Review
Risk of metabolic syndrome in adolescents with polycystic ovarian syndrome: A systematic review and meta-analysis

https://doi.org/10.1016/j.dsx.2018.03.014Get rights and content

Abstract

Background

Polycystic ovarian syndrome (PCOS) is the commonest reproductive disorder in women and is closely associated with the development of metabolic syndrome (MetS). The objective of this systematic review and meta-analysis was to describe the risk of MetS in adolescent with PCOS to help diagnosing and preventing of morbidity and mortality later in life.

Methods

Pubmed, Medline, EMBASE, CINAHL and other sources were searched for metabolic syndrome in adolescents with polycystic ovarian syndrome using PRISMA guidelines (Moher et al., 2009). All type of study design of women aged 10–20 reported association of PCOS with metabolic syndrome was included in this study. Meta-analysis was conducted for MetS and its individual component using bias adjusted quality effect model and we compare the results from quality effects with random effects and IVhet model. Data were presented as prevalence, odds ratio (95% confidence interval and mean difference (95% confidence interval).

Results

This systematic review included 9 studies while the meta-analysis included 7 studies. Meta-analysis showed that the odds of being experiencing MetS in PCOS groups was 2.69 (1.29, 5.60) times than girls without PCOS. The mean difference between girls with PCOS and without PCOS for systolic blood pressure was 5.00 (1.28, 8.72), diastolic blood pressure was 3.50 (0.48, 6.56), triglycerides level was 4.20 (−3.99, 12.45), glucose level was 1.30 (−0.46, 3.05), HDL level was −1.40 (−4.85, 2.00).

Conclusion

This systematic review and meta-analysis support the hypothesis that the risk of MetS is much greater in adolescents with PCOS compared to the normal population. It is important to screen PCOS in early age to prevent MetS and its complications which lead to morbidity and mortality later in life.

Introduction

Polycystic ovary syndrome (PCOS) is the most common reproductive disorder in women characterized by hirsutism, infertility, menstrual irregularities, obesity, and polycystic ovaries [1]. The aetiology is unknown but PCOS is associated with dysfunctional uterine bleeding, endometrial carcinoma, diabetes, mood disorder, dyslipidemia, infertility and hypertension [[1], [2], [3]]. These women are at high risk of cardiovascular morbidity and mortality in later life [2]. It is estimated to affect up to 10% of reproductive-aged women worldwide according to 1990 National Institute of Health (NIH) criteria and even more using the Rotterdam criteria [2,4]. In Australia, the prevalence of PCOS is estimated at about 6–7% of reproductive women especially in the Aboriginal population [5]. PCOS usually occur during puberty [6]. The aetiology is still unknown but recent studies suggest that the principal underlying disorder is one of insulin resistance with hyperinsulinaemia stimulating excess androgen production. This insulin hormonal dysregulation associated with PCOS begins in adolescence [4]. Genetics and environmental factors are also proposed to be causes of PCOS. Women are at risk if they have a genetic predisposition, although the onset of symptoms can be triggered by environmental factors, particularly obesity [7].

During the last decade, the prevalence of metabolic syndrome (MetS) has increased in men and women especially in young people [6]. Metabolic features start in adolescence and increase with age [6]. As PCOS and the metabolic syndrome share insulin resistance as an important element in their pathophysiology, there is much overlap between the two clinical arenas [8]. It has been suggested that PCOS may be the female-specific manifestation of the metabolic syndrome [8]. However, the evidence of the association between PCOS and MetS among young women in less studied.

A systematic review of the association between MetS and PCOS has been performed [9]. This study reviewed the prevalence of MetS in women with PCOS and found the women appeared to be more susceptible to developing MetS [9]. However, the outcomes were generally for women in the reproductive age group. The onset of PCOS occurs during puberty and no systematic review and meta-analysis to relate PCOS with the development of MetS in adolescents. Findings of this study will have implication to detect MetS in early stage of life to prevent future morbidity and mortality.

