Abstract
BACKGROUND: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder associated with reproductive and metabolic dysfunction. Emerging evidence indicates that the lipid accumulation product (LAP) and visceral adiposity index (VAI) could be valuable indicators for evaluating metabolic dysfunction. This study aims to compare LAP and VAI between women with PCOS and healthy controls to evaluate their potential role in metabolic risk assessment. METHODS: A structured database search was carried out on March 18, 2025, using PubMed, Web of Science, Scopus, and Embase. Observational studies comparing LAP/VAI levels between women with PCOS and healthy controls were included. Risk of bias was assessed using the Joanna Briggs Institute checklists. A random-effects meta-analysis was carried out to evaluate the pooled differences in LAP and VAI levels between individuals with PCOS and those in the control group. Subgroup analyses were conducted based on the PCOS phenotypes (A, B, C, and D) defined by the Rotterdam criteria and the body mass index categories (lean and overweight/obese). RESULTS: Fifty studies (13,741 women) were analyzed, with 41 included in the meta-analysis. LAP (32 studies: Cohen's d = 0.597 [0.469-0.726]; P-value < 0.001; I(2) = 88.22%) and VAI (28 studies: Cohen's d = 0.457 [0.378-0.537]; P-value < 0.001; I(2) = 65.16%) were significantly higher in PCOS women, with calculated pooled values of 37.1 vs. 23.9 and 3.1 vs. 2.6, respectively. Subgroup analyses revealed that LAP lost significance across all phenotypes (P-value > 0.05), while VAI remained elevated in phenotypes A (P-value < 0.001), B (P-value = 0.001), and D (P-value = 0.001), with marginal significance in C (P-value = 0.051). Stratified by body mass index, LAP was non-significant in lean women (P-value = 0.083) but higher in overweight/obese women (P-value = 0.001). Conversely, VAI was significantly elevated in both lean and overweight/obese groups (P-value = 0.001 each). CONCLUSIONS: This study demonstrates significantly higher levels of LAP and VAI in patients with PCOS compared to controls. These readily calculable indices may serve as practical tools for metabolic risk stratification in PCOS populations. However, further research is needed to establish their diagnostic accuracy and validate their clinical utility.