Leptin-to-Adiponectin, Adiponectin-to-Leptin Ratios, and Insulin Are Specific and Sensitive Markers Associated with Polycystic Ovary Syndrome: A Case-Control Study from Bahrain

Objective: Hyperinsulinemia and adipokines such as leptin and adiponectin with respective proatherogenic and antiatherogenic properties are reported to be the major contributors to pathogenesis of polycystic ovary syndrome (PCOS), including to the development of type 2 diabetes and coronary artery disease. In this study, the association of hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, high leptin-to-adiponectin (L/A) and adiponectin-to-leptin (A/L) ratios as risk factors associated with PCOS in Bahraini women was investigated. Participants and Methods: Serum levels of insulin, leptin, adiponectin, cholesterol, triglyceride, A/L and L/A ratios were compared in women with PCOS and controls to investigate tentative and potential diagnostic markers for women with PCOS. Results: Insulin was significantly higher in PCOS cases than controls (15.0 +/- 3.0 vs. 6.5 +/- 1.72, P < 0.001). Leptin was significantly higher in PCOS cases than in controls (39.9 +/- 4.6 vs. 26.4 +/- 3.4, P < 0.001), whereas adiponectin was significantly lower in PCOS cases than in controls (8.7 +/- 3.0 vs. 11.1 +/- 3.6, P < 0.001). In addition, L/A ratios were significantly higher in PCOS cases than in controls (4.8 +/- 2.7 vs. 2.3 +/- 1.6, P < 0.001), whereas A/L ratios were significantly lower in PCOS cases than in controls (0.25 +/- 0.08 vs. 0.50 +/- 0.1, P < 0.001). In multivariate logistic regression analyses, insulin [odds ratio (OR) = 2.1, confidence interval (CI) 1.2-3.8, P = 0.01], A/L (OR = 1.6, CI 1.4-7.2, P = 0.03), and L/A (OR = 1.4, CI 1.2-2.0, P = 0.04) were independently associated with PCOS. Receiver operating characteristic analyses showed that the best predictive markers for PCOS were insulin [area under the curve (AUC) = 0.937, CI 0.887-0.989] L/A and A/L ratios (AUC = 0.861, CI 0.786-0.936), indicating their high sensitivity and specificity for diagnosis of PCOS. Conclusion: In Bahraini women with PCOS, insulin, L/A, and A/L ratios seem to be the best markers to distinguish women with and without PCOS.