Download PDF
Exp Clin Endocrinol Diabetes 2012; 120(09): 511-516
DOI: 10.1055/s-0032-1309006
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Lean Muscle Mass in Classic or Ovulatory PCOS: Association with Central Obesity and Insulin Resistance[*]

F. M. Mario
1   Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
,
F. do Amarante
2    National Institute of Hormones and Women’s Health, CNPq, Porto Alegre, Brazil
,
M. K. Toscani
1   Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
2    National Institute of Hormones and Women’s Health, CNPq, Porto Alegre, Brazil
,
P. M. Spritzer
1   Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
2    National Institute of Hormones and Women’s Health, CNPq, Porto Alegre, Brazil
3    Laboratory of Molecular Endocrinology, Department of Physiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
› Author Affiliations
Further Information

Publication History

received 18 December 2011
first decision 07 February 2012

accepted 13 March 2012

Publication Date:
10 May 2012 (online)

Also available at
    Permissions and Reprints

Abstract

This age-matched case-control study assessed total and segmental lean muscle mass in classic or ovulatory polycystic ovary syndrome (PCOS) patients and investigated whether lean mass is associated with hormone and metabolic features. Participants underwent anthropometric and clinical evaluation. Habitual physical activity was assessed with a digital pedometer, and body composition by dual-energy X-ray absorptiometry. Laboratory measurements included total cholesterol, cholesterol fractions, triglycerides, glucose, total serum testosterone, serum insulin, estradiol, luteinizing hormone, and SHBG. Energy intake was calculated using a food frequency questionnaire. Classic PCOS patients had higher body mass index (BMI), waist circumference, testosterone and lipid accumulation product values than ovulatory PCOS and controls. Energy consumption, homeostasis model assessment index, SHBG, free androgen index and triglycerides, total and trunk lean mass were higher only in classic PCOS women vs. controls. Arm, leg, trunk, total or limb lean masses were not correlated with hormone levels in any of the groups. However, in PCOS women lipid accumulation product was positively correlated with total (r=0.56, p=0.001), trunk (r=0.59, p=0.001), arm (r=0.54, p=0.001), leg (r=0.44, p=0.03) and limb (r=0.48, p=0.001) lean masses. BMI was positively correlated with all lean mass segments and independently associated with total lean mass. Lipid accumulation product and BMI were independently associated with trunk lean mass variation. The increase in lean mass in classic PCOS appears to be associated with insulin resistance and central obesity rather than with energy intake, physical activity or androgens.

Key words

hyperandrogenemia - polycystic ovary syndrome - metabolic features - obesity
*

*  This study was carried out at Gynecological Endocrino­logy Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.


 

