Accepted on 06 Aug 2019
Submitted on 06 Aug 2019
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.
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.
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).
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.
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 |
Statistical Support Provided by the Department of Pediatrics-Icahn School of Medicine at Mount Sinai.
