Predictive Factors of Menstrual Recovery After Laparoscopic Sleeve Gastrectomy in Polycystic Ovary Syndrome Women with Obesity

Figures & data

Figure 1 The flow diagram of patient recruitment, grouping, and follow-up process.

Table 1 Clinical and Biochemical Characteristics at Baseline and 6 Months Follow Up After LSG

Items	Control Group			PCOS Group			Baseline	Changes After LSG
	Baseline Mean (95% CI) (n= 76)	6 Months After LSG Mean (95% CI) (n=38)	P-value 1	Baseline Mean (95% CI) (n= 88)	6 Months After LSG Mean (95% CI) (n=50)	P-value 2	P-value 3	P-value 4
Age at surgery (years)	30.09 (28.48, 31.71)	/	/	28.90 (27.75, 30.05)	/	/	0.223	/
Age at menarche (years)	13.00 (12.68, 13.32)	/	/	13.32 (12.78, 13.85)	/	/	0.354	/
Time from PCOS diagnosis (years)	10.27 (8.55, 11.99)	/	/	11.14 (9.64, 12.65)	/	/	0.445	/
Duration of PCOS (years)	0	/	/	5.90 (4.71, 7.10)	/	/	<0.001**	/
Ferriman-Gallway score	5.35 (3.26, 7.45)	/	/	6.78 (5.70, 7.86)	6.63 (5.59, 7.66)	0.366	0.203	/
Menstruation number (no./yr)	11.21 (11.03, 11.39)	11.07 (10.91, 11.22)	0.092	4.70 (4.11, 5.28)	7.02 (6.48, 7.57)	<0.001**	<0.001**	<0.001**
SBP (mmHg)	134.58 (127.93, 141.24)	120.80 (115.37, 126.23)	<0.001**	132.38 (128.96, 135.81)	120.83 (116.58, 125.07)	<0.001**	0.540	0.274
DBP (mmHg)	83.49 (78.91, 88.06)	76.92 (72.40, 81.44)	0.001**	83.90 (81.04, 86.75)	77.24 (73.51, 80.96)	<0.001**	0.876	0.888
WC (cm)	111.59 (108.41, 114.76)	90.73 (82.93, 98.52)	<0.001**	116.34 (113.54, 119.14)	96.62 (91.78, 101.45)	<0.001**	0.029*	0.684
HC (cm)	119.95 (117.27, 122.63)	104.14 (95.34, 112.93)	<0.001**	120.94 (118.60, 123.27)	105.85 (100.90, 110.8)	0.002**	0.535	0.862
WHR	0.93 (0.92, 0.94)	0.87 (0.83, 0.90)	0.001*	0.96 (0.95, 0.97)	0.91 (0.89, 0.94)	<0.001**	0.005*	0.929
BMI (kg/m^2)	37.40 (36.10, 38.73)	27.83 (24.90, 30.76)	<0.001**	38.65 (37.48, 39.82)	28.64 (27.28, 30.20)	<0.001**	0.162	0.868
%TBF	46.57 (45.56, 47.58)	39.97 (37.35, 42.59)	<0.001**	47.26 (46.44, 48.08)	41.48 (39.82, 43.15)	<0.001**	0.248	0.998
VAT Mass (kg)	1.05 (0.98, 1.12)	0.62 (0.52, 0.71)	<0.001**	1.17 (1.11, 1.24)	0.70 (0.62, 0.78)	<0.001**	0.013*	0.415
SAT Mass (kg)	3.06 (2.82, 3.29)	1.76 (1.33, 2.19)	<0.001**	3.37 (3.13, 3.61)	2.11 (1.82, 2.40)	<0.001**	0.053	0.378
HbA1c (%)	6.12 (5.74, 6.50)	5.34 (5.12, 5.56)	0.004*	6.10 (5.76, 6.44)	5.3 (5.18, 5.42)	0.001**	0.937	0.416