  • References

  • 1 Azziz R, Sanchez LA, Knochenhauer ES et al. Androgen excess in women: experience with over 1 000 consecutive patients. J Clin Endocrinol Metab 2004; 89 (02) 453-462
    Google Scholar
  • 2 Azziz R, Woods KS, Reyna R et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89 (06) 2745-2749
    CrossrefPubMedGoogle Scholar
  • 3 Norman RJ, Masters SC, Hague W et al. Metabolic approaches to the subclassification of polycystic ovary syndrome. Fertil Steril 1995; 63 (02) 329-335
    PubMedGoogle Scholar
  • 4 Ehrmann DA, Liljenquist DR, Kasza K et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91 (01) 48-53
    CrossrefPubMedGoogle Scholar
  • 5 Kirchengast S, Huber J. Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod 2001; 16 (06) 1255-1260
    CrossrefPubMedGoogle Scholar
  • 6 Yucel A, Noyan V, Sagsoz N. The association of serum androgens and insulin resistance with fat distribution in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2006; 126 (01) 81-86
    CrossrefPubMedGoogle Scholar
  • 7 Moran L, Norman RJ. Understanding and managing disturbances in insulin metabolism and body weight in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004; 18 (05) 719-736
    CrossrefPubMedGoogle Scholar
  • 8 Wiltgen D, Benedetto IG, Mastella LS et al. Lipid accumulation product index: a reliable marker of cardiovascular risk in polycystic ovary syndrome. Hum Reprod 2009; 24 (07) 1726-1731
    Google Scholar
  • 9 Penaforte FR, Japur CC, Diez-Garcia RW et al. Upper trunk fat assessment and its relationship with metabolic and biochemical variables and body fat in polycystic ovary syndrome. J Hum Nutr Diet 2011; 24 (01) 39-46
    CrossrefPubMedGoogle Scholar
  • 10 Azziz R, Carmina E, Dewailly D et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91 (02) 456-488
    CrossrefPubMedGoogle Scholar
  • 11 Kuchenbecker WK, Groen H, Zijlstra TM et al. The subcutaneous abdominal fat and not the intraabdominal fat compartment is associated with anovulation in women with obesity and infertility. J Clin Endocrinol Metab 2010; 95 (05) 2107-2112
    CrossrefPubMedGoogle Scholar
  • 12 Toscani M, Migliavacca R, Sisson de Castro JA et al. Estimation of truncal adiposity using waist circumference or the sum of trunk skinfolds: a pilot study for insulin resistance screening in hirsute patients with or without polycystic ovary syndrome. Metabolism 2007; 56 (07) 992-997
    CrossrefPubMedGoogle Scholar
  • 13 Wiltgen D, Spritzer PM. Variation in metabolic and cardiovascular risk in women with different polycystic ovary syndrome phenotypes. Fertil Steril 2010; 94 (06) 2493-2496
    CrossrefPubMedGoogle Scholar
  • 14 Lecke SB, Mattei F, Morsch DM et al. Abdominal subcutaneous fat gene expression and circulating levels of leptin and adiponectin in polycystic ovary syndrome. Fertil Steril 2011; 95 (06) 2044-2049
    CrossrefPubMedGoogle Scholar
  • 15 Douchi T, Yoshimitsu N, Nagata Y. Relationships among serum testosterone levels, body fat and muscle mass distribution in women with polycystic ovary syndrome. Endocr J 2001; 48 (06) 685-689
    CrossrefPubMedGoogle Scholar
  • 16 Glintborg D, Andersen M, Hagen C et al. Association of pioglitazone treatment with decreased bone mineral density in obese premenopausal patients with polycystic ovary syndrome: a randomized, placebo-controlled trial. J Clin Endocrinol Metab 2008; 93 (05) 1696-1701
    CrossrefPubMedGoogle Scholar
  • 17 Carmina E, Guastella E, Longo RA et al. Correlates of increased lean muscle mass in women with polycystic ovary syndrome. Eur J Endocrinol 2009; 161 (04) 583-589
    CrossrefPubMedGoogle Scholar
  • 18 Forbes GB. Longitudinal changes in adult fat-free mass: influence of body weight. Am J Clin Nutr 1999; 70 (06) 1025-1031
    PubMedGoogle Scholar
  • 19 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 20 Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961; 21: 1440-1447
    CrossrefPubMedGoogle Scholar
  • 21 Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 (19) 2560-2572
    CrossrefPubMedGoogle Scholar
  • 22 Graff SK, Alves BC, Toscani MK et al. Benefits of pedometer-measured habitual physical activity in healthy women. J Appl Physiol Nutr Metab in press 2011;
    PubMedGoogle Scholar
  • 23 Lara S, Casanova G, Spritzer PM. Influence of habitual physical activity on body composition, fat distribution and metabolic variables in early postmenopausal women receiving hormonal therapy. Eur J Obstet Gynecol Reprod Biol 2010; 150 (01) 52-56
