Division of Endocrinology, Department of Clinical Medicine, St Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, Italy.
Eur J Endocrinol. 2011 Jan;164(1):53-60. doi: 10.1530/EJE-10-0692. Epub 2010 Oct 18.
Treatment of obesity improves all features of the polycystic ovary syndrome (PCOS). There is, however, a heterogeneous response to weight loss, and predictive factors are unknown. Objective This follow-up study aimed to investigate obese women with PCOS treated with a long-term lifestyle program to evaluate responsiveness and predictability.
One hundred PCOS women meeting the criteria for selection were invited to participate and 65 of them agreed. Lifestyle intervention had consisted of a 1200-1400 kcal/day diet for 6 months, followed by mild calorie restriction and physical activity. The protocol, which was similar at baseline and follow-up, included anthropometry, clinical evaluation, pelvic ultrasound, and laboratory investigations. The mean follow-up period was 20.4±12.5 months.
After the follow-up period, women were reclassified into three groups according to the persistence (group 1, 15.4%), partial (group 2, 47.7%), or complete (group 3, 36.9%) disappearance of the categorical features of PCOS (hyperandrogenism, menses, and ovulatory dysfunctions). Duration of the follow-up and extent of weight loss were similar among the three groups, as were fasting and glucose-stimulated insulin and indices of insulin resistance. Baseline waist circumference, waist to hip ratio (WHR), and androstenedione blood levels were negatively correlated with a better outcome in the univariate analysis. However, only basal androstenedione values persisted to a highly significant extent (P<0.001) in the multivariate analysis.
Responsiveness to weight loss in overweight/obese PCOS women varies considerably and more than one third of women may achieve full recovery. These findings add new perspectives to the impact of obesity on the pathophysiology of PCOS.
肥胖症的治疗可改善多囊卵巢综合征（PCOS）的所有特征。然而，对于体重减轻的反应存在异质性，且预测因素未知。目的 本随访研究旨在调查接受长期生活方式干预的肥胖 PCOS 女性，以评估其反应性和可预测性。
符合入选标准的 100 名 PCOS 女性受邀参加，其中 65 名同意。生活方式干预包括 6 个月的 1200-1400kcal/天饮食，随后进行轻度热量限制和身体活动。方案在基线和随访时相似，包括人体测量、临床评估、盆腔超声和实验室检查。平均随访时间为 20.4±12.5 个月。
随访结束后，根据 PCOS 分类特征（高雄激素血症、月经和排卵功能障碍）的持续（第 1 组，15.4%）、部分（第 2 组，47.7%）或完全（第 3 组，36.9%）消失，将女性重新分类。三组间的随访持续时间和体重减轻程度相似，空腹和葡萄糖刺激胰岛素以及胰岛素抵抗指数也相似。单因素分析显示，基线腰围、腰臀比（WHR）和雄烯二酮血水平与更好的结果呈负相关。然而，仅基础雄烯二酮值在多因素分析中仍具有显著意义（P<0.001）。
超重/肥胖 PCOS 女性对体重减轻的反应差异很大，超过三分之一的女性可能完全康复。这些发现为肥胖对 PCOS 病理生理学的影响增添了新的视角。
