Correlação entre composição corporal, alterações metabólicas e inflamatórias em mulheres portadoras da Síndrome dos Ovários Policísticos

Abstract

The accumulation of central fat and excess ectopic fat may be associated with increased cardiometabolic risk in women with Polycystic Ovary Syndrome (PCOS). In this cross-sectional study, we compared the body composition, focusing on ectopic fat deposition in intra-abdominal, hepatic, and epicardial sites, between women with PCOS and healthy controls matched by body mass index (BMI), exploring their correlations with hormonal, metabolic, and inflammatory parameters. Additionally, we evaluated the diagnostic performance and cut-off points of epicardial adipose tissue thickness (EATT) and hepatic steatosis assessment in predicting visceral adipose tissue (VAT). Seventy-two women (35 with PCOS and 37 controls), aged 18 to 39 years with a BMI <35 kg/m² were included. We analyzed hormonal and metabolic profiles, inflammatory biomarkers (tumor necrosis factor-alpha and interleukin-6), anthropometry, including the calculation of the lipid accumulation product (LAP) and visceral adiposity index, body fat distribution using dual-energy X-ray absorptiometry (DXA), transient elastography (TE) with controlled attenuation parameter (CAP) and transthoracic echocardiography for the measurement of epicardial and hepatic fat, respectively. PCOS women exhibited higher levels of androgens, insulin resistance (IR) parameters, LDL-c and triglycerides. Despite having a similar body fat mass (FM), women with PCOS exhibited greater fat deposition in the trunk and intra-abdominal regions, as well as increased EATT. Both truncal FM and VAT were significantly associated with insulinemia, HOMA-IR, and anthropometric indices and measurements. Among the anthropometric parameters, LAP proved to be the most effective tool for the clinical assessment of central fat deposition and metabolic dysfunction in PCOS. EATT was inversely correlated with HDL-c, while VAT was positively correlated with triglycerides. In PCOS women aged 18-29 years, the optimal cut-off points for CAP and EATT to identify excess VAT were 198.0 dB/m and 3.07 mm, respectively, with the area under the curve (AUC) for CAP outperforming that of EATT. In those aged 30-39, the cut-off values for CAP and EATT were 209.5 dB/m and 3.36 mm, respectively, with the AUC for EATT being greater. Our results suggest that IR is more closely related to central/visceral fat than androgens or pro-inflammatory cytokines in PCOS women, and that VAT is associated with more metabolic disorders than either TE-CAP or EATT. The TE-CAP measurement was superior for screening VAT in younger, reproductive-aged PCOS women (18-29 years), while the EATT measurement demonstrated similar applicability in women aged 30 to 39 years.