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288 South Asians With PCOS -
Metabolic Risk in Future Generation

Comparisons with other medical conditions and gy- Hypertension in PCOS
naecological populations have also yielded partic- In South Asians,Interestingly, their larger waist cir-
ularly low scores on psychological well-being and cumference is linked to greater IR but not hypertri-
quality of life for women with PCOS
glyceridemia. We recommend a study of pregnan-
Overall, there has been a great paucity of research cy-induced hypertension in women with PCOS from
comparing the influence of ethnicity or cultural back- differing ethnic origins. This is likely to shed more
ground on HRQoL in women with PCOS. Two studies light on the less understood long-term cardiovascular
have tentatively explored this relationship. However, risks of PCOS.
this was inter-country research and the impact of cul-
tural, social and economic differences between the Metabolic risks & Hyperandrogenism of
two countries is unexplained. Twenty percent of the PCOS
world’s population are South Asian.
The relationship between HA and metabolic pheno-
The metabolic phenotypic differences of PCOS ob- type also shows ethnic variation. Yet, their hyperan-
served in Asians include: drogenemia is independently associated with a five-
fold risk of developing T2DM. However, the direct
• Indigenous south Asians, at a younger age and
with a lower BMI (26 kg/m ) have greater meta- relationship between metabolic problems and HA
2
bolic derangement than older, obese white cau- was not mirrored in the cohort of indigenous south
casians; their central obesity rather than BMI cor- Asians their metabolic problems being similar among
relating with metabolic manifestations; all phenotypic subgroups of PCOS with and without
HA. In fact, their degree of obesity was noted to
• However, they have the highest prevalence of be related to the occurrence of oligo-amenorrhea, .
MetS (50%) women with obesity, where obesity and metabolic
problems do not correlate in a linear fashion with HA.
• Indigenous Thai women with PCOS (mean BMI
2
of 27 kg/m ) have similar prevalence of MetS to Such variations based on ethnicity in the susceptibil-
south Asians at a slightly older age. ity of PCOS to metabolic derangement that is seem-
ingly independent of the HA of PCOS must be noted,
These highlight that central obesity rather than BMI
(based on standard cutoff of 30 kg/m ) affects the in that the less apparent hirsutism must not discour-
2
metabolic issues of PCOS in Asians; thus the need to age the practitioner from suspecting PCOS. There-
measure waist circumference rather than BMI alone. fore, utilizing an ethnic-appropriate cutoff level for FG
and diagnostic definition of PCOS must be chosen
in order to optimally benefit individual patients of a
Low SHBG in PCOS
given population, as well as for comparison of data
Sex hormone-binding globulin (SHBG) is significantly from different geographic regions and self-identified
lower in affected south Asians compared with their ethnicities.
white European counterparts. Since SHBG is lowered
by hyperinsulinemia and considered a surrogate Ethnicity is a factor that determines the degree of
marker of IR,. Therefore, it is logical to encourage life- hyperandrogenism and warrants measuring plasma
style modification and weight reduction upon diag- androgens, having defined the cutoff based on eth-
nosis of PCOS in these ethnic groups, even though nically matched normal women (women unaffected
they have a ‘lower’ BMI. by PCOS). The degree of obesity must also be tak-
en into account, along with its impact on androgen
Acanthosis Nigricans & Family History of Diabetes metabolism. This aspect needs further elucidation, in
in PCOS particular among differing ethnic groups.
A common clinical sign of IR is acanthosis nigricans.
A large cohort of Sri Lankan women with PCOS re- Psychosocial Impact of PCOS
vealed acanthosis nigricans as an important predictor PCOS causes significant psychological distress and
of the MetS-complicating PCOS. This supports the leads to poor health-related Quality of Life in wom-
recommendation to adopt a policy of training primary en due to their physical, reproductive and metabolic
healthcare givers in Asia, on the need to evaluate effects. While western women have poor QoL due to
young woman complaining of irregular menses and obesity, it is different in others, with the main cause
HA with or without infertility for PCOS, which must being infertility and hirsutism among Arab wom-
also be perceived as a long-term metabolic risk. en and hirsutism in south Asians. The likely cause
may be sociocultural factors, with obesity being per-

GCDC 2017