    CrossrefPubMedGoogle Scholar
  • 24 Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18 (06) 499-502
    CrossrefPubMedGoogle Scholar
  • 25 Matthews DR, Hosker JP, Rudenski AS et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28 (07) 412-419
    Google Scholar
  • 26 Kahn HS. The “lipid accumulation product” performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC Cardiovasc Disord 2005; 5: 26
    Google Scholar
  • 27 Maturana MA, Moreira RM, Spritzer PM. Lipid accumulation product (LAP) is related to androgenicity and cardiovascular risk factors in postmenopausal women. Maturitas 2011; 70 (04) 395-399
    CrossrefPubMedGoogle Scholar
  • 28 Zanolla AF, Olinto MT, Henn RL et al. Assessment of reproducibility and validity of a food frequency questionnaire in a sample of adults living in Porto Alegre, Rio Grande do Sul State, Brazil. Cad Saude Publica 2009; 25 (04) 840-848
    CrossrefPubMedGoogle Scholar
  • 29 Baim S, Binkley N, Bilezikian JP et al. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 2008; 11 (01) 75-91
    CrossrefPubMedGoogle Scholar
  • 30 Ibanez L, de Zegher F. Ethinylestradiol-drospirenone, flutamide-metformin, or both for adolescents and women with hyperinsulinemic hyperandrogenism: opposite effects on adipocytokines and body adiposity. J Clin Endocrinol Metab 2004; 89 (04) 1592-1597
    CrossrefPubMedGoogle Scholar
  • 31 McKittrick M. Diet and Polycystic Ovary Syndrome. Nutr Today 2002; 37 (02) 63-69
    CrossrefPubMedGoogle Scholar
  • 32 Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352 (12) 1223-1236
    CrossrefPubMedGoogle Scholar
  • 33 Vrbikova J, Hainer V. Obesity and polycystic ovary syndrome. Obes Facts 2009; 2 (01) 26-35
    PubMedGoogle Scholar
  • 34 Spritzer PM, Wiltgen D. Prevalence of metabolic syndrome in patients of south of Brazil with polycystic ovary syndrome (PCOS). Arq Bras Endocrinol Metabol 2007; 51 (01) 146-147
    PubMedGoogle Scholar
  • 35 Carmina E. The spectrum of androgen excess disorders. Fertil Steril 2006; 85 (06) 1582-1585
    CrossrefPubMedGoogle Scholar
  • 36 Carmina E, Chu MC, Longo RA et al. Phenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters. J Clin Endocrinol Metab 2005; 90 (05) 2545-2549
    CrossrefPubMedGoogle Scholar
  • 37 Guastella E, Longo RA, Carmina E. Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril 2010; 94 (06) 2197-2201
    CrossrefPubMedGoogle Scholar
  • 38 Peppa M, Koliaki C, Nikolopoulos P et al. Skeletal muscle insulin resistance in endocrine disease. J Biomed Biotechnol 2010; 2010: 527850
    PubMedGoogle Scholar
  • 39 Corbould A, Zhao H, Mirzoeva S et al. Enhanced mitogenic signaling in skeletal muscle of women with polycystic ovary syndrome. Diabetes 2006; 55 (03) 751-759
    CrossrefPubMedGoogle Scholar
  • 40 Dobs AS, Nguyen T, Pace C et al. Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in postmenopausal women. J Clin Endocrinol Metab 2002; 87 (04) 1509-1516
    CrossrefPubMedGoogle Scholar
  • 41 Ballor DL, Poehlman ET. Exercise-training enhances fat-free mass preservation during diet-induced weight loss: a meta-analytical finding. Int J Obes Relat Metab Disord 1994; 18 (01) 35-40
    PubMedGoogle Scholar
  • 42 Ryan AS, Pratley RE, Elahi D et al. Resistive training increases fat-free mass and maintains RMR despite weight loss in postmenopausal women. J Appl Physiol 1995; 79 (03) 818-823
    PubMedGoogle Scholar
  • 43 Noyan V, Yucel A, Sagsoz N. The association of bone mineral density with insulin resistance in patients with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2004; 115 (02) 200-205
    CrossrefPubMedGoogle Scholar
  • 44 Pocock N, Eisman J, Gwinn T et al. Muscle strength, physical fitness, and weight but not age predict femoral neck bone mass. J Bone Miner Res 1989; 4 (03) 441-448
    PubMedGoogle Scholar
  • 45 Marin RV, Pedrosa MA, Moreira-Pfrimer LD et al. Association between lean mass and handgrip strength with bone mineral density in physically active postmenopausal women. J Clin Densitom 2010; 13 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 46 Wang MC, Bachrach LK, Van Loan M et al. The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone 2005; 37 (04) 474-481
    CrossrefPubMedGoogle Scholar
  • 47 Ho-Pham LT, Nguyen ND, Lai TQ et al. Contributions of lean mass and fat mass to bone mineral density: a study in postmenopausal women. BMC Musculoskelet Disord 2010; 11: 59
    CrossrefPubMedGoogle Scholar