Age at adiposity rebound in childhood is associated with PCOS diagnosis and obesity in adulthood-longitudinal analysis of BMI data from birth to age 46 in cases of PCOS

Abstract

Background: Adiposity rebound (AR), the second BMI rise in childhood at around the age of 6 years, is associated with obesity and metabolic alteration in later life. Given that polycystic ovary syndrome (PCOS) has a strong metabolic component, early life growth patterns could reveal a risk of PCOS. Thus, we aimed to investigate the associations between age at AR and PCOS diagnosis and BMI later in life.

Materials and methods: This study is part of a prospective, population-based longitudinal study, where women with PCOS diagnosis by age 46 (n = 280) were compared with asymptomatic women (CTRLs, n = 1573). Weight and height data from birth to age 13 years, at age at menarche, and at ages 31 and 46 years were analyzed RESULTS: Women with PCOS had lower birth weight (3357 ± 477 vs. 3 445 ± 505 g, p < 0.001), earlier age at AR (5.2 ± 1.0 vs. 5.6 ± 0.90 years, p < 0.001) and higher BMI from AR onwards compared with controls. Early timing of AR was associated with PCOS diagnosis independently of BMI (OR 1.62, 95% Cl 1.37-1.92). Women with PCOS and early AR had higher BMI at 31 and 46 years when compared to controls with early AR. The age at AR did not associate with T levels at ages 31 or 46 years.

Conclusions: Early AR was associated with PCOS diagnosis and high BMI in adulthood. Adolescent girls with early AR and persisting obesity should be screened for PCOS symptoms, such as persistent irregular cycles and hirsutism.

Fig. 1

Birth weight (a) and adiposity rebound (AR) age (b) in control women (CTRL) and women with polycystic ovary syndrome (PCOS) by age 46 (tPCOS). Women with PCOS had lower birth weight and age at AR was lower in these women compared with controls. Significance assessed by using one-way analysis of variance and the Games-Howell post hoc test

Fig. 2

Body mass index (BMI) trajectories in women with polycystic ovary syndrome (tPCOS, black line) and in controls (gray line). 95% confidence intervals (95% CI) shown as dashed line in a–c. BMI trajectories from birth to 13 years show early adiposity rebound (AR) in women with PCOS (a). No difference was observed in the growth patterns during infancy (from birth until 18 months, including adiposity peak) (b). Detailed childhood growth pattern analysis from 18 months until 13 years showed early AR in women with PCOS (c). BMI trajectory from 18 months to 13 years and single BMI data points at ages 31 and 46 (d). Women with PCOS present with early deviation in growth pattern (BMI) from AR onwards, extending to adulthood

Fig. 3

Association between birth weight and timing of adiposity rebound (AR) with polycystic ovary syndrome (PCOS) diagnosis by age 46. The result are expressed, for birth weight: by 100 g decrease in birth weight and for AR per 1 year decrease in the age at AR. Hosmer and Lemeshow GOF test p_AR = 0.389 and p_BW = 0.144. The analyses were carried out using logistic regression and the results are reported as odds ratios (ORs) with 95% confidence intervals (95% CIs). Birth weight was adjusted for maternal pre-pregnancy body mass index (BMI), maternal smoking, and gestational age. Timing of AR was adjusted for maternal smoking, pre-pregnancy BMI, gestational age, BMI at ages 31 and 46, waist circumference, and testosterone at age 31. Adjustment models shown in Supplementary Figure 3

Fig. 4

Body mass index (BMI) at menarche (a) and at the ages of 31 (b) and 46 (c) in women with polycystic ovary syndrome (PCOS) and in controls with early adiposity rebound (AR) and normal/late AR. Women with early AR had higher BMI at menarche and at ages 31 and 46, particularly those with PCOS. Significance assessed by using the Kruskal–Wallis test with multiple comparisons