visceral adiposity index among diagnosed …mean bmi & vai among young adolescent girls bmi vai...

Visceral Adiposity Index (VAI) among Adolescent PCOS cases & its association with

Phenotypes and Metabolic Risk

Dr. Beena JoshiScientist E (Deputy Director)

Department of Operational ResearchNational Institute for Research in Reproductive Health

Indian Council of Medical ResearchMumbai

Background

• A community based study among adolescents and young girls aged 15-24 years in a defined geographical area of Mumbai estimated the prevalence of PCOS to be 22.5% using Rotterdam Criteria and 10.7% using AES Criteria

• Among them 71% were non obese and belonged to mild phenotypes

• Only one case was diagnosed with Metabolic Syndrome

• About 19% had hyperinsulinemia

• It was challenging to motivate these young non obese girls into healthy lifestyles -LFU

• Dilemma to assess their cardio-metabolic risk

Literature Review

• While majority of PCOS present with obesity, there are several reports of lean PCOS in India

• Although lean cases may not have excess subcutaneous fat, it is imperative to measure their visceral fat

• Body Mass Index (BMI) does not measure visceral adiposity

• Waist circumference most commonly used to identify visceral adiposity, does not differentiate between visceral and subcutaneous fat

• MRI and CT are now considered the gold standard for the quantitative evaluation of Visceral and Subcutaneous Adipose Tissue

• Since these two methods are extremely expensive and complicated to perform, they cannot be recommended in routinely clinical practice

Visceral Adiposity Index

• Visceral Adiposity Index (VAI) is a simple surrogate maker of visceraladipose dysfunction and it can be used as a useful predictor ofunhealthy PCOS phenotypes in low resource settings.

• It is indicative of fat distribution and function and a better predictivepower for incident diabetes events than its individual components suchas WC, BMI, TG and HDL (

• Calculated using both anthropometric and functional parameters

• In general conditions, a VAI>2.53 indicated metabolically unhealthy fat.

• VAI greater than 1.67 for detecting metabolic syndrome among PCOSwomen

M. C. Amato and C. Giordano. Galia et al. 2013

Objectives

• To estimate VAI and BMI cases among adolescents withdifferent PCOS phenotypes

• To estimate the risk of metabolic disorders using VAI amongdifferent phenotypes of PCOS

• To compare the overall diagnostic performance of VAI, BMIand waist circumference in the sampled population of younggirls aged 15-24 yrs

Limitations of VAI estimations

• Caucasian populations• >16 years

Mean BMI & VAI among Young Adolescent Girls

BMI VAI

Mean 21.39 + 4.68 2.9 + 1.05

Analysis

Secondary data of 106 PCOS and 121 Non-PCOS cases which had all theparameters to measure VAI. Therefore a total sample of 227 was analyzed.61% were non obese PCOS

PCOS Controls

BMI21.78 21.06

VAI 3.02 2.81

VAI among BMI categories of PCOS

VAI

BMI Mean N P-value

Under weight (<18) 2.72 + 0.80 23 0.65

Normal(18-23) 2.94 + 1.04 46

Over weight (23-25) 2.6 + 1.09 10

Obese(>25) 2.73 + 0.64 27

Total 2.81 + 0.90 106

BMI

TotalP-

valueNon-Obese Obese/Overweight

VAINormal 1.4% 8.1% 3.8%

0.121Abnormal* 98.6% 91.9% 96.2%

*Ref Value 1.67

VAI and Phenotypes

Phenotypes

Mild Frank Classic Ovulatory Total

VAI

NormalN 2 1 0 1 4

% 2.6% 14.3% 0.0% 7.1% 3.8%

AbnormalN 76 6 7 13 102

% 97.4% 85.7% 100.0% 92.9% 96.2%

Amato M.C 2011 oligomenorrhic phenotypes

BMI vs Phenotypes

Phenotypes

Mild Frank Classic Ovulatory Total

BMI

Non-

Obese

N 55 3 6 5 69

% 70.5% 42.9% 85.7% 35.7% 65.1%

ObeseN 23 4 1 9 37

% 29.5% 57.1% 14.3% 64.3% 34.9%

Independent Variables Sig. Adj. OR95% C.I.

