Waist circumference,hip circumference,arm span,and waist-to-hip ratio high risk of polycystic ovarian syndrome

Abstract

Background and Aims

Polycystic ovarian syndrome is a reproductive problem of women with high prevalence cases accompanied by obesity conditions. Obesity condition can be seen from the size of waist circumference, hip circumference, arm span, and waist-to-hip ratio. This study aims to find out the risk factors between waist circumference size, hip circumference, arm span, and waist-to-hip ratio with polycystic ovarian syndrome.

Methods

This research is an analytical observation using a case-control approach conducted at Sekar Fertility Clinic and Poly Obgyn Dr Moewardi General Hospital Surakarta. Subjects were 150 consisting of 75 polycystic ovarian syndrome women and 75 normal fertile women. Sampling techniques used in this study are purposive sampling, researchers doing anthropometric measurements in the form of waist circumference, hip circumference, arm span, and waist-to-hip ratio simultaneously. The results were analyzed using Statistic Product and Service Solution 25.

Results

The results of the study obtained waist circumference with polycystic ovarian syndrome (b = 3.002; CI 95% = 3.41–123.5; p = 0.001), hip circumference (b = −2.671; CI 95% = 0.01–0.37; p = 0.002), arm span (b = 5.318; CI 95% = 32.23–129.58; p < 0.001) and waist-to-hip ratio (b = 1.761; CI 95% = 1.02–33.01; p = 0.047).

Conclusion

Waist circumference size, hip circumference, arm span, and waist-to-hip ratio correlate to a high risk of polycystic ovarian syndrome. Arm span is more dominant as an indicator of high risk to polycystic ovarian syndrome compared to waist circumference, hip circumference, and waist-to-hip ratio.

Keywords

Obesity polycystic ovary syndrome waist circumference waist-to-hip ratio

Introduction

Polycystic ovarian syndrome (PCOS) is a reproductive problem of women with high prevalence cases accompanied by obesity conditions.¹ Obesity is defined as an accumulation disease of excess body fat due to impaired food intake and energy consumption. Obesity can be seen from the size of the waist circumference, hip circumference, and waist-to-hip ratio (WHR). Obesity is also included in the risk factors for subfertility.² It is characterized by chronic anovulation, oligomenorrhea or amenorrhea, hyperandrogenism, and polycystic ovarian morphology.^3,4 Women with PCOS experience increased weight and body fat.⁵ The anthropometric examination can be used as one of the initial efforts to determine the condition of PCOS.⁶ Polycystic ovary syndrome is closely related to a combination of genetic and environmental factors that can be found in all women of different ages but is common in women of reproductive age.^7–10 Increased waist circumference is associated with increased predictive body mass index (BMI) value.¹¹ PCOS in adolescence occurs menstrual irregularities, increased waist circumference, impaired glucose tolerance (IGT), subclinical atherosclerosis characterized by changes in visceral fat, and epicardial fat thickness.⁶ Women with PCOS are at risk for myocardial infarction, due to the prevalence of glucose intolerance, hypertension, insulin resistance, central obesity, and dyslipidemia.¹² Changes in PCOS lipid levels are characterized primarily by increased triglycerides and decreased levels of high-density lipoprotein (HDL). Most of the atherogenic lipoprotein patterns in PCOS have been linked to obesity.¹² Criteria for metabolic syndrome in adolescents lead to adult criteria including increased high triglyceride concentration, increased concentration of high HDL cholesterol, fasting blood glucose 110 mg/dL, increased waist circumference, and hypertension.⁸ Increased WHR and BMI, will be at risk of developing various diseases, including hypertension, diabetes, cancer, fertility problems, and depression.¹³ Evidence of a link between WHR with PCOS shows that patients with a BMI of > 24 kg/m2 experienced an increase in the number of follicles or multi follicular's, an increase in the total dose of gonadotropin used, and a lower number of eggs produced.^6,8,14 Accumulation of excess fat will affect the size of the WHR of a person. There is a high correlation between waist-hip circumference ratio and visceral fat. WHR to identify people who have higher visceral fat and are at high risk of disease.⁸

WHR >0.8 is significantly related to PCOS and may reflect its effect on patients in the form of the clinical picture, metabolic disorders, and endocrine profile.^7,15 Research is needed to determine the risk factors between waist circumference, hip circumference, arm span, WHR to examine risk factors, anthropometric factors, and body composition in PCOS.

