Reich L A, St Fleur R G, Gjelsvik A, Field A E, Ziobrowski H N
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.
Hum Reprod. 2025 Mar 1;40(3):545-552. doi: 10.1093/humrep/deae294.
Are empirically derived adolescent overweight/obesity phenotypes differentially associated with polycystic ovary syndrome (PCOS) in young adulthood?
Self-reported PCOS diagnosis risk in young adulthood varied by empirically derived adolescent overweight/obesity phenotypes, with the highest risk observed among those in the 'mothers with obesity' and 'early puberty' phenotypes.
Overweight and obesity during puberty are postulated to promote the development of PCOS. Much of the prior literature in this area is cross-sectional and defines weight status based solely on BMI, yet emerging research suggests that not all people with overweight/obesity have the same risk for chronic health conditions, including PCOS.
STUDY DESIGN, SIZE, DURATION: Data came from 4838 female participants in the Growing Up Today Study (GUTS), an ongoing prospective cohort study in the USA that has followed children aged 9-14 into young adulthood (ages 31-37, with 16 waves of data collection between 1996 and 2019).
PARTICIPANTS/MATERIALS, SETTINGS, METHODS: We previously used latent class analysis to empirically derive obesity phenotypes among 2038 female participants aged 14-19 years with overweight/obesity in the sample, as determined by participants' self-reported height and weight status. Indicators in the latent class analysis were participants' maternal weight status, disordered eating behaviors, body image and weight concerns, depressive symptoms and pubertal timing. The derived obesity phenotypes included 'mothers with obesity', 'early puberty', 'high weight concerns', and 'mixed'. Among these participants and female participants without adolescent overweight/obesity, we used logistic regression with generalized estimating equations to examine associations of adolescent obesity phenotypes with self-reported PCOS diagnosis after age 19. Analyses were adjusted for potential confounders.
Participants in all four obesity phenotypes were more likely than participants without overweight/obesity to report a PCOS diagnosis ('mothers with obesity' phenotype: odds ratio (OR) = 4.50, 95% CI = 2.61, 7.77; 'early puberty' phenotype: OR = 2.51, 95% CI = 1.59, 3.97; 'high weight concerns' phenotype: OR = 2.01, 95% CI = 1.24, 3.24; 'mixed' phenotype: OR = 1.94, 95% CI = 1.33, 2.82). Individuals in the 'mothers with obesity' phenotype had a significantly greater risk of PCOS diagnosis compared to those in the 'mixed' and 'high weight concerns' phenotypes (P < 0.05).
LIMITATIONS, REASONS FOR CAUTION: Participants self-reported PCOS diagnosis, which may underestimate new-onset PCOS and limit our ability to establish a temporal order between overweight/obesity and PCOS development. Residual confounding may also explain some of the observed associations in our analysis. Despite the fact that participants were from all regions across the USA, the results may not be generalizable to non-White and socioeconomically diverse populations.
Among females, the risk of PCOS in young adulthood varied by distinct adolescent obesity phenotypes. Those in the 'mothers with obesity' and 'early puberty' phenotypes had higher risks of PCOS, which suggests a potential underlying biological component. It may be beneficial to tailor PCOS surveillance according to these high-risk adolescent obesity phenotypes.
STUDY FUNDING/COMPETING INTEREST(S): This project was funded by research grants from the National Institutes of Health (R01 DK127585, U01 HL145386, and U01 CA176726). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no competing interests to disclose.
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通过实证得出的青少年超重/肥胖表型与成年早期的多囊卵巢综合征（PCOS）之间是否存在差异关联？
成年早期自我报告的PCOS诊断风险因通过实证得出的青少年超重/肥胖表型而异，在“母亲肥胖”和“青春期提前”表型的人群中观察到的风险最高。
青春期的超重和肥胖被认为会促进PCOS的发展。该领域的许多先前文献都是横断面研究，仅根据BMI定义体重状况，但新出现的研究表明，并非所有超重/肥胖者患慢性健康疾病（包括PCOS）的风险都相同。
研究设计、规模、持续时间：数据来自“今日成长研究”（GUTS）中的4838名女性参与者，这是美国一项正在进行的前瞻性队列研究，跟踪了9至14岁的儿童直至成年早期（年龄在31至37岁之间，在1996年至2019年期间进行了16次数据收集）。
参与者/材料、设置、方法：我们之前使用潜在类别分析，根据参与者自我报告的身高和体重状况，在样本中2038名年龄在14至19岁且超重/肥胖的女性参与者中实证得出肥胖表型。潜在类别分析中的指标包括参与者的母亲体重状况、饮食失调行为、身体形象和体重担忧、抑郁症状以及青春期时间。得出的肥胖表型包括“母亲肥胖”、“青春期提前”、“高度关注体重”和“混合型”。在这些参与者以及没有青少年超重/肥胖的女性参与者中，我们使用广义估计方程的逻辑回归来检验青少年肥胖表型与19岁后自我报告的PCOS诊断之间的关联。分析对潜在混杂因素进行了调整。
所有四种肥胖表型的参与者比没有超重/肥胖的参与者更有可能报告PCOS诊断（“母亲肥胖”表型：优势比（OR）=4.50，95%置信区间（CI）=2.61，7.77；“青春期提前”表型：OR=2.51，95%CI=1.59，3.97；“高度关注体重”表型：OR=2.01，95%CI=1.24，3.24；“混合型”表型：OR=1.94，95%CI=1.33，2.82）。与“混合型”和“高度关注体重”表型的个体相比，“母亲肥胖”表型的个体患PCOS诊断的风险显著更高（P<0.05）。
局限性、谨慎原因：参与者自我报告PCOS诊断，这可能低估新发性PCOS，并限制我们确定超重/肥胖与PCOS发展之间时间顺序的能力。残余混杂因素也可能解释我们分析中观察到的一些关联。尽管参与者来自美国所有地区，但结果可能不适用于非白人及社会经济背景多样的人群。
在女性中，成年早期患PCOS的风险因不同的青少年肥胖表型而异。“母亲肥胖”和“青春期提前”表型的人群患PCOS的风险更高，这表明可能存在潜在的生物学因素。根据这些高风险的青少年肥胖表型调整PCOS监测可能是有益的。
研究资金/利益冲突：该项目由美国国立卫生研究院的研究资助（R01 DK127585、U01 HL145,386和U01 CA176726）。内容完全由作者负责，不一定代表美国国立卫生研究院的官方观点。作者没有利益冲突需要披露。
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