Sex hormone-binding globulin, oligomenorrhea, polycystic ovary syndrome, and childhood insulin at age 14 years predict metabolic syndrome and class III obesity at age 24 years

Charles J Glueck; John A Morrison; Stephen Daniels; Ping Wang; Davis Stroop

doi:10.1016/j.jpeds.2011.01.018

Reproductive Endocrinology · Ovarian Hormones

Sex hormone-binding globulin, oligomenorrhea, polycystic ovary syndrome, and childhood insulin at age 14 years predict metabolic syndrome and class III obesity at age 24 years

Glueck CJ, Morrison JA, Daniels S, Wang P, Stroop D

Published August 2011 The Journal of pediatrics, 159(2), 308-13.e2

DOI 10.1016/j.jpeds.2011.01.018 PMID 21362574 PMC PMC3418049

RRM Academy Synopsis

PCOS at age 14 was linked to metabolic syndrome at age 24

Girls with PCOS at age 14 more often had metabolic syndrome at age 24. In a Cincinnati cohort, 12 girls met the definition of polycystic ovary syndrome (PCOS, now called PMOS, polyendocrine metabolic ovarian syndrome). About 3 out of 10 had metabolic syndrome at 24, against fewer than 1 out of 10 of 333 girls without long cycles.

Key Findings

Sex hormones were measured at age 14 in 493 girls (237 white, 256 black). Metabolic syndrome status at age 24 was known for 420 of them.
PCOS was defined in 12 of 30 girls with cycles of 42 days or longer. By age 24, 4 of those 12 (33%) had metabolic syndrome and 4 (33%) Class III obesity.
Among girls without such long cycles, metabolic syndrome affected 7.8% (26/333, p=.014) and Class III obesity 8.4% (29/345, p=.018).
Four early factors independently predicted metabolic syndrome at age 24 (AUC =0.826): childhood insulin, metabolic syndrome, bottom-decile SHBG and PCOS category.
For long cycles (42 days or longer) at age 14, free testosterone was the only significant variable (odds ratio 1.90, 95% CI 1.22-2.95).

Interpretation

This prospective cohort study follows girls from age 14 to about age 24 and reports associations. The design cannot show that PCOS or low sex hormone-binding globulin (SHBG) caused later metabolic syndrome. Twelve girls met the PCOS definition, which lacked pelvic ultrasound data. The cohort included Black and white girls only. More white than Black girls were left out of the regression models for missing data, and predictors were measured at different ages. The authors call these factors potentially reversible pathways. The study tested no treatment.

RRM Context

The authors advise assessing insulin, sex hormones and PCOS when long cycles appear in adolescence. Restorative reproductive medicine treats the cycle as a vital sign, so long cycles in a teenager prompt a search for the underlying cause. This cohort adds ten years of follow-up that connects that early signal with later metabolic outcomes.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

We hypothesized that oligomenorrhea (menstrual cyclicity ≥42 days), hyperandrogenism, low levels of sex hormone-binding globulin (SHBG), childhood insulin, and metabolic syndrome (MetS) at age 14 years would predict MetS and class III obesity (body mass index ≥40 kg/m(2)) at age 24 years.

Study Design

In this prospective study of schoolgirls, at age 14 years, the girls were categorized as regularly cycling (n = 375), oligomenorrheic (n = 18), or oligomenorrhea plus biochemical hyperandrogenism (polycystic ovary syndrome [PCOS]; n = 12), together designated PCOS.

Results

Significant explanatory variables for MetS at age 24 years included childhood insulin, MetS, and PCOS category (all positive) and SHBG (negative) at age 14 years. Using categorical data, top decile of childhood insulin, MetS at age 14, bottom decile of SHBG, and PCOS category were significant positive predictors for MetS at age 24. SHBG (negative), black race (positive), and oligomenorrhea (positive) were significant explanatory variables for class III obesity at age 24. Using categorical data, black race, MetS at age 14, bottom decile of SHBG, PCOS category, and top decile of childhood insulin were positive explanatory variables for class III obesity at age 24 years.

Conclusions

Oligomenorrhea, PCOS (a subcohort of oligomenorrhea), hyperandrogenism, low SHBG, MetS, and childhood insulin at age 14 years may represent a critical, reversible pathway for the development of MetS and class III obesity in young adulthood.

Topics

Reproductive Endocrinology › Ovarian Hormones › Androgens · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · PMOS / PCOS › Long Term Health › Metabolic Risk

Charles J Glueck, John A Morrison, Stephen Daniels, Ping Wang, Davis Stroop

Charlie Glueck, Chuck Glueck, C Glueck, Jack Morrison, J Morrison, Steve Daniels, S Daniels, P Wang, D Stroop

PMID 21362574 21362574 DOI 10.1016/j.jpeds.2011.01.018 10.1016/j.jpeds.2011.01.018 Glueck et al. 2011, Glueck 2011

Sex hormone-binding globulin, oligomenorrhea, polycystic ovary syndrome, and childhood insulin at age 14 years predict metabolic syndrome and class III obesity at age 24 years

PCOS at age 14 was linked to metabolic syndrome at age 24

Key Findings

Interpretation

RRM Context

Abstract

Topics

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