Methods

This research is observational analytics using a case-control approach conducted in July - September 2020 at Sekar Fertility Clinic and Poly Obgyn Dr Moewardi General Hospital Surakarta. The study subjects were 150 women who had signed consent consisting of 75 PCOS women and 75 normal fertile women. The subjects of this study were PCOS patients and normal fertile women who met inclusion criteria: Patients with PCOS diagnosis with Rotterdam criteria: anovulation/oligo, hyperandrogenic and polycystic images of one or two ovaries, normal fertile women patients, patients with a reproductive age of 25–49 years. In this study, testosterone levels were not seen, but it was seen that in PCOS clinical signs of hyperandrogenic such as hirsutism (abnormal hair growth and pattern-like in men, the assessment of hirsutism was based on Ferriman-Gallwey (FG) scores ≥ 8 and ≥ 5 for Asian subjects.^16,17 Exclusion criteria: patients with cardiovascular disorders, patients who used hormonal contraceptives in the last 6 months. The sampling technique used in this study is purposive sampling which is a non-random sampling technique using researchers measuring anthropometrics in the form of size of waist circumference, hip circumference, arm span, and WHR simultaneously in both groups. Waist circumference is obtained using a measurement of the circumference length measured at the smallest circumference between crista illiaca and costa XII. Hip circumference using a measurement of the maximum circumference length measured starting from the buttocks and the top symphysis ossis pubis. The arm span is the length between the right and left hands that by stretching both hands beside the body, then measured using a measuring tape. WHR is obtained by calculating the ratio between waist circumference and hip circumference. The measuring instrument used a non-elastic meter band with a precision of 1 mm and a unit of measurement in cm. In the Asian population, the cut-off value of waist circumference in men is ≥ 90 cm and in women ≥ 80 cm.¹⁸ hip circumference cutoff is 104.5 hip circumference cutoff is ≥ 100.¹⁹ Based on the Indonesian anthropometry recap shows that the normal value of a woman's arm span at reproductive age is about 150 cm. WHR cutoff in women is < 0.85.²⁰ The results were analyzed using the Chi-Square method and Logistic Regression using Statistic Product and Service Solution (SPSS) (Version 21.0; IBM Corp., Armonk, NY, USA), with a significance of p values < 0.05.

Ethical clearance

This study was approved by the ethical health research commission of the Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia, Number: 088/ UN27.06.6.1/ KEPK/ 2020, dated July 20, 2020.

Results

(Table 1.)

Table 1.

Bivariate analysis of waist circumference, hip circumference, arm span, and waist-to-hip ratio with PCOS.

		PCOS		Normal Fertile Women		OR	p-value
Characteristics		n	%	N	%
Waist circumference	< 85 cm	21	30	49	70	20.52	< 0.001
Waist circumference	≥ 85 cm	54	67.5	26	32.5
Hip circumference	≥ 100 cm	48	72.7	18	27.3	0.069	< 0.001
Hip circumference	< 100 cm	27	32.1	57	67.9
Arm span	≥ 150 cm	4	6.25	60	93.75	203.9	< 0.001
Arm span	< 150 cm	71	82.6	15	17.4
Waist-to-hip ratio	≥ 0.85	60	81.1	14	18.9	5.187	< 0.001
Waist-to-hip ratio	< 0.85	15	19.7	61	80.3

PCOS: polycystic ovary syndrome; OR: odds ratio.

Women with waist circumference ≥ 85 cm were 20.52 times more likely to have PCOS (OR = 20.52; p < 0.001). Hip circumference ≥ 100 cm were 0.069 times more likely to have PCOS (OR = 0.069; p < 0.001). Women with arm span < 150 cm were 203.9 times more likely to have PCOS (OR = 203.9; p <0.001). WHR of ≥ 0.85 was 5.187 times more likely to have PCOS (OR = 5.187; p < 0.001).

(Table 2.)

Table 2.

Results of logistic regression analysis of, waist circumference, hip circumference, arm span and waist-to-hip ratio with PCOS.

Independent Variables	b	95% CI		p
Independent Variables	b	Lower	Upper	p
Waist circumference ( ≥ 85 cm)	3.002	3.41	123.5	0.001
Hip circumference (< 100 cm)	−2.671	0.01	0.37	0.002
Arm span (< 150 cm)	5.318	32.23	129.58	<0.001
Waist-to-hip ratio ( ≥ 0.85)	1.761	1.02	33.01	0.047
N observation = 150
Nagelkerke R-Square = 83.2%

Table 2 showed that risk PCOS increase with waist circumference size ≥85 cm (b = 3.002; 95% CI = 3.41 to 123.5; p = 0.001). Decrease with hip circumference size < 100 cm (b = −2.671; 95% CI = 0.01 to 0.37; p = 0.002). Increase with arm span size < 150 cm (b = 5.318; 95% CI = 32.23 to 129.58; p < 0.001). Increase WHR size ≥ 0.85 (b = 1.761; 95% CI = 1.02 to 33.01; p = 0.047).