HOMA-IR	6.85 (5.82, 7.88)	2.19 (1.40, 2.97)	<0.001**	9.36 (8.02, 10.69)	1.90 (1.60, 2.20)	<0.001**	0.004*	0.106
FBG (mmol/L)	5.98 (5.51, 6.46)	4.63 (4.32, 4.93)	<0.001**	6.52 (5.96, 7.07)	4.41 (4.27, 4.56)	<0.001**	0.157	0.077
PBG (mmol/L)	9.14 (8.14, 10.14)	4.46 (3.71, 5.21)	<0.001**	10.22 (9.29, 11.14)	4.13 (3.78, 4.49)	<0.001**	0.119	0.327
FINS (mU/L)	25.40 (22.17, 28.64)	9.74 (7.45, 12.01)	<0.001**	32.25 (28.58, 35.92)	9.49 (8.04, 10.94)	<0.001**	0.007*	0.444
PINS (mU/L)	116.76 (93.95, 139.57)	19.82 (13.58, 26.06)	<0.001**	170.02 (140.12, 199.91)	38.82 (21.37, 56.27)	<0.001**	0.005*	0.699
Uric acid (umol/L)	371.16 (352.20, 390.12)	321.91 (301.89, 341.94)	0.001**	406.54 (389.27, 423.81)	345.38 (318.90, 371.86)	<0.001**	0.007*	0.176
Creatinine (umol/L)	59.13 (54.02, 64.23)	57.94 (54.56, 61.32)	0.965	56.35 (53.41, 59.30)	60.29 (57.07, 63.52)	0.096	0.332	0.951
ALT (U/L)	35.20 (28.27, 42.13)	12.62 (9.41, 15.83)	<0.001**	56.20 (47.94, 64.46)	11.34 (9.60, 13.09)	<0.001**	<0.001**	0.039*
AST (U/L)	26.09 (21.73, 30.45)	16.74 (13.38, 20.10)	0.006**	37.05 (31.65, 42.45)	14.16 (13.14, 15.19)	<0.001**	0.002**	0.224
TC (mmol/L)	4.54 (4.36, 4.73)	4.49 (4.18, 4.79)	0.735	4.65 (4.47, 4.82)	4.62 (4.37, 4.88)	0.868	0.412	0.540
TG (mmol/L)	1.58 (1.36, 1.79)	0.92 (0.76, 1.09)	<0.001**	2.03 (1.71, 2.36)	1.02 (0.85, 1.19)	<0.001**	0.025*	0.351
HDL-c (mmol/L)	1.14 (1.07, 1.20)	1.18 (1.10, 1.26)	0.329	1.04 (0.98, 1.10)	1.29 (1.18, 1.40)	<0.001**	0.036*	0.004**
LDL-c (mmol/L)	2.80 (2.64, 2.96)	2.83 (2.54, 3.11)	0.613	2.83 (2.67, 2.99)	2.76 (2.50, 3.03)	0.633	0.769	0.792
LH/FSH	1.41 (1.20, 1.62)	1.47 (0.99, 1.95)	0.843	2.43 (1.10, 3.77)	1.48 (1.17, 1.79)	0.300	0.165	0.373
P (nmol/L)	6.32 (3.16, 9.49)	11.07 (5.28, 16.85)	0.117	3.23 (1.72, 4.75)	3.90 (1.72, 6.08)	0.609	0.082	0.850
TT (ng/mL)	1.25 (1.09, 1.41)	1.13 (0.63, 1.63)	0.575	1.63 (1.44, 1.82)	1.27 (1.04, 1.49)	0.0018**	0.002**	0.217
cFT (nmol/L)	4.81 (0.98, 8.64)	2.23 (0.42, 4.02)	0.471	11.75 (6.69, 16.81)	2.24 (1.13, 3.35)	0.005**	0.030*	0.686
SHBG (nmol/L)	23.77 (18.88, 28.67)	65.17 (23.26, 93.00)	0.027**	18.98 (15.26, 22.69)	61.8 (41.92, 80.08)	0.001**	0.114	0.940
FGL-1 (ng/mL)	30.52 (20.98, 40.07)	32.41 (18.46, 46.36)	0.817	41.05 (35.51, 46.58)	25.00 (20.63, 29.37)	<0.001**	0.040*	0.606

