Metabolically healthy polycystic ovary syndrome (MH-PCOS) and metabolically unhealthy polycystic ovary syndrome (MU-PCOS): a comparative analysis of four simple methods useful for metabolic assessment.

study question:Is it possible to distinguish metabolically healthy polycystic ovary syndrome (MH-PCOS) from metabolically un-healthy PCOS (MU-PCOS) by simple diagnostic tools such as body mass index (BMI), waist/hip ratio (WHR), at-risk category suggestedby Androgen Excess Society (AES) and visceral adiposity index (VAI)?summary answer:VAI could be an easy and useful tool in clinical practice and in population studies for assessment of MU-PCOS.what is known already:VAI is a good indicator of insulin sensitivity and cardiometabolic risk in oligo-ovulatory women withPCOS.study design, size, duration:We conducted a cross-sectional study of 232 women with PCOS in a university hospital setting.participants/materials, setting, methods:Anthropometric, hormonal and metabolic parameters were evaluated. Anoral glucose tolerance test measured areas under the curve (AUC) for insulin (AUC2h insulin) and for glucose (AUC2h glucose). Homeostasismodel assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity (ISI), the oral dispositional index (DIo) and VAIwere determined.main results and the role of chance:The prevalence of MU-PCOS according to the different criteria was: BMI, 56.0%;WHR, 18.1%; at-risk criteria of AES, 72.0% and VAI, 34.5%. The likelihood that a woman would exhibit MU-PCOS (except when diagnosedby the WHR criterion) showed a significant positive association with high HOMA2-IR [BMI criterion: (odds ratio (OR): 1.86; 95% confidenceinterval (CI): 1.43–2.41); risk criteria of AES (OR: 1.86; 95% CI: 1.36–2.56); VAI criterion (OR: 1.45; 95% CI: 1.17–1.80)] and a significantnegative association with low ISI Matsuda [BMI criterion: (OR: 0.81; 95% CI: 0.72–0.91); risk criteria of AES (OR: 0.78; 95% CI: 0.69–0.89);VAI criterion (OR: 0.82; 95% CI: 0.71–0.94)]. Only MU-PCOS according to the VAI criterion showed a significant association with low DIo(OR: 0.85; 95% CI: 0.75–0.96); these women also showed a significant association with low luteal progesterone levels (OR: 0.97; 95% CI:0.95–0.99).limitations, reasons for caution:The analysis is limited by the lack of a gold standard definition of metabolic health thatwould have allowed the execution of a receiver operator characteristic analysis of the four proposed criteria.wider implications of the findings:The results will facilitate the early recognition of cardiometabolic risk in women withPCOS before they develop overt metabolic syndrome.