University of Oulu

Lingaiah S, Arffman RK, Morin-Papunen L, et al. Markers of gastrointestinal permeability and dysbiosis in premenopausal women with PCOS: a case–control study. BMJ Open2021;11:e045324.

Markers of gastrointestinal permeability and dysbiosis in premenopausal women with PCOS : a case–control study

Saved in:
Author: Lingaiah, Shilpa1; Arffman, Riikka K.1; Morin-Papunen, Laure1;
Organizations: 1Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
2Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: BMJ, 2021
Publish Date: 2021-11-01


Objectives: Altered intestinal permeability and gut barrier dysfunction have been suggested to play a role in the pathogenetic mechanism of polycystic ovary syndrome (PCOS), the most common endocrine and metabolic condition in reproductive-aged women. However, data on intestinal permeability and dysbiosis of the gut microbiota in PCOS is still limited, with conflicting results. To this end, the concentrations of gastrointestinal permeability and gut dysbiosis markers were analysed in women with PCOS.

Design: Case–control study.

Setting: General community.

Participants: 104 women with PCOS and 203 body mass index (BMI) matched control women at age 46.

Primary and secondary outcome measures: Serum levels of zonulin, fatty acid-binding protein 2 (FABP2), urinary levels of indican, and hormonal and metabolic parameters.

Results: Serum levels of zonulin (128.0±17.0 vs 130.9±14.0 ng/mL, p=0.13) and FABP2 (1.5±0.9 vs 1.5±0.7 ng/mL, p=0.63) and urinary levels of indican (9.5±5.5 vs 8.4±4.2 mg/dL, p=0.07) were comparable in women with PCOS and controls in the whole study population. Likewise, when the study population was divided into different BMI groups as normal weight, overweight and obese, the levels of the above markers were comparable between the study groups. After BMI adjustment, zonulin levels correlated with the levels of high-sensitivity C reactive protein and homoeostasis model assessment of insulin resistance (p<0.05) both in women with PCOS and controls.

Conclusions: Intestinal permeability markers zonulin and FABP2, and the dysbiosis marker indican do not seem to be altered in women with PCOS at age 46 compared with BMI-matched controls. Serum zonulin levels correlated with BMI, insulin resistance and inflammatory marker levels, but did not segregate women with PCOS and controls. This suggests that metabolic factors, but not PCOS per se, is the driving force of dysbiosis in premenopausal women with PCOS.

see all

Series: BMJ open
ISSN: 2044-6055
ISSN-E: 2044-6055
ISSN-L: 2044-6055
Volume: 11
Issue: 7
Article number: e045324
DOI: 10.1136/bmjopen-2020-045324
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was funded by grants from the Academy of Finland, the Sigrid Jusélius Foundation, Oulu University Scholarship Foundation, Helsinki University Hospital and Oulu University Hospital Research Funds, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu.
Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.