Notes: Data were presented as mean and 95% confidence intervals (CI). P-value 1 was a significant difference between baseline and after 6 months of LSG in control individuals. P-value 2 was a significant difference between baseline and after 6 months of LSG in PCOS individuals. P-value 3 was a significant difference between the control group and the PCOS group before LSG. P-value 4 was a significant difference in the changes of clinical indicators before and after 6 months of LSG between the control group and the PCOS group. *Means P<0.05, **Means P<0.01.

Abbreviations: LSG, laparoscopic sleeve gastrectomy; SBP, systolic blood pressure; DBP, diastolic blood pressure; WC, Waist circumference; HC, Hip circumference; WHR, waist to hip ratio; BMI, body mass index; %TBF, the percentage of total body fat; VAT, visceral adipose tissue; SAT, abdominal subcutaneous adipose tissue; HbA1c, glycosylated hemoglobin A1c; HOMA-IR, homeostatic model assessment insulin resistance index; FBG, fasting plasma glucose; PBG, postprandial plasma glucose; FINS, fasting serum insulin; PINS, postprandial insulin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TC, total cholesterol; TG, triglycerides; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; LH, luteinizing hormone; FSH, follicle-stimulating hormone; P, progesterone; TT, total testosterone; cFT, calculated free testosterone; SHBG, sex hormone-binding globulin; FGL-1, fibrinogen-like protein 1.

Figure 2 Menstrual status and weight loss in PCOS patients with obesity before and after LSG. (A) The number of menstrual cycles per year, (B) the percentage of menstrual regularity, (C) the percent excess weight loss (%EWL), and (D) the percent total weight loss (%TWL) levels at baseline and after LSG. Calculation of percent excess weight loss (%EWL) was done as follows: (preoperative weight–last weight) / (preoperative weight – ideal weight to produce BMI 25 kg/m²) × 100. ;Percent total weight loss (%TWL) was defined by the formula: (preoperative weight − last weight) / preoperative weight × 100. *means P<0.05, **means P<0.01.

Abbreviation: LSG, Laparoscopic sleeve gastrectomy.

Table 2 Binary Logistic Regression Analysis of Variables at Baseline and Menstrual Status of PCOS Patients with Obesity Within 6 Months After LSG

Variables	Unadjusted				Adjusted
	β	P-value	OR	95% CI	β	P-value	OR	95% CI
Time from PCOS diagnosis (yr)	−0.210	0.007**	0.811	0.696–0.944	−0.239	0.006**	0.787	0.663–0.934
Duration of obesity (yr)	0.053	0.432	1.054	0.924–1.203	0.080	0.290	1.084	0.934–1.258
Menstruation number (no./yr)	0.198	0.210	1.218	0.895–1.659	0.251	0.166	1.285	0.929–1.778
BMI (kg/m^2)	−0.176	0.007**	0.839	0.738–0.953	−0.223	0.008**	0.800	0.680–0.942
HOMA-IR	−0.044	0.359	0.957	0.871–1.051	−0.015	0.849	0.985	0.840–1.154
TT (ng/mL)	−0.976	0.038*	0.377	0.150–0.947	−1.263	0.023**	0.283	0.095–0.843

Notes: The unadjusted regression coefficients, p-values, odds ratio (OR), and 95% confidence interval (CI) in the left half of the table are based on the logistic regression analysis without adjusting for any confounding factors. The adjusted regression coefficients, p-values, OR, and 95% CI in the right half of the table are based on the logistic regression analysis adjusted for confounding factors, including age, systolic blood pressure, heart rate, aspartate aminotransferase, fertility, and marital status. β means regression coefficient; *Means P<0.05; **Means P<0.01.

Abbreviations: LSG, laparoscopic sleeve gastrectomy; BMI, body mass index; HOMA-IR, homeostatic model assessment insulin resistance index; TT, total testosterone.