Discussion
obesity, PCOS
OBESITY, INSULIN RESISTANCE, TYPE 2 DIABETES
To our knowledge this is the first longitudinal study comparing the effects of OCs Girls with PCOS and without obesity showed similar serum follistatin concentrations as compared to age- and BMI-matched healthy girls, in contrast to previously reported data (Overall, our data agree with previous studies showing a raise in follistatin concentrations after treatment with OCs containing different combinations of estroprogestagens (In our population of girls with PCOS, follistatin associated positively with mean serum insulin concentrations during an OGTT and with liver fat. These findings agree with a previous report showing that the rise in follistatin levels is capable of inducing adipose tissue insulin resistance and thus could increase the risk for type 2 diabetes (Limitations of the present study include the relative small number of patients allocated to each intervention and the lack of follistatin results during the period off intervention. The strengths include the longitudinal design, the homogenity of the study population and the assessment of two different interventions with insulin sensitizing therapies (PioFluMet and SPIOMET), and with OCs as well (EE-CA and EE-LNG); i.e., with two approaches with divergent effects on metabolic health.In conclusion, in girls with PCOS, follistatin levels rise significantly after 6 months on OCs and this increase associates to a worsening of markers of insulin resistance and to the changes in ectopic fat depots, specifically in liver fat.