title: Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic.
abstract: BACKGROUND
  Compared with other populations, South Asians have a greater propensity to insulin resistance and the metabolic syndrome (MetS). This is the first study to determine the distribution of phenotypes of polycystic ovary syndrome (PCOS) and their relationship to the MetS among indigenous South Asians.
  
  
  METHODS
  An evaluation of the phenotype and metabolic characteristics of PCOS was conducted by recruiting consecutive women diagnosed by Rotterdam consensus criteria from an Endocrine clinic in Colombo, Sri Lanka. Prevalence of MetS was determined, in relation to the phenotypic subgroup of PCOS and compared with ethnically matched, BMI- and age-adjusted controls (n =231).
  
  
  RESULTS
  Acanthosis nigricans (AN) occurred in 64.6% of women with PCOS (n= 469). MetS occurred in 30.6% of the PCOS group compared with 6.34% of controls (P = 0.0001). Those with PCOS and MetS had significantly higher median BMI, blood pressure (BP), fasting plasma glucose, insulin and triglycerides and lower high-density lipoprotein and sex hormone-binding globulin (SHBG), but similar testosterone concentrations compared with those with PCOS alone. Prevalence of MetS was similar in the four PCOS phenotypes, although oligomenorrhoeic women were more obese compared with the normal cycling hyperandrogenic group. Multivariate logistic regression confirmed age ≥35 years, BMI ≥25 kg/m(2) and AN as significant predictors of MetS in PCOS. Case-control comparisons showed that the presence of PCOS results in higher odds of having the MetS, a high waist circumference, elevated diastolic BP, abnormal fasting lipids and high fasting insulin and plasma testosterone concentrations.
  
  
  CONCLUSIONS
  Young indigenous South Asians with PCOS have greater odds of being centrally obese, with a third having the MetS that bears no relationship to the androgenic phenotype. Significant predictors for MetS within the PCOS cohort are advancing age, obesity determined by the Asian cut off (BMI >25 kg/m(2)) and AN, while family history of diabetes, hyperandrogenism and elevated SHBG have no predictive value.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. mandika59@hotmail.com
authors.forename: Chandrika N
authors.initials: CN
authors.lastname: Wijeyaratne
authors.forename: Ruwanthi de A
authors.initials: Rde A
authors.lastname: Seneviratne
authors.forename: Shamalka
authors.initials: S
authors.lastname: Dahanayake
authors.forename: Vindya
authors.initials: V
authors.lastname: Kumarapeli
authors.forename: Ethusha
authors.initials: E
authors.lastname: Palipane
authors.forename: Nadeera
authors.initials: N
authors.lastname: Kuruppu
authors.forename: Chandrika
authors.initials: C
authors.lastname: Yapa
authors.forename: Rohini de A
authors.initials: Rde A
authors.lastname: Seneviratne
authors.forename: Adam H
authors.initials: AH
authors.lastname: Balen
mesh_terms: D000554:Ambulatory Care Facilities; D000568:Amenorrhea / Q000150:complications; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications; D007194:India / Q000208:ethnology; D007247:Infertility, Female / Q000150:complications; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000150:complications / Q000208:ethnology*; D009839:Oligomenorrhea / Q000150:complications; D010053:Ovary / Q000000981:diagnostic imaging; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000208:ethnology*; D013188:Sri Lanka / Q000208:ethnology; D014463:Ultrasonography