Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome.
BACKGROUND
Treatment of obesity improves all features of the polycystic ovary syndrome (PCOS). There is, however, a heterogeneous response to weight loss, and predictive factors are unknown. Objective This follow-up study aimed to investigate obese women with PCOS treated with a long-term lifestyle program to evaluate responsiveness and predictability.


METHODS
One hundred PCOS women meeting the criteria for selection were invited to participate and 65 of them agreed. Lifestyle intervention had consisted of a 1200-1400 kcal/day diet for 6 months, followed by mild calorie restriction and physical activity. The protocol, which was similar at baseline and follow-up, included anthropometry, clinical evaluation, pelvic ultrasound, and laboratory investigations. The mean follow-up period was 20.4±12.5 months.


RESULTS
After the follow-up period, women were reclassified into three groups according to the persistence (group 1, 15.4%), partial (group 2, 47.7%), or complete (group 3, 36.9%) disappearance of the categorical features of PCOS (hyperandrogenism, menses, and ovulatory dysfunctions). Duration of the follow-up and extent of weight loss were similar among the three groups, as were fasting and glucose-stimulated insulin and indices of insulin resistance. Baseline waist circumference, waist to hip ratio (WHR), and androstenedione blood levels were negatively correlated with a better outcome in the univariate analysis. However, only basal androstenedione values persisted to a highly significant extent (P<0.001) in the multivariate analysis.


CONCLUSIONS
Responsiveness to weight loss in overweight/obese PCOS women varies considerably and more than one third of women may achieve full recovery. These findings add new perspectives to the impact of obesity on the pathophysiology of PCOS.
Division of Endocrinology, Department of Clinical Medicine, St Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, Italy. renato.pasquali@unibo.it
Renato
R
Pasquali
Alessandra
A
Gambineri
Carla
C
Cavazza
Daniela
D
Ibarra Gasparini
Walter
W
Ciampaglia
Graciela Estela
GE
Cognigni
Uberto
U
Pagotto
D000328:Adult; D000368:Aged; D000735:Androstenedione / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat; D016015:Logistic Models; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology*; D011237:Predictive Value of Tests; D040242:Risk Reduction Behavior; D015431:Weight Loss
D000735:Androstenedione