Lean Adolescents With PCOS Show Increased Adipose Dysfunction and Insulin Resistance: Study

While PCOS is typically associated with obesity, a growing body of data suggests that metabolic risk may extend beyond those with excess body weight. This study was carried out as part of Project Viva, a prospective prebirth cohort. PCOS status was determined at the mid-teen visit when participants, on average, were 17.7 years of age. A diagnosis of PCOS was based either on self-reported diagnosis or based on oligo-anovulation combined with clinical or biochemical hyperandrogenism.

Anthropometric measurements and dual-energy x-ray absorptiometry were used for growth and adiposity assessment. Participants were divided into two categories based on their body mass index: BMI ≥85th percentile and BMI <85th percentile. Within each BMI stratum, unadjusted linear regression models compared growth trajectories, measures of adiposity, and cardiometabolic biomarkers between adolescents with and without PCOS. Mixed effects models graphed the trajectories of BMI and linear growth over time.

Key findings

• Among 358 female adolescents with available mid-teen data, 51 participants (14%) met the criteria for PCOS.

• Of these, 27 adolescents with PCOS were in the BMI <85th percentile group, while the remaining participants were distributed across the higher BMI category.

• Among adolescents with BMI <85th percentile, those with PCOS experienced an earlier age at peak height velocity compared with peers without PCOS.

• The difference was statistically significant, with a β value of −0.57 years (95% CI −0.96 to −0.18). In adolescents with BMI <85th percentile, PCOS was associated with significantly higher insulin resistance.

• The Homeostatic Model Assessment of Insulin Resistance was elevated among those with PCOS (β = 0.77; 95% CI 0.23 to 1.30).

• Additionally, markers of adipose tissue function differed by PCOS status.

• The adiponectin-leptin ratio was significantly lower in lean adolescents with PCOS compared with those without PCOS (β = −0.35; 95% CI −0.65 to −0.06), indicating early adipose tissue dysfunction.

• Among females with BMI ≥85th percentile, cardiometabolic biomarkers were similar regardless of PCOS status.

This population-based study shows that young women with PCOS and a BMI below the 85th percentile have significant metabolic dysfunction, including insulin resistance and impaired adipose tissue signaling. This study confirms that PCOS cardiovascular risk is real and exists independently of body weight. There must be early metabolic screening of young women with PCOS.

Reference:

Rachel C Whooten, Sheryl L Rifas-Shiman, Izzuddin M Aris, Wei Perng, Jorge E Chavarro, Emily Oken, Marie-France Hivert, Adolescent “Lean PCOS” Is Characterized by Higher Insulin Resistance and Adverse Adipokine Profile, The Journal of Clinical Endocrinology & Metabolism, 2025;, dgaf606, https://doi.org/10.1210/clinem/dgaf606