Visceral adiposity and lipid-related metabolic markers in normal-weight adolescent girls with polycystic ovary syndrome.
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UNLABELLED: Polycystic ovary syndrome (PCOS) has metabolic implications during adolescence, including among individuals within the normal body mass index (BMI) range. This study evaluated visceral adipose tissue (VAT) thickness and lipid-related metabolic markers in normal-weight adolescents with PCOS. In this cross-sectional case-control study based on prospectively collected standardized data, adolescents aged 13-19 years with BMI percentiles within the normal range were included. Twenty-nine adolescents with PCOS diagnosed according to international adolescent-specific criteria and 31 age-matched healthy controls were analyzed. VAT thickness was assessed by abdominal ultrasonography. Fasting glucose, insulin, lipid parameters, HOMA-IR, and HOMA-β were evaluated. Correlation, multivariable regression, BMI percentile-adjusted, and exploratory sensitivity analyses were performed. Adolescents with PCOS had higher BMI percentiles than controls, although all participants were normal-weight. VAT thickness, triglyceride levels, and TG/HDL-C ratio were higher in the PCOS group in unadjusted analyses. After adjustment for BMI percentile, VAT thickness remained significantly higher, whereas the TG/HDL-C difference was attenuated and no longer statistically significant. Fasting insulin and HOMA-IR did not differ between groups, whereas HOMA-β was higher in adolescents with PCOS. VAT thickness was independently associated with the TG/HDL-C ratio in the PCOS group. In the overall cohort, VAT thickness and waist circumference, but not BMI percentile or group status, were associated with the TG/HDL-C ratio. CONCLUSION: Normal-weight adolescents with PCOS showed greater visceral adiposity than controls. Triglycerides and the TG/HDL-C ratio should be interpreted cautiously as complementary exploratory lipid-related markers associated with visceral adiposity, rather than as definitive or superior predictors. WHAT IS KNOWN: • Polycystic ovary syndrome in adolescence is associated with metabolic alterations, particularly in individuals with overweight or obesity. • Normal-weight adolescents with PCOS may also show metabolic vulnerability, but data on visceral adiposity and lipid-related markers in this subgroup remain limited. WHAT IS NEW: • Normal-weight adolescents with PCOS showed greater ultrasonographically assessed visceral adipose tissue thickness than controls, and this difference persisted after adjustment for BMI percentile. • Lipid-related markers, including triglycerides and the TG/HDL-C ratio, were exploratory and should be interpreted cautiously in relation to visceral adiposity.