title: Cut-off levels for hyperandrogenemia among Samoan women: An improved methodology for deriving normative data in an obese population.
abstract: OBJECTIVE
  To define biochemical hyperandrogenemia (HA) among a population-based sample of reproductive-aged Samoan women, taking into consideration their high BMI levels.
  
  
  METHODS
  A secondary analysis was performed among a cross-sectional sample of Samoan women aged 25-39years (n=494) who were part of a larger genome-wide association study (GWAS) of adiposity. Women indicating pregnancy/lactation, hysterectomy, oophorectomy, cancer treatment, or use of contraceptive injections were excluded from the study. We analyzed the distribution of free androgen index (FAI) values to establish normative androgen data among Samoan women of reproductive age. Using the lowest tertile of body mass index (BMI), we defined HA as free androgen index (FAI) values >95(th) FAI percentile in that subsample. We compared the anthropometric and metabolic characteristics of women with HA to women with normal androgen levels.
  
  
  RESULTS
  HA was defined as FAI>8.5. Using this definition, 14% of women were classified as hyperandrogenemic. Women with HA had significantly higher average BMI values, abdominal circumferences, fasting triglycerides, and insulin levels as well as significantly lower adiponectin levels.
  
  
  CONCLUSIONS
  This study is the first to define normative androgen values among Samoan women with a quantitative assessment of the relationship between adiposity and androgen levels. The uniquely high BMI levels in the population not only provide important clinical insight into normative androgen values among Samoan women, but they also serve as references for the clinical assessment of HA, taking into consideration BMI, in other populations.
authors.affiliation: Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI 02912, USA; Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI 02912, USA. Electronic address: HasinaMaredia@gmail.com.
authors.forename: Hasina
authors.initials: H
authors.lastname: Maredia
authors.affiliation: Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI 02912, USA.
authors.forename: Geralyn M
authors.initials: GM
authors.lastname: Lambert-Messerlian
authors.affiliation: Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI 02912, USA.
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Palomaki
authors.affiliation: National University of Samoa, Apia, Samoa.
authors.forename: Satupaitea
authors.initials: S
authors.lastname: Viali
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06520, USA.
authors.forename: Nicola L
authors.initials: NL
authors.lastname: Hawley
authors.affiliation: Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI 02912, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: McGarvey
mesh_terms: D052242:Adiponectin / Q000097:blood*; D050154:Adiposity; D000328:Adult; D000368:Aged; D000728:Androgens / Q000097:blood*; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017588:Hyperandrogenism / Q000097:blood* / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000097:blood*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D018947:Samoa / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood*; D055815:Young Adult
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D000728:Androgens; D015415:Biomarkers; D014280:Triglycerides
keywords: Androgens; Body mass index; Obesity; Samoa