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Prevalence and Risk Factors of Polycystic Ovarian Syndrome Among an Ethnically Diverse Overweight/Obese Adolescent Population

Authors:

Jacqueline Maya ,

Women and Children’s Division, Department of Pediatrics, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, US
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Janet Siegel,

Division of Adolescent Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, US
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Tina Q. Cheng,

Division of Pediatric Endocrinology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, US
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Thaina Rousseau-Pierre

Division of Adolescent Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, US
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Abstract


How to Cite: Maya, J., Siegel, J., Cheng, T.Q. and Rousseau-Pierre, T., 2019. Prevalence and Risk Factors of Polycystic Ovarian Syndrome Among an Ethnically Diverse Overweight/Obese Adolescent Population. Journal of Scientific Innovation in Medicine, 2(2), p.23. DOI: http://doi.org/10.29024/jsim.38
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  Published on 21 Aug 2019
 Accepted on 06 Aug 2019            Submitted on 06 Aug 2019

Background

More remains to be known about polycystic ovary syndrome (PCOS) among overweight/obese adolescents across different ethnicity especially in regards to mental illness as an associated comorbidity.

Hypothesis/Aim

To determine the prevalence of PCOS among overweight and obese adolescents, to further evaluate known risk factors for PCOS in a diverse population, and to discern cardiovascular risk and mental health comorbidity.

Methods

Electronic medical records of patients at an Adolescent Clinic between April 1, 2016 and July 30, 2018 were filtered using the following: obese, overweight and BMI ≥85%. Charts were reviewed to identify the presence of PCOS using NIH criteria, race/ethnicity, and known risk factors for PCOS (lipid, BMI, HA1c, BP) and mental health conditions associated with PCOS (anxiety/depression and self-harm/suicidal ideation).

Results

Of the 451 charts reviewed, 447 were analyzed. Of those, 47% of adolescents were overweight, 53% were obese and 10.5% were diagnosed with PCOS. Ages ranged from 14 to 22 years with a median of 17 years. Patients were predominantly Hispanic (76.1%), and the majority of non-Hispanic patients were from South Asia (Pakistan, Bangladesh, and India). Patients with PCOS were more likely to be hyperlipidemic (19% vs 9.9%, p = 0.04) and obese (67.4% vs 50.9%) than those without PCOS and more likely to have acanthosis (68.9% vs 28.2%). Interestingly, PCOS was not more common among the Hispanic population –57.8% of Hispanic ethnicity with PCOS versus 77.9% of non- Hispanics. Although we were able to identify a significant percentage of our population with depression and anxiety, there was no difference in the prevalence of depression and anxiety with or without PCOS (37% vs 33%, respectively, p = 0.590). Reporting of self-harm and suicidal ideation were comparable in those with and without PCOS (17% vs 17%, p = 0.96). In a logistic regression model, after adjusting for all demographics and clinical features of interest, ethnicity, acanthosis and BMI were all significant risk factors for PCOS.

Conclusion

Patients with PCOS are more likely to be obese, have hyperlipidemia, have a diagnosis of acanthosis and be of Non-Hispanic ethnicity. However, there was no difference in the prevalence of depression/anxiety and self-harm/suicidal ideation among adolescents with or without PCOS.

Table 1

Demographics and Clinical Features of Obese and Overweight Adolescents.

Overweight and Obese Adolescents (N = 447)

No. Observed n (%)

PCOS 438 46 (10.5)
Ethnicity (Hispanic) 444 338 (76.1)
Elevated Lipids 439 49 (11.2)
Acanthosis 440 141 (32.0)
Hemoglobin A1c 386
    Normal 328 (85.0)
    Elevated (Pre-DM) 51 (13.2)
    Diabetes Mellitus 7 (1.8)
Weight Statusa 445
    Overweight 209 (47.0)
    Obese 236 (53.0)
Blood Pressure 443
    Normal 390 (88.0)
    Elevated BP 48 (10.8)
    Hypertension 5 (1.1)
Depression and/or Anxiety 445 148 (33.3)
Self-Harm and/or Suicidality 446 77 (17.3)

aAverage (±SD) for BMI was 30.1 ± 4.8; Median [IQR] for BMI was 29.1 [26.9, 32.7].

Table 2

Demographics and Clinical Features of Obese and Overweight Adolescents Stratified by PCOS status.

No PCOS (N = 392) PCOS (N = 46) p-value

No. Observed n (%) No. Observed n (%)

Ethnicity 390 45 0.003
Hispanic 304 (77.9) 26 (57.8)
Non-Hispanic 85(21.8) 19(42.2)
Elevated Lipids 384 38 (9.9) 46 9 (19.6) 0.05
Acanthosis 387 109 (28.2) 45 31 (68.9) <0.001
Hemoglobin A1c 337 42 0.02
    Normal 291 (86.4) 31 (73.8)
    Elevated (Pre-DM) 39 (11.6) 11 (26.2)
    Diabetes Mellitus 7 (2.1) 0 (0.0)
Weight Statusab 391 46 0.03
    Overweight 192 (49.1) 15 (32.6)
    Obese 199 (50.9) 31 (67.4)
Blood Pressure 389 46 0.70
    Normal 343 (88.2) 39 (84.8)
    Elevated BP 42 (10.8) 6 (13.0)
    Hypertension 4 (1.0) 1 (2.2)
Depression and/or Anxiety 391 129 (33.0) 46 17 (37.0) 0.59
Self-Harm and/or Suicidality 391 67 (17.1) 46 8 (17.4) 0.97

aAverage (±SD) for BMI was 29.8 ± 4.4 and 33.3 ± 6.6 in the no PCOS and PCOS group, respectively (t-test p-value <0.001).

bMedian [IQR] for BMI was 29.0 [26.7, 32.2] and 32.7 [28.6, 36.4] in the no PCOS and PCOS group, respectively (Wilcoxon rank-sum test p-value <0.001).

Table 3

Logistic Regression Model Results for PCOS (Yes v. No).

Clinical Features OR (95% CI) p-value

Ethnicitya (Hispanic) 0.31 (0.15, 0.66) 0.002
Elevated Lipids 1.33 (0.50, 3.54) 0.57
Acanthosis 2.84 (1.28, 6.29) 0.01
Hemoglobin A1cb (Pre-DM/DM) 1.49 (0.64, 3.47) 0.35
BMI 1.10 (1.02, 1.19) 0.01
Blood Pressurec
    Elevated BP 0.33 (0.10, 1.15) 0.08
    Hypertension 0.38 (0.03, 5.18) 0.47
Depression and/or Anxiety 1.79 (0.79, 4.06) 0.16
Self-Harm and/or Suicidality 0.86 (0.32, 2.31) 0.76

aReference set to “Non-Hispanic”.

bReference set to “Normal”; note that Pre-DM and DM were combined due to the lack of DM cases in the PCOS group.

cReference set to “Normal”.

Table 4

PCOS, Metabolic Abnormalities, Psychiatric Diagnosis Stratified by Ethnicity Status.

Hispanics Non Hispanics p-value

n (%) n (%)

PCOS 26 (7.8) 19 (18.2) 0.003
Obesity 18 (69.2) 12 (63.2) 0.670
Elevated Lipids 7 (26.9) 2 (10.5) 0.264
Acanthosis Nigricans 14 (56.0) 16(84.2) 0.05
Depression and/or Anxiety 11(42.3) 6 (31.6) 0.543
Self-Harm and/or Suicidality 6 (23.1) 2(10.5) 0.435

Acknowledgements

Statistical Support Provided by the Department of Pediatrics-Icahn School of Medicine at Mount Sinai.

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