Visceral Adipose Tissue was Associated with Increased Risk of Insulin Resistance in Lean Polycystic Ovarian Syndrome, Independent with Retinol Binding Protein-4

Abstract

Visceral Adipose Tissue was Associated with Increased Risk of Insulin Resistance in Lean Polycystic Ovarian Syndrome, Independent with Retinol Binding Protein-4 Jaringan Adiposa Viseral berkaitan dengan Peningkatan Risiko Resistensi Insulin pada Sindrom Ovarium Polikistik dengan Indeks Massa Tubuh Normal, Independen terhadap Retinol Binding Protein-4 Vita Silvana, Andon Hestiantoro, Muharam Natadisastra, Kanadi Sumapraja, Budi Wiweko Division of Reproductive Immunoendocrinology Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Abstract Abstrak Objective: To determine whether visceral adipose tissue or serum RBP-4 were related to the risk increment of insulin resistance in normal BMI PCOS patients. Tujuan: Untuk menentukan apakah jaringan adiposa viseral atau serum RBP-4 berhubungan dengan peningkatan risiko resistensi insulin pada Sindrom Ovarium Polikistik dengan indeks masa tubuh normal. Methods: This was a cross-sectional study conducted in normal body mass index PCOS patients at Yasmin Clinic, RSCM, Jakarta from July 2014 until March 2015. Diagnosis of PCOS was established using Rotterrdam (2003) criteria. Insulin resistance was confi rmed by using ratio of HOMA-IR >1.4. Metode: Studi potong lintang dilakukan pada subjek SOPK dengan IMT normal di Klinik Yasmin, RSCM, Jakarta sejak Juli 2014 sampai dengan Maret 2015. Penegakan diagnosis SOPK dilakukan dengan kriteria Rotterdam (2003). Resistensi insulin dikonfi rmasi dengan pemeriksaan rasio HOMA-IR > 1.4 Results: Among 40 subjects, 20 subjects (50%) belong insulin resistance group. Serum RBP-4 level was higher in the insulin-resistant group (p=0.06). After ROC analysis was conducted, the area under curve for serum RBP-4 was 69.9% (CI 95% -3754.77 - (186.60-7696.14, p=0.061)). The cut-off level of serum RBP-4 was 23814.5 ng/mL yielded sensitivity and specifi city to a level of 60% and 60%, respectively. After logistic regression was analyzed, visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients. Hasil: Diantara 40 subjek, sebanyak 20 subjek (50%) mengalami resistensi insulin. Kadar serum RBP-4 lebih tinggi pada kelompok resistensi insulin (p=0.06). Setelah dilakukan analisis Receiver Operating Curve (ROC), serum RBP-4 memiliki Area Under the Curve (AUC) sebesar 69.9% (IK 95% -3754.77 - (186.60-7696.14, p=0,061)). Titik potong kadar serum RBP-4 adalah 23814.5 ng/mL dengan sensitivitas dan spesifi sitas masing-masing 60% dan 60%. Setelah dilakukan analisis regresi logistik, jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada pasien SOPK dengan IMT normal. Conclusions: Visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients, independent with serum RBP-4 levels. Kesimpulan: Jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada SOPK dengan IMT normal, independen terhadap kadar serum RBP-4. Keywords: body mass index, diagnosis, insulin resistance, PCOS, retinol-binding protein-4. Kata kunci: diagnosis, indeks masa tubuh, resistensi insulin, retinol binding protein-4, SOPK