Discussion

The main causes of obesity in PCOS patients are excessive daily intake of carbohydrates, a diet high in glycemic, high in saturated fats, and lack of exercise.²¹ Weight loss of 5–10% can lead to decreased serum testosterone levels, return of normal ovulation cycle, reduce cardiometabolic risk factors, improve menstrual function, and increase the pregnancy success rate.¹ PCOS can be addressed by reducing the risk of long-term metabolism, severity, overweight, and obesity leading to exacerbation of endocrine metabolic disorders and reproductive metabolism.^22,23 From the results of the study obtained WHR ≥ 0.85 is significantly related to PCOS. In line with other studies, WHR > 0.8 is significantly related to PCOS and may reflect its effect on patients in the form of the clinical picture, metabolic disorders, and endocrine profile.^7,15 Based on the results of the logistic regression test on variable WHR has a significance of 0.047.

Central obesity with a waist circumference ≥ 88 cm in women defined by the American Heart Association (AHA)/National Heart Lung Blood Institute (NHLBI) Adult Treatment Panel (ATP) III in 2001 as one of the risk factors for metabolic syndrome.^3,24 The results of this study support the theory, based on the table of logistics regression test results showed the significance of the variable waist circumference ≥ 85 cm. BMI of women with PCOS has a high prevalence of obesity indicated by an increase in waist circumference and a greater WHR compared to women in control.²⁵

Increased waist circumference and hip circumference are associated with increased PCOS.⁶ Subcutaneous and visceral fat topography in women with PCOS have more adipose tissue mass in the abdominal area, waist than normal women.^22,26,27 In this study, hip circumference size ≥ 100 cm more likely to have PCOS. This happens because the accumulation of excess fat associated with increased androgens and hyperinsulinemia in PCOS patients will affect the size of a person's waist and pelvis circumference. The increase in androgens can form the accumulation of fat at certain locations and increase the excretion of inflammatory cytokines and cause the metabolic processes of PCOS sufferers to be disrupted.^28,29 High androgens can cause unfavorable metabolic disorders, dyslipidemia, and the central distribution of fats. For obese women, excess insulin and androgens may contribute to the development of PCOS and metabolic syndrome.³ In the arm span < 150 cm more likely to have PCOS. There was a weak positive correlation found between BMI, waist circumference, and hip circumference.²⁸ Women who are infertility with PCOS have a higher percentage of visceral fat, waist circumference, hip circumference, total body fat, total subcutaneous fat, stem subcutaneous fat, arm subcutaneous fat, leg subcutaneous fat ratio, stem/peripheral fat ratio, BMI, and high diastolic blood pressure.²⁴

Novelty: in this case researchers looked for which results were referred to as indicators of high risk to PCOS. It was found that arm span is more dominant as an indicator of high risk to PCOS with (b = 5.318; 95% CI = 32.23 to 129.58; p < 0.001) compared to waist circumference, hip circumference, and WHR.

Conclusion

Waist circumference size, hip circumference, arm span, and waist-to-hip ratio correlate to a high risk of PCOS. Arm span is more dominant as an indicator of high risk to PCOS compared to waist circumference, hip circumference, and WHR.

Limitations

In this study, hormonal testosterone levels were not included and androgen levels were seen from clinical androgen signs.

Authors’ contribution

Tazkia Mawaddatina, Uki Retno Budihastuti, Dwi Rahayu: conception and design of study.

Tazkia Mawaddatina: acquisition of data.

Tazkia Mawaddatina: analysis and/or interpretation of data.

Uki Retno Budihastuti: drafting the manuscript.

Tazkia Mawaddatina, Uki Retno Budihastuti, Dwi Rahayu: approval of the version of the manuscript to be published.

Footnotes

Acknowledgments

The researchers thanked Director Dr Moewardi General Hospital, Dr Cahyono Hadi, dr, Sp.OG (K) and Dr Adrianes Bachnas, dr, SpOG (K) for their support in this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Uki Retno Budihastuti

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