Serum levels of high-density lipoprotein-linked enzyme paraoxonase-1 (PON-1) were lower in patients with polycystic ovary syndrome (PCOS), particularly those with obesity, suggesting this enzyme may be a marker for PCOS in certain patients, according to study findings published in Cureus.

In a prospective, case-control study, researchers evaluated the potential utility of serum fetuin-A and PON-1 levels as markers in women with infertility admitted to a university clinic in 2021. Patients included those with PCOS (n=50; mean age, 24.8 years) and a control group without PCOS but unexplained infertility (n=40; mean age, 31.3 years).

Participants were divided as PCOS-low-body mass index (BMI ≤25; n=19) vs controls-low-BMI (BMI ≤25; n=20) and PCOS-high-BMI (BMI >25; n=31) vs controls-high-BMI (BMI >25; n=20). The investigators compared the PCOS and controls groups in regard to serum fetuin-A and PON-1 levels.

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There was no significant difference between the PCOS and control groups in terms of the mean fetuin-A levels (1298.0±60.7 vs 1292.4±79.3 μg/mL, respectively; P =.955). In contrast, mean serum PON-1 levels were significantly lower in patients with vs without PCOS (109.1±61.4 vs 140.1±80.0 U/L; P =.040), but this difference was not statistically significant in analyses adjusted for age (110.6±12.4 vs 138.3±12.4 U/L; P =.123) and BMI (110.4±10.0 vs 138.6±11.3 U/L; P =.068).

In the subgroup of patients with BMI <25, there was no difference between those with vs without PCOS in terms of the mean PON-1 levels (124.0±57.9 vs 122.1±55.1, respectively; P =.820). However, the PON-1 levels were significantly lower in patients with PCOS vs without PCOS with a BMI ≥25 (100.0±62.6 vs 158.1±97.0; P =.048).

Limitations of the study included the small sample size as well as the inclusion of patients from a single university center.

“Fetuin-A does not appear to be a possible marker for PCOS patients of any weight,” the researchers concluded, but noted that “PON-1 decreased significantly in [the] obese PCOS patients. Obesity plays an essential role in the occurrence of PCOS and may affect the PON-1 levels. PON-1 levels may be a possible marker for PCOS among obese women. Further studies are needed to investigate PON-1 levels in PCOS women with different BMIs.”


Gurbuz T, Tosun SA, Cebi A, Gokmen O, Usta M. Investigating fetuin-a and paraoxonase-1 activity as markers in polycystic ovary syndrome based on body mass index: a prospective case-control study. Cureus. 2021;13(10):e18553. doi:10.7759/cureus.18553

This article originally appeared on Endocrinology Advisor