Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City

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Alterations in metabolic and hormonal regulators such as ghrelin, leptin, and Sex Hormone-Binding Globulin (SHBG) may contribute to the complex pathophysiology observed in affected women. Understanding these biochemical changes within the local population is essential for diagnostic accuracy and clinical management in Fallujah City. Objective To compare serum levels of ghrelin, leptin, Sex Hormone-Binding Globulin (SHBG), insulin, glucose, and Luteinizing Hormone (LH) between obese women with PCOS and healthy obese controls. Methods This case–control study was performed from October 15, 2024, to January 15, 2025, at the Laboratory Department at Fallujah Teaching Hospital , Anbar Governorate,Iraq in addition to several private laboratories in Fallujah City. A total of seventy obese women aged 18–45 years were enrolled and divided into two groups: 35 healthy controls and 35 women diagnosed with PCOS based on ultrasound findings and clinical evaluation by a specialist . Blood samples were collected, centrifuged, and analyzed for insulin, glucose, LH, SHBG, leptin, and ghrelin. Results The findings demonstrated a significant decrease in serum SHBG and ghrelin levels in the PCOS group compared with controls, whereas glucose, insulin, leptin, and LH levels were significantly increased (p ≤ 0.001). Conclusion The biochemical profile of obese women with PCOS in this study reveals clear disturbances in both metabolic and hormonal parameters. Reduced ghrelin and SHBG level , alongside increased leptin, insulin, glucose, and LH, highlight the complex metabolic burden associated with PCOS and underscore the importance of early biochemical evaluation in this population. 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F1000Research 2026, 15 :324 ( https://doi.org/10.12688/f1000research.174654.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City [version 1; peer review: 1 approved with reservations] Mohammed Amer Fayyadh https://orcid.org/0000-0001-8161-2655 1 , Abdulhakeem Dahham Hussein 2 Mohammed Amer Fayyadh https://orcid.org/0000-0001-8161-2655 1 , Abdulhakeem Dahham Hussein 2 PUBLISHED 26 Feb 2026 Author details Author details 1 Chemistry and Biochemistry, University of Fallujah, College of Medicine, Al-Fallujah, Al Anbar Governorate, 31002, Iraq 2 College of Applied Science, University of Fallujah College of Applied Sciences, Al-Fallujah, Al Anbar Governorate, Iraq Mohammed Amer Fayyadh Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Abdulhakeem Dahham Hussein Roles: Data Curation, Formal Analysis, Software, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Fallujah Multidisciplinary Science and Innovation gateway. Abstract Background Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders among women of reproductive age and is frequently exacerbated by obesity. Alterations in metabolic and hormonal regulators such as ghrelin, leptin, and Sex Hormone-Binding Globulin (SHBG) may contribute to the complex pathophysiology observed in affected women. Understanding these biochemical changes within the local population is essential for diagnostic accuracy and clinical management in Fallujah City. Objective To compare serum levels of ghrelin, leptin, Sex Hormone-Binding Globulin (SHBG), insulin, glucose, and Luteinizing Hormone (LH) between obese women with PCOS and healthy obese controls. Methods This case–control study was performed from October 15, 2024, to January 15, 2025, at the Laboratory Department at Fallujah Teaching Hospital , Anbar Governorate,Iraq in addition to several private laboratories in Fallujah City. A total of seventy obese women aged 18–45 years were enrolled and divided into two groups: 35 healthy controls and 35 women diagnosed with PCOS based on ultrasound findings and clinical evaluation by a specialist . Blood samples were collected, centrifuged, and analyzed for insulin, glucose, LH, SHBG, leptin, and ghrelin. Results The findings demonstrated a significant decrease in serum SHBG and ghrelin levels in the PCOS group compared with controls, whereas glucose, insulin, leptin, and LH levels were significantly increased (p ≤ 0.001). Conclusion The biochemical profile of obese women with PCOS in this study reveals clear disturbances in both metabolic and hormonal parameters. Reduced ghrelin and SHBG level , alongside increased leptin, insulin, glucose, and LH, highlight the complex metabolic burden associated with PCOS and underscore the importance of early biochemical evaluation in this population. READ ALL READ LESS Keywords PCOS, Ghrelin, Leptin, Insulin, SHBG Corresponding Author(s) Mohammed Amer Fayyadh ( [email protected] ) Close Corresponding author: Mohammed Amer Fayyadh Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Fayyadh MA and Hussein AD. