Does body weight affect cardiometabolic risk in women with polycystic ovary syndrome?


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Volume 111, Issue 1, Pages 56–57


Anuja Dokras, M.D., Ph.D.


Reflections on "Metabolic disturbances in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis" by Zhu et al.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


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about 3 years ago

We are very grateful to Dr. Anuja Dokras for his valuable comment on our work reviewing the metabolic risks in non-obese PCOS women (1) and for providing valuable insights into the research. As mentioned by Dr. Dokras, most of PCOS patients are reported obese and are recommended for CVD risk counselling. However, whether cardiometabolic risks in PCOS women are obesity-associated or just resulted from PCOS per se remain uncertain, and whether early screening and intervention for metabolic risks are needed in non-obese PCOS is a problem worth exploring. Thus, we systematically reviewed the articles regarding metabolic risks in non-obese PCOS women. In this systematic review and meta-analysis, we found that non-obese women with PCOS showed a higher prevalence of hyperinsulinemia, insulin resistance (IR), impaired glucose intolerance (IGT), type 2 diabetes, hypertriglyceridemia, low-high density lipoprotein (low-HDL) and metabolic syndrome (Mets), indicating that metabolic disturbances and the risk of long-term metabolic complications may similarly exist in non-obese PCOS patients (1).

     Systematic review and meta-analysis is an effective statistical method that draws evidence-based conclusions by summarizing the available data from existing studies, which the between-study heterogeneity is inevitable (2). Therefore, a good meta-analysis needs to interpret these heterogeneities cautiously. In our work, we implemented strict inclusion and exclusion criteria, which may lead to a limited study number and weakened result robustness. Therefore, large-scale prospective cohort studies are expected for this topic. Polycystic ovary syndrome is a complex endocrinal disease with high heterogeneity. Since evidences have reported that the hyperandrogenism might be a risk factor of non-alcoholic fatty liver disease (NAFLD) in non-obese PCOS (3), we fully agree Dr. Dokras’ suggestion of analyzing the outcomes separately according to different PCOS phenotypes. Similarly, we also notice heterogeneity of different ethnic in our research. Non-obese Americans appear to be more susceptible to metabolic abnormalities than the Nordics and Asians. It is necessary to discuss in the future whether this difference is due to genetic background or environmental exposure (4, 5). Therefore, great effort remains to be done. We hope that more research will focus on this topic and further elucidate the metabolic characteristic of non-obese PCOS with different phenotypes and ethnicities, which may help to understand pathophysiological mechanism of this syndrome.


Shiqin Zhu, M.D.a

Linlin Cui, M.D., Ph.D.a

Zi-Jiang Chen, M.D.,

a Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; b Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; and c Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China



1.  Zhu S, Zhang B, Jiang X, Li Z, Zhao S, Cui S, Chen Z. Metabolic disturbances in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertility Sterility. 2018; :167-176

2.  Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons, 2011.

3.    Kim JJ, Kim D, Yim JY, Kang JH, Han KH, Kim SM et al. Polycystic ovary syndrome with hyperandrogenism as a risk factor for non-obese non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2017;45:1403-12.

4.    Hayes MG, Urbanek M, Ehrmann DA, Armstrong LL, Lee JY, Sisk R et al. Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations. Nat Commun 2015;6:7502.

5.    Garruti G, De Palo R, De Angelisc M. Weighing the Impact of Diet and Lifestyle on Female Reproductive Function. Curr Med Chem 2017.