Comparison of Clinical, Metabolic, and Hormonal Profiles in Obese Versus Lean Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.
Fatema Tuz Zahura Aalpona, Apurba Sarker, Lutfun Nahar et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared clinical, metabolic, and hormonal profiles in obese and lean women with polycystic ovary syndrome (PCOS). It included 42 studies with 5363 participants (3078 obese and 2285 lean). Obesity was associated with greater reproductive and metabolic abnormalities; for example, metabolic syndrome was more prevalent in obese than lean PCOS (51.2% vs. 11.9%; RR 3.59). Lean women with PCOS also had substantial reproductive and metabolic burdens, so the findings do not imply absence of risk in this group.
Key findings
- Metabolic syndrome was more prevalent in obese than lean PCOS (51.2% vs. 11.9%; RR 3.59).
- Diabetes prevalence was 8.6% in obese versus 2.7% in lean PCOS (RR 2.58).
- Acanthosis nigricans was more prevalent in obese than lean PCOS (52.7% vs. 22.6%; RR 1.94).
- Obese PCOS was associated with higher HOMA-IR and glucose levels, and a less favourable lipid profile.
Why it matters
The comparison highlights that obesity in PCOS is associated with a greater burden of reproductive and cardiometabolic abnormalities, while lean PCOS is not free of these concerns. Recognising this distinction can inform clinical assessment of risk across body-size groups, without treating the pooled associations as proof that obesity caused the differences.
What to keep in mind
The included studies were observational, and substantial heterogeneity across several outcomes warrants cautious interpretation.