L.I U.I

VAI 0.00 5.532 2.395 12.782

BMI 0.075 1.313 0.973 1.771

Waist circumference 0.851 1.009 0.918 1.109

HOMA values 0.7 1.131 0.604 2.119

Risk of Metabolic syndrome among PCOS cases

A unit increase in VAI score is associated with 5.23 times higher risk of metabolic syndrome (AOR: 5.23, 95% CI: 2.261-12.086)

>80th percentile of normal values- Risk of MS


L.I U.I

VAI 0.001 6.534 2.192 19.474

BMI 0.582 1.183 0.651 2.149


HOMA values 0.642 1.254 0.484 3.25

Risk of Metabolic syndrome among Lean PCOS cases

Comparison Of The Overall Diagnostic Performance Of VAI, BMI

And Waist Circumference To Identify VAD Among PCOS Cases-

Rotterdam Criteria

Diagnostic test Cut-Off Sensitivity Specificity

VAI - literature 1.67 1 0.06

VAI- study 2.73 0.76 0.699

BMI 23.05 0.47 0.77

Waist circumference 79.5 0.61 0.685

ROC analysis cut-off for metabolic disorders

among PCOS cases

Comparison Of The Overall Diagnostic Performance OfVAI, BMI And Waist Circumference To Identify VAD Among

Lean PCOS Cases

Diagnostic test Cut-Off Sensitivity specificity

VAI- literature 1.67 1 0.02

VAI- study 2.81 0.82 0.71

BMI 21.57 0.09 0.91

Waist circumference 70.5 0.82 0.42

ROC analysis cut-off for metabolic disorders among lean PCOS cases


L.I U.I

VAI 0.002 8.287 2.183 31.465

BMI 0.53 1.081 0.848 1.379


HOMA values 0.653 1.137 0.65 1.987

Risk of Metabolic Disorders Using VAI among PCOS cases according to VAI cut-off of 2.73

Independent

VariablesSig. Adj. OR

95% C.I.

L.I U.I

BMI 0.775 1.07 0.674 1.697

Waist

circumference0.268 1.077 0.945 1.227

HOMA values 0.457 1.339 0.62 2.896

VAI 0.011 9.869 1.676 58.107

Risk of Metabolic Disorders Using VAI among lean PCOS cases-Rotterdam criteria according to

VAI cut-off of 2.81

Conclusions

• Need to validate cutoffs among different age groups using good PCOS and matched controls

• Validate it with markers-free fatty acids, adiponectin etc

• Nevertheless it is a good tool to motivate non obese PCOS women to get into a healthy lifestyle

Acknowledgements

• Director, Dr. Smita Mahale

• Research team and colleagues at NIRRH

• Dr. Rama Vaidya

• Ms. Tejal Lakhan- IIPS Student

THANK YOU

Results:

• Findings from a study among adolescent PCOS where almost 61% were lean PCOS reveal that mean VAI among PCOS was significantly higher than normal controls. Mean VAI levels did not differ between different BMI parameters.

• Using VAI we found that Ovulatory, Frank and Mild phenotype of PCOS have highest metabolic risk. A unit increase in VAI score is associated with 5.23 times higher risk of metabolic syndrome (AOR: 5.23, 95% CI: 2.261-12.086).

• Our population demonstrated that a higher VAI with cut off value of 2.81 with sensitivity of 0.82 and specificity of 0.71 to predict risk of metabolic syndrome unlike the western figure of 1.67.

• The above findings highlight the need to emphasize that all women with PCOS should be screened for metabolic syndrome, educated about these complications and managed appropriately.

Conclusion:

• BMI cannot differentiate between Metabolically Healthy PCOS and

Metabolically Unhealthy PCOS.

• VAI is important to detect metabolically unhealthy PCOS among lean cases

who are generally waived off from healthy lifestyle programs.

• Hence screening all cases of PCOS irrespective of whether they are obese or

non-obese for cardio-metabolic risks is important.

• Screening programs should be initiated for the ovulatory phenotype of PCOS

as they do not have any major presenting menstrual complaints.

• VAI cut-off of 2.73 better predicts the risk of cardio metabolic disorder in the

study population

Phenotypes

Waist

circumferen

ce

Blood

Sugar

Fasting

Blood

Pressure-

systolic

Blood

Pressure-

diastolic

HDLTriglycerid

e

HOMA

Values

Controls77.48+11.03 72.68+7.26

110.45+11.6

872.04

45.39+10.2

7

67.89+17.9

9

2.67+1.0

8

121 120 112 112 121 121 108

Mild 79.32+13.03 71.50+5.83

111.97+10.9

073.1+7.48 45.15+9.80

64.04+12.7

6

2.94+1.1

4

76.00 74.00 71.00 71.00 76.00 76.00 74.00

Frank 80.5+15.27 70.33+5.24 112+8.37 74+5.48

40.07+11.0

5

64.62+16.1

6

3.03+0.6

7

6.00 6.00 5.00 5.00 6.00 6.00 5.00

Classic 73.29+10.52 70.83+13.26 110+8.94 75+5.48 46.37+7.10 55.27+9.66

3.35+1.7

1

7.00 6.00 6.00 6.00 7.00 7.00 3.00

Ovulatory 83.39+11.98 71.64+3.91 107.5+16.03 75+6.74 45.92+9.64

72.01+11.9

72.4+1.58

13.00 11.00 12.00 12.00 13.00 13.00 11.00

visceral adiposity index among diagnosed …mean bmi & vai among young adolescent girls bmi vai...

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