Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycys
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ORIGINAL ARTICLE
Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria Miro Sˇimun Alebic´ • Tomislav Bulum Natasˇa Stojanovic´ • Lea Duvnjak
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Received: 17 November 2013 / Accepted: 21 January 2014 Ó Springer Science+Business Media New York 2014
Abstract Polycystic ovary syndrome (PCOS) women are more insulin resistant than general population. Prevalence data on insulin resistance (IR) in PCOS vary depending on population characteristics and methodology used. The objectives of this study were to investigate whether IR in PCOS is exclusively associated with body mass and to assess the prevalence of IR in lean and overweight/obese PCOS. Study included 250 consecutive women who attended a Department of Human Reproduction diagnosed as having PCOS according to the Rotterdam criteria. Control group comprised 500 healthy women referred for male factor infertility evaluation during the same period as the PCOS women. PCOS women (n = 250) were more insulin resistant than controls (n = 500) even after adjustment for age and body mass index (BMI) (P = 0.03). Using logistic regression analysis, BMI C25 kg/m2 (OR 6.0; 95 % CI 3.3–11.0), PCOS (OR 2.2; 95 % CI 1.4–3.5) and waist circumference C80 cm (OR 2.0; 95 % CI 1.1–3.8) were identified as independent determinants of IR (P \ 0.001). IR was more prevalent in overweight/obese controls (n = 100) than in lean PCOS women (n = 150), 31 versus 9.3 %, but less prevalent than in overweight/ obese PCOS (n = 100), 31 versus 57 %. The prevalence of M. Sˇ. Alebic´ Department of Human Reproduction, Merkur University Hospital, Zagreb, Croatia T. Bulum (&) L. Duvnjak Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia e-mail: [email protected] N. Stojanovic´ Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, Croatia
IR between lean controls (5 %) and lean PCOS (9.3 %) did not significantly differ. Both PCOS-specific and obesityrelated IR independently contribute to IR in PCOS. Using HOMA-IR cutoff value of 3.15 specific for Croatian women in our clinical setting, the assessed prevalence of IR in lean and overweight/obese PCOS women was 9.3 and 57 %, respectively. Keywords Insulin resistance Polycystic ovary syndrome Body mass index
Introduction The polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women with prevalence estimates ranging from 6 to 20 % depending on the diagnostic criteria applied and the characteristics of population studied [1–4]. It is a very heterogeneous syndrome, with ethnicity, race, geographic region and environmental factors contributing to both different clinical manifestation of PCOS and PCOS-associated long-term health risk [5]. Insulin resistance (IR) is typically defined as decreased sensitivity or responsiveness to the metabolic action of insulin [6]. IR is a prominent
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