, a total of 68 studies were included in the present analysis.”
§ Prevalence of endocrine disorders in obese patients > Study selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, the reported prevalence numbers in our review differed considerably and ranged from 0 to 58.3% (subclinical hypothyroidism) and 1.7-43.7%(overt hypothyroidism).”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixty-two articles (91%) studied a BMI defined population, 6 (9%) studied a WC defined population.”
§ Prevalence of endocrine disorders in obese patients > Study selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although heterogeneity was high for all analyses, subgroup analyses and meta-regression did not reveal clear sources of heterogeneity.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prevalence of PCOS ranged from 9.1 to 25%, and no pooled proportion was estimated given the low number of studies.”
§ Prevalence of endocrine disorders in obese patients > Prevalence of hyperandrogenism
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For eligible studies, data were independently extracted by two reviewers (L T v H and O D). Disagreements between reviewers were resolved by consensus.”
§ Prevalence of endocrine disorders in obese patients > Data extraction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Lastly, it should be noted that patients treated with levothyroxine were classified as having hypothyroidism.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Secondly, aromatase cytochrome P450 in adipocytes increases the conversion of testosterone to estradiol.The higher levels of estradiol cause augmentation of estrogen receptor beta expression, which downregulates glucose transporter (GLUT) 4 and therefore induce insulin resistance (57).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [57]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“All but one (33) included studies performed only one measurement of testosterone and were therefore considered at higher risk of bias.”
§ Prevalence of endocrine disorders in obese patients > Risk of bias
What the sources say
- Not checked yetcites [33]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“where it is reported that a high prevalence of endemic goiter persists despite the implementation of iodized salt (42).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [42]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All studies included unselected obese premenopausal female patients with adequate assessment of exposure; obesity was defined by BMI.”
§ Prevalence of endocrine disorders in obese patients > Risk of bias
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“It is important to consider that hypogonadism can be the cause but also the consequence of obesity (6).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [6]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The HIM (Hypogonadism in Males) study previously reported a prevalence of hypogonadism of 38.7% of men aged ≥45 years presenting to primary care offices in the United States (54), with an increased risk in men with obesity (odds ratio 2.38).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [54]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“the prevalence of thyroid disorders is known to be higher in females (4).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [4]
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The negative correlation between testosterone and BMI in men is well established and low testosterone levels promote accumulation of total and visceral fat mass (55).”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [55]
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Risk of bias assessment was based on design elements that potentially bias an association between the exposed population under study (patients with obesity) and the outcome (endocrine disorders) (3):”
§ Prevalence of endocrine disorders in obese patients > Risk of bias assessment
What the sources say
- Not checked yetcites [3]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whereas the prevalence of hypercortisolism was low (<1%), the prevalence of hypothyroidism and hypogonadism was considerable.”
§ Prevalence of endocrine disorders in obese patients > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“All included studies used ≥2 of the biochemical tests for assessment of hypercortisolism as recommended by the Endocrine Society Guideline (5), and if positive, followed by imaging studies to determine the source of hypercortisolism.”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [5]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The pooled prevalence of subclinical hypothyroidism and overt (newly diagnosed or already treated) hypothyroidism in obesity were 14.6 and 14.0%, respectively.These numbers are clearly higher than numbers in the general population, where prevalence numbers of 4.3 and 0.3% are reported for respectively subclinical hypothyroidism and overt hypothyroidism in America, and of 3.8 and 0.4% in Europe (37”
§ Prevalence of endocrine disorders in obese patients > Discussion
What the sources say
- Not checked yetcites [37]
- Not checked yetcites [38]
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
Obesity and the endocrine disorders considered share many clinical characteristics, so the value of biochemical testing in obese patients is unclear.
“However, obesity and above mentioned endocrine disorders share many clinical characteristics and therefore the precise merits of biochemical testing for endocrine disorders in obese patients remain unclear.”
The paper relies on this without support.
Detailed knowledge of the prevalence of endocrine conditions in obesity is necessary for evidence-guided testing.
“For evidenceguided testing, detailed knowledge of the prevalence of endocrine conditions in obesity is a prerequisite.”
The authors state this as an assumption.
The choice of endocrine tests and cut-off values used in the included articles is acceptable for defining endocrine disorders.
“We relied on the choice of endocrine tests as presented in included articles and the definition of a positive test was based on cut-off values provided in included articles.”
The paper relies on this without support.
The increasing prevalence of obesity will increase demand for endocrine testing.
