Discussion
non-alcoholic fatty liver disease, NAFLD, inflammation, PCOS, hyperinsulinemic PCOS, FAI, adiposity, PCOS phenotypesThis
OBESE, INFLAMMATION, NON-ALCOHOLIC FATTY LIVER DISEASE, INSULIN RESISTANCE, ADIPOSITY, TYPE 2 DIABETES MELLITUS
In this cross-sectional analysis, abnormalities of anthropometric parameters, higher triglyceride levels, hs-CRP, ALT, and FAI as well as lower SHBG were observed among insulin-resistant women with PCOS.We noticed higher hs-CRP levels in participants with abnormal HOMA-IR values. In recent years, increasing attention has been paid to the significance of inflammation in PCOS. Interleukin-18, as a potent proinflammatory biomarker, was shown to be related to indices of adiposity and insulin resistance in PCOSOur study also found an association between FAI and SHBG levels with the HOMA-IR index. Previous studies suggested that low SHBG levels in the general population are a predictor of increased risk of developing type 2 diabetes mellitusWe found a positive correlation between HOMA-IR and diastolic blood pressure in obese/overweight PCOS women, which is consistent with a previous study that indicated higher diastolic blood pressure in obese hyperinsulinemic PCOS women compared to lean hyperinsulinemic onesOur analyses also showed a weak positive correlation between HOMA-IR and ALT levels in normal weight participants. It is to be noted that we did not screen participants regarding non-alcoholic fatty liver disease (NAFLD). Nevertheless, elevated liver enzymes, as a surrogate marker of NAFLD, are common in women with PCOSThere is evidence of high ALT levels in lean PCOS patientsThe association of HOMA-IR in PCOS phenotypes is variable across the studies. Some previous studies have investigated the risk of insulin resistance in the various PCOS phenotypes and showed that HOMA-IR does not differ among the four PCOS phenotypesThis study has its strengths; a comprehensive comparison of clinical and biochemical profiles of PCOS women with/without insulin resistance and also among different PCOS phenotypes was provided. Phenotypic categorization of PCOS women can help to predict risk of insulin resistance. To mention the limitations, the current study was restricted to Iranian women, and further research is required with a larger sample size involving patients of different ethnicities. Another limitation of the current study is the use of HOMA-IR cut-off for diagnosis of insulin resistance. However, the euglycemic hyperinsulinemic clamp is the gold standard method for direct measurement of insulin resistance.