Section snippets

Search strategy

We conducted a Pubmed, Medline, EMBASE, CINAHL and other sources search of Metabolic Syndrome in adolescents with Polycystic Ovarian Syndrome using PRISMA guidelines [10]. All type of study design of women aged 10–20 years reported association of PCOS with metabolic syndrome was included in this study. Adolescent girls with conditions similar to PCOS such as hyperprolactinaemia, cushing’s syndrome, hyperthyroidism, hypothyroidism and congenital adrenal hyperplasia were excluded from the review.

Defining PCOS

Characteristics of included studies

The search yielded 266 studies (Fig. 1). After assessments of title abstract and full-length articles, for final analysis, 9 studies were included (Table 3). All included studies were observational cross-sectional or case controlled studies except 3 studies; 2 medical records reviews and one longitudinal cohort [[19], [20], [21]]. PCOS diagnosis in five of the studies used the Rotterdam/ESHRE criteria [20,[22], [23], [24], [25]], one study used the NIH criteria [26], three studies used NIH

Discussion

This is the first systematic review and meta-analysis to assess the risk of metabolic syndrome in adolescents with PCOS. We found that adolescents with PCOS had 2.69 times higher risk for metabolic syndrome compared to healthy girls when the quality scores were considered. The clinical features of metabolic syndrome of both groups were also presented as weighted mean difference and showed PCOS girls had higher level of triglycerides, glucose, blood pressure and waist circumference while lower

Conclusion

Overall, adolescent girls diagnosed with PCOS appear to be more susceptible to develop metabolic syndrome. Eventhough this review has several limitations, many research studies have shown that PCOS and Metabolic Syndrome are highly related and seem to have major clinical implications such as cardiovascular disease later on [31]. To minimize the morbidity and mortality from the related diseases, Metabolic Syndrome and PCOS should be diagnosed and treated in adolescence when symptoms first

Conflict of interest

Polycystic ovarian syndrome (PCOS) is the commonest reproductive disorder in women and is closely associated with the development of metabolic syndrome (MetS). The objective of this systematic review and meta-analysis was to describe the risk of MetS in adolescent with PCOS to help diagnosing and preventing of morbidity and mortality later in life.

Acknowledgments

I would like to express my sincere gratitude to my supervisors, Associate Professor Abdullah Mamun and Professor Maxine Whittaker for continues support and guidance. Also, I sincerely appreciate the editing of this review by Vivienne Chavez and Scott Macintyre who has helped me a lot in general. Last but not least, I would like to thank my family; my parents and my brothers for supporting me endlessly throughout my life.

References (42)

  • P. Dabadghao et al.

    Glucose tolerance abnormalities in Australian women with polycystic ovary syndrome

    Med J Aust

    (2007)
  • D.A. Cirik et al.

    What do we know about metabolic syndrome in adolescents with PCOS?

    J Turk Ger Gynecol Assoc

    (2014)
  • J. Boyle et al.

    Polycystic ovary syndrome – an update

    Aust Fam Physician

    (2012)
  • E. Kandaraki et al.

    Metabolic syndrome and polycystic ovary syndrome… and vice versa

    Arq Bras Endocrinol Metabol

    (2009)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    Ann Intern Med

    (2009)
  • E. Carmina

    Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines

    Minerva Ginecol

    (2004)
  • E. Carmina

    Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines

    Minerva Ginecol

    (2004)
  • L. Silveira et al.

    Metabolic syndrome: criteria for diagnosing in children and adolescents

    Endocrinol Metab Synd

    (2013)
  • S. Cook et al.

    Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994

    Arch Pediatr Adolesc Med

    (2003)
  • N.C.E.P.N.E. Panel

    Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III) final report

    Circulation

    (2002)
  • G. Alberti et al.

    The IDF consensus definition of the metabolic syndrome in children and adolescents

    Int. Diabetes Fed.

    (2007)
  • Cited by (0)

    This systematic review and meta-analysis has been written by Nur Ezza Fazleen Mohd Fathil in partial requirement of the Master of Public Health and was supervised by Dr Abdullah Mamun, Associate Professor of Biostatistics and Epidemiology and Professor Maxine Whittaker, Professor of International and Tropical Health. A manuscript of this study is under consideration for publication.

    View full text