title: Metabolically healthy polycystic ovary syndrome (MH-PCOS) and metabolically unhealthy polycystic ovary syndrome (MU-PCOS): a comparative analysis of four simple methods useful for metabolic assessment.
abstract: OBJECTIVE
  Is it possible to distinguish metabolically healthy polycystic ovary syndrome (MH-PCOS) from metabolically unhealthy PCOS (MU-PCOS) by simple diagnostic tools such as body mass index (BMI), waist/hip ratio (WHR), at-risk category suggested by Androgen Excess Society (AES) and visceral adiposity index (VAI)?
  
  
  CONCLUSIONS
  VAI could be an easy and useful tool in clinical practice and in population studies for assessment of MU-PCOS.
  
  
  BACKGROUND
  VAI is a good indicator of insulin sensitivity and cardiometabolic risk in oligo-ovulatory women with PCOS.
  
  
  METHODS
  We conducted a cross-sectional study of 232 women with PCOS in a university hospital setting.
  
  
  METHODS
  Anthropometric, hormonal and metabolic parameters were evaluated. An oral glucose tolerance test measured areas under the curve (AUC) for insulin (AUC 2h insulin) and for glucose (AUC 2h glucose). Homeostasis model assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity (ISI), the oral dispositional index (DIo) and VAI were determined.
  
  
  RESULTS
  The prevalence of MU-PCOS according to the different criteria was: BMI, 56.0%; WHR, 18.1%; at-risk criteria of AES, 72.0% and VAI, 34.5%. The likelihood that a woman would exhibit MU-PCOS (except when diagnosed by the WHR criterion) showed a significant positive association with high HOMA2-IR [BMI criterion: (odds ratio (OR): 1.86; 95% confidence interval (CI): 1.43-2.41); risk criteria of AES (OR: 1.86; 95% CI: 1.36-2.56); VAI criterion (OR: 1.45; 95% CI: 1.17-1.80)] and a significant negative association with low ISI Matsuda [BMI criterion: (OR: 0.81; 95% CI: 0.72-0.91); risk criteria of AES (OR: 0.78; 95% CI: 0.69-0.89); VAI criterion (OR: 0.82; 95% CI: 0.71-0.94)]. Only MU-PCOS according to the VAI criterion showed a significant association with low DIo (OR: 0.85; 95% CI: 0.75-0.96); these women also showed a significant association with low luteal progesterone levels (OR: 0.97; 95% CI: 0.95-0.99).
  
  
  CONCLUSIONS
  The analysis is limited by the lack of a gold standard definition of metabolic health that would have allowed the execution of a receiver operator characteristic analysis of the four proposed criteria.
  
  
  CONCLUSIONS
  The results will facilitate the early recognition of cardiometabolic risk in women with PCOS before they develop overt metabolic syndrome.
authors.affiliation: Biomedical Department of Internal and Specialist Medicine (Di.Bi.M.I.S.), Section of Endocrinology, Diabetology and Metabolism, University of Palermo, Piazza delle Cliniche 2, Palermo, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Amato
authors.forename: V
authors.initials: V
authors.lastname: Guarnotta
authors.forename: D
authors.initials: D
authors.lastname: Forti
authors.forename: M
authors.initials: M
authors.lastname: Donatelli
authors.forename: S
authors.initials: S
authors.lastname: Dolcimascolo
authors.forename: C
authors.initials: C
authors.lastname: Giordano
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004734:Energy Metabolism; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis / Q000378:metabolism*; D012307:Risk Factors
keywords: PCOS; metabolic assessment; visceral adiposity index