The Interplay of Age, Obesity Measures, and Micronutrient Deficiencies in PCOS-associated Metabolic Dysfunction Findings from a Retrospective Postobservational Cohort Study.
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BACKGROUND: Polycystic ovary syndrome (PCOS) is a complex endocrine-metabolic disorder with significant age-related, anthropometric, and metabolic variations. Understanding the interplay between age, body composition, and micronutrient status can help identify predictors of metabolic dysfunction and long-term complications in women with PCOS. Most studies assess these factors in isolation, resulting in fragmented evidence and inconsistent conclusions. OBJECTIVES: This study aimed to evaluate the predictive associations of age, anthropometric parameters, and micronutrient levels (vitamin B12 and vitamin D3) with key metabolic, cardiovascular, and nutritional markers in women diagnosed with PCOS. MATERIALS AND METHODS: A cross-sectional analysis was conducted among women with PCOS, divided into two age-groups: group I (15-30 years) and group II (31-40 years). One-way analysis of variance (ANOVA) and linear regression analyses were performed to investigate age- and obesity-related differences in metabolic parameters. Pearson's correlations and regression models were applied to assess the predictive strength of age, body mass index (BMI), waist circumference (WC), vitamin B12, and vitamin D3 on metabolic outcomes. The Benjamini-Hochberg method was applied to control the false discovery rate (FDR) for multiple comparisons and ensure conclusions account for the increased risk of type I error due to multiple comparisons, thereby supporting the validity of the study's observations. RESULTS: The PCOS cohort exhibited generalized overweight (BMI 23.0-24.9 kg/m2) and obesity (BMI ≥25.0 kg/m2) in 40 and 54% of subjects, respectively; notably, visceral obesity (WC ≥80 cm) was present in 97% of the cohort, underscoring a marked predominance of central adiposity even among those with lower BMI thresholds. The PCOS cohort demonstrated high metabolic risk, with frequent insulin resistance, dyslipidemia, and hypertension; notably, 25% had nonalcoholic fatty liver disease (NAFLD), predominantly mild steatosis, indicating a substantial risk for future cardiometabolic complications. Advancing age was significantly associated with higher fasting blood sugar (FBS) (p = 0.019) and glycated hemoglobin (HbA1c) (p = 0.048), while fasting insulin declined with age (p = 0.048). BMI and WC were strong predictors of metabolic risk, positively impacting fasting insulin, FBS, HbA1c, and blood pressure (p < 0.05), while showing significant negative associations with high-density lipoprotein cholesterol (HDL-C) (p < 0.001). Vitamin B12 and D3 levels showed no significant impact on metabolic parameters. Vitamin B12 was predicted only by age (p < 0.001) and vitamin D3 (p < 0.001), while vitamin D3 was influenced by age (p < 0.001) and vitamin B12 levels (p = 0.041). CONCLUSION: Central obesity markers-particularly WC and BMI-are robust predictors of metabolic dysfunction in PCOS, offering greater prognostic value than micronutrient levels such as vitamin B12 or D3, which showed limited association with metabolic disturbances in this population. These findings highlight the primacy of early detection and intervention targeting adiposity and insulin resistance to reduce long-term cardiometabolic risk among women with PCOS. Integrated, multifactorial risk assessment remains essential, as age, nutritional deficits, and obesity-related factors independently and collectively drive adverse metabolic outcomes in PCOS, emphasizing the need for comprehensive preventive and management strategies.