“The increasing prevalence of obesity is expected to promote the demand for endocrine testing.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The rising worldwide prevalence of obesity is of concern in this context, because 14% of obese patients have subclinical hypothyroidism, often without thyroid antibodies [58–60].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [60]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Serum TSH is significantly higher in obese patients than in normal weight controls; subclinical hypothyroidism is recorded in 13.7% of obese patients, but thyroid autoimmunity is not a major cause [58–60].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [60]
Experimental — accuracy not yet measured
Citations
Cites
Yaşlı Kadınlarda Üreme Sağlığı
Kokanalı, D., & Engin Üstün, Y. (n.d.) · DergiPark (Istanbul University) · Cited by 170,090
Hollowell, J. G., Staehling, N. W., Flanders, W. D., Hannon, W. H., Gunter, E. W., Spencer, C. A., & Braverman, L. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.87.2.489 · Cited by 4,279
Type 2 diabetes as an inflammatory disease
Donath, M. Y., & Shoelson, S. E. (2011) · Nature Reviews Immunology · doi:10.1038/nri2925 · Cited by 3,737
European Guidelines for Obesity Management in Adults
Yumuk, V., Tsigos, C., Fried, M., Schindler, K., Busetto, L., Micic, D., & Toplak, H. (2015) · Obesity Facts · doi:10.1159/000442721 · Cited by 3,432
Self-citationThe diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718
Metaprop: a Stata command to perform meta-analysis of binomial data
Nyaga, V. N., Arbyn, M., & Aerts, M. (2014) · Archives of Public Health · doi:10.1186/2049-3258-72-39 · Cited by 2,139
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
(2020) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr · Cited by 2,095
Ehrmann, D. A. (2005) · New England Journal of Medicine · doi:10.1056/nejmra041536 · Cited by 1,920
Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., Nadolsky, K., Pessah-Pollack, R., & Plodkowski, R. (2016) · Endocrine Practice · doi:10.4158/ep161365.gl · Cited by 1,914
Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.
Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-00229 · Cited by 1,736
Research works printed but not linked: 4
- Duntas L, Hauner H, Rosenthal J & Pfeiffer EF. Thyrotropin releasing hormone (TRH) immunoreactivity and thyroid function in obesity. International Journal of Obesity 1991 15 83-87.
- Eds A Pinchera, SH Ingbar, JM McKenzie & GF Fenzi. Boston, MA: Springer, 1987.
- Gupta H, Sheth SP & Vaishnav B. Association of subclinical hypothyroidism with metabolic syndrome: a cross-sectional study from Western India. Asian Journal of Pharmaceutical and Clinical Research 2016 9 265-269.
- Verma A, Jayaraman M, Kumar HKVS & Modi KD. Hypothyroidism and obesity, cause of effect? Saudi Medical Journal 2008 29 1135-1138.
Cited by
Sorted by citations
Salonia, A., Bettocchi, C., Boeri, L., Capogrosso, P., Carvalho, J., Çilesiz, N. C., Cocci, A., Corona, G., Dimitropoulos, K., Gül, M., et al. (2021) · European Urology · doi:10.1016/j.eururo.2021.06.007 · Cited by 858
“Since obesity is frequently associated with hypogonadism (mostly functional) [31,32], determination of body mass index (BMI) and measurement of waist circumference are strongly recommended in all individuals.”
BackgroundEuropean Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity
Pasquali, R., Casanueva, F., Haluzik, M., van Hulsteijn, L., Ledoux, S., Monteiro, M. P., Salvador, J., Santini, F., Toplak, H., & Dekkers, O. M. (2020) · European Journal of Endocrinology · doi:10.1530/eje-19-0893 · Cited by 188
Self-citationSubclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review
Biondi, B. (2023) · Nutrients · doi:10.3390/nu16010087 · Cited by 122
“[26].”
Obesity, type 2 diabetes, and testosterone in ageing men
Wittert, G., & Grossmann, M. (2022) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-022-09746-5 · Cited by 89
“SHBG is synthesised in hepatocytes of the liver A variable serum SHBG concentration is a source of the marked heterogeneity of serum testosterone concentrations among men with obesity [7].”
BackgroundSanti, D., Lotti, F., Sparano, C., Rastrelli, G., Isidori, A. M., Pivonello, R., Barbonetti, A., Salonia, A., Minhas, S., Krausz, C. G., et al. (2023) · Andrology · doi:10.1111/andr.13460 · Cited by 73
Metadata
- Authors
- van Hulsteijn, L. T., Pasquali, R., Casanueva, F., Haluzik, M., Ledoux, S., Monteiro, M. P., Salvador, J., Santini, F., Toplak, H., & Dekkers, O. M.
- Affiliations
- 1Department of Clinical Endocrinology and Metabolism, University Medical Centre Groningen, Groningen, The Netherlands
- University of Bologna (IT)
- Complejo Hospitalario Universitario de Santiago (ES)
- 4Diabetes Centre and Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine and Institute of Endocrinology, Prague, Czech Republic
- Hôpital Louis-Mourier (FR)
- Universidade do Porto (PT)
- Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES)
- Azienda Ospedaliera Universitaria Pisana (IT)
- Medical University of Graz (AT)
- Leiden University Medical Center (NL)
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-01
- Volume
- 182
- Issue
- 1
- Pages
- 11-21
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2982103410
- Semantic Scholar
- f26e27329bf690a4e349269e7237db120d2fa785
- Cited by
- 103
- References
- 67
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 16 · 2023: 18 · 2022: 11 · 2021: 19 · 2020: 12
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- European Journal of Endocrinology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion, cc-by)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Scopus (Elsevier) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Keywords
- obesity, endocrine disorders, hypothyroidism, subclinical hypothyroidism, hypercortisolism, Cushing's syndrome, hypogonadism, hyperandrogenism, testosterone, prevalence
- MeSH terms
- Cross-Sectional Studies, Endocrine System Diseases, Hypothyroidism, Obesity, Prevalence, Risk Assessment
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.
A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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.
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