Serum PON-1 May Be a Possible Marker for PCOS in Women With Obesity

Obesity, unhealthy weight. Nutritionist calculating body mass index of fat woman for obesity treatment
Polycystic ovary syndrome is often linked with metabolic syndrome and other disorders, but researchers say current screening tools are inadequate. Researchers sought to discover more precise biomarkers to screen people for polycystic ovary syndrome.

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.

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