Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2020; 11(2): 42-51
Published online Feb 15, 2020. doi: 10.4239/wjd.v11.i2.42
Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome
Chantal Anifa Amisi, Massimo Ciccozzi, Paolo Pozzilli
Chantal Anifa Amisi, Paolo Pozzilli, Endocrinology and Diabetes Unit, Department of Medicine, Universita Campus Bio-medico di Rome, Rome 00128, Italy
Massimo Ciccozzi, Medical Statistics and Epidemiology Unit, Department of Medicine, Universita Campus Bio-medico di Rome, Rome 00128, Italy
Author contributions: Amisi CA designed and performed the research, and wrote the paper; Amisi CA and Ciccozzi M analysed data; Pozzilli P made important intellectual contributions to the study design and supervised the study; Amisi CA and Pozzilli P revised the paper; the final manuscript draft was approved by all the authors.
Institutional review board statement: The Institutional Review Board of Università Campus Bio-Medico di Roma provided approval for this study.
Informed consent statement: Written informed consent was obtained from each subject before entry into the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Dataset can be provided by Chantal Anifa Amisi.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chantal Anifa Amisi, MD, PhD, Doctor, Senior Researcher, Endocrinology and Diabetes Unit, Department of Medicine, Universita Campus Bio-medico di Roma, via Alvaro del Portillo 21, Rome 00128, Italy. chantalamisi@yahoo.fr
Received: July 1, 2019
Peer-review started: July 1, 2019
First decision: August 2, 2019
Revised: November 27, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: February 15, 2020
Abstract
BACKGROUND

Insulin resistance (IR) is the main complication found in 35%-80% of women with polycystic ovary syndrome (PCOS). However, there is no definite consensus regarding which marker to use for its assessment in PCOS women. Research has shown that hyperinsulinemia is correlated with increased bone mass. Given that most women with PCOS are insulin resistant, which is independent from body fat and characterized by hyperinsulinemia, it could be hypothesized that there would be an increased bone mass in the patient as a result. Subsequently, increased bone mass could be measured using the wrist circumference method.

AIM

To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.

METHODS

Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group, were enrolled in the study (mean age 24.33 ± 5.36 years). Fasting biochemical parameters, and the Homeostasis Model Assessment of insulin resistance (HOMA-IR) and body composition were evaluated. The non-dominant wrist circumference was measured manually, as was the waist circumference (WC), hip circumference, height and weight. Calculated measures included evaluation of body mass index (BMI), Waist-to-Height (WHtR) and Waist-to-hip ratio (WHR). In addition, body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.

RESULTS

The non-dominant wrist circumference was more closely correlated with HOMA-IR (r = 0.346; P = 0.003) and was the best anthropometrical marker correlated with IR (P = 0.011 ) compared with other anthropometrical markers in women with PCOS: Dominant Wrist Circumference (r = 0.315; P = 0.007), Waist Circumference (WC) (r = 0.259; P = 0.028), BMI (r = 0.285; P = 0.016), WHR (r = 0.216; P = 0,068) and WHtR (r = 0.263; P = 0.027). The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.72. A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.

CONCLUSION

Non-dominant wrist circumference is, to date, the best anthropometrical marker of IR in Sub-Saharan African women with PCOS. It could be suggested as an easy-to-detect marker for assessing IR.

Keywords: Wrist circumference, Insulin resistance, Polycystic ovary syndrome, Congolese women, Sub-Saharan African women, Marker of insulin resistance, Homeostasis Model Assessment of insulin resistance, Easy-to-detect marker

Core tip: In a previous study, we found that insulin resistance (IR), which is independent of the body fat and central distribution in women with polycystic ovary syndrome (PCOS), is commonly found among the African population. Among various markers of IR, the role of anthropometric indicators is obvious in developing countries. Therefore, a more appropriate method that should be easy to perform is sought. In the present study, we found for the first time that non-dominant wrist circumference is not only a marker of IR, but the best anthropometric marker known to date for the assessment of IR in women with PCOS.