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.
Journal article, 2011
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/m2 (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 (R2=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.
Body Mass Index
pathology
Female
Sex Hormone-Binding Globulin
Body Height
Insulin Resistance
Waist-Hip Ratio
blood
physiology
Adipose Tissue
Waist Circumference
blood
Cell Size
Adipocytes
Body Weight
blood
Immunohistochemistry
Polycystic Ovary Syndrome
pathology
Adiponectin
blood
metabolism
Amyloid
Lipoprotein Lipase
physiology
pathology
Glycerol
Macrophages
metabolism
pathology
Gonadal Steroid Hormones
physiology
Adult
Humans
Author
Louise Mannerås Holm
University of Gothenburg
Henrik Leonhardt
University of Gothenburg
Joel Kullberg
Akademiska Sjukhuset
Eva Jennische
University of Gothenburg
Anders Odén
University of Gothenburg
Chalmers, Mathematical Sciences, Mathematical Statistics
Göran Holm
University of Gothenburg
Mikael Hellström
University of Gothenburg
Lars Lönn
University of Gothenburg
Gunilla Olivecrona
Umea universitet
Elisabet Stener-Victorin
University of Gothenburg
Malin Lönn
University of Gothenburg
Journal of Clinical Endocrinology and Metabolism
0021-972X (ISSN)
Vol. 96 2 E304-11Subject Categories (SSIF 2011)
Endocrinology and Diabetes
DOI
10.1210/jc.2010-1290
PubMed
21084397