## 4 Discussion  
Our results highlight the importance of body composition (especially the predominant percentage of fat mass) as an anthropometrical characteristic of PCOS, and the relationship of fat mass with worse metabolic profile. Even more, PCOS was related to worse HOMA-IR independent of body composition. Other metabolic parameters (higher total cholesterol and LDL-c) should be especially monitored in women with PCOS since they easily worsened with age compared to controls. Overall, we found that there were differences in body composition estimated by anthropometric method between women with PCOS and controls (percentage of fat mass: 30.2% PCOS vs. 27.6% controls). These results are in agreement with [PERSON] et al. [33], who reported that women with PCOS had higher total body fat when compared to their age- and BMI-matched controls, and [PERSON] et al. [34], who established a diagnostic cutoff point over 29% of fat mass for PCOS condition independent of the methodology employed to quantify adiposity [35; 36; 37]. Regarding the percentage of lean mass, we did not find statistically significant differences. However, other authors have reported higher lean mass in women with PCOS in relation to higher androgens levels [33; 38; 39]. These differences in body composition could be explained by the abnormal endocrine milieu (hyperandrogenism and hyperestrogenemia) that characterizes PCOS. Even though androgens are known to increase muscle mass, these steroids seem to have a limited effect on lean muscle mass in women with PCOS [40; 41]. Similarly, no significant differences in bone mass between PCOS and controls were seen in our study, although women with PCOS tended to present lower percentages. This aspect also remains unclear in the literature. Several studies have reported lower bone mass in PCOS evaluated by DEXA [36; 42; 43] or CAT scan [44]. On the other hand, other authors found that women with PCOS presented greater bone density using the DEXA methodology [45; 46; 47]. Regarding hormonal and biochemical parameters, we found significant differences between PCOS and controls. Obesity and PCOS are linked to similar metabolic disorders (hyperandrogenism, insulin resistance). In addition, several studies have shown that the incidence rate of obesity in women with PCOS is 30-70% [4; 5], higher than in non-PCOS women. In a recent metanalysis, [PERSON] et al. [48] concluded that metabolic disorders in adolescent women with PCOS are worsened by concomitant obesity. As a result, obesity in women with PCOS leads to worsening their endocrine, reproductive, and metabolic disturbances [7]. [PERSON] et al. [34] compared BMI, abdominal circumference, and fat mass measured by impedanciometry and concluded that the percentage of fat mass was the best predictor of insulin resistance in women with PCOS. Our results in Table 2 show that the percentage of fat mass predicted higher TG, LDL-c, and HOMA-IR and lower HDL-c levels in both groups, not only in PCOS. The question arises whether body composition (specifically the percentage of fat mass) is an independent variable apart from PCOS condition for a worse metabolic profile in these women. In the multivariate analysis (Table 3), we found that only higher HOMA-IR remained associated with PCOS regardless of the effect of body composition. Other authors have suggested that the metabolic impairment in women with PCOS seems to not only be dependent on the total fat mass content and body weight but might also be ascribed to the androgen excess [49]. We discarded this possibility because we included testosterone in our model, showing the effect of PCOS condition by itself. Our results suggest that both body composition and PCOS could predict metabolic disorders (especially insulin resistance) independently. This means that both PCOS and fat mass are independent and summative risk factors for higher HOMA, with the PCOS condition being the main risk factor when both coexist.