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Fayyadh MA and Hussein AD. Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :324 ( https://doi.org/10.12688/f1000research.174654.1 ) First published: 26 Feb 2026, 15 :324 ( https://doi.org/10.12688/f1000research.174654.1 ) Latest published: 26 Feb 2026, 15 :324 ( https://doi.org/10.12688/f1000research.174654.1 ) Introduction Despite established diagnostic criteria, the medical and scientific understanding of the etiology of polycystic ovary syndrome (PCOS) remains incomplete. The condition involves a complex interaction of genetic, environmental, and epigenetic factors. 1 Intrauterine growth may also contribute to the development of PCOS features. 2 Hypersecretion of androgens by the theca and stromal cells of the polycystic ovary subsequently leads to the characteristic manifestations of the syndrome. 3 Since androgens are one of the ovulation mechanisms that inhibit the growth of immature follicles, PCOS is regarded as an endocrine gland disorder that affects young people in the early stages of reproduction. The disease is characterized by an increase in the secretion of gonadotropin and androgen, and it affects up to 13% of women worldwide who are of childbearing age. 4 In addition, PCOS represents a complex, multifactorial disorder that occurs due to environmental, genetic, hormonal, and metabolic factors in the bodies of patients with this syndrome. 5 Disturbances in the ovarian response to the pituitary gland, excessive pulses of GnRH from the hypothalamus, stimulation of testosterone secretion by the ovary, a drop in FSH levels, or they may remain constant and unchanged all contribute to the pituitary gland’s hypersecretion of LH. 6 Ovarian androgen production is strongly stimulated by insulin through a distinct insulin receptor that does not exhibit insulin resistance. Because insulin prevents the liver from producing SHBG, a glycoprotein that binds most sex hormones, it increases both the action of LH and the degree of hyperandrogenism. Therefore, high body weight exacerbates the underlying hormonal abnormalities (increased androgen and insulin levels), free androgen levels rise, and women with polycystic ovarian syndrome exhibit the clinical signs. 7 Overweight people make up around 40% of patients with PCOS. Adipokines and other mediators, including cytokines, have been secreted by adipose tissue, leading to low-grade chronic inflammation and insulin resistance, both of which are factors in ovarian disorders. However, not all obese women have PCOS, and not all PCOS patients are obese. Moreover, lowering body fat may successfully lessen the syndrome’s severity. 8 The body mass index (BMI) in patients with polycystic ovary syndrome is greater than 30 kg/m² of visceral fat (fat that is concentrated in the abdominal area and not the entire body) and the waist-to-hip ratio is also increased. This increase is a common finding in obese women with polycystic ovary syndrome, 9 and obesity mainly contributes to infertility in PCOS patients through its effect on hyperandrogenism, hyperinsulinemia, and insulin resistance. 10 Changes in lifestyle are part of the treatment for polycystic ovarian syndrome. The syndrome and its symptoms can be eliminated by increasing daily activity and eating a diet high in fiber and low in sugar, which will help reduce excess weight and maintain a healthy waist circumference. 11 The most important treatment used in addition to medication therapy is metformin, which helps stimulate ovulation and egg formation by lowering blood glucose levels by increasing insulin sensitivity without increasing insulin concentration. Additionally, it lessens miscarriage in women with polycystic ovarian syndrome and enhances and controls the menstrual cycle. 12 Along with Clomid (clomiphene citrate), it is the most popular therapy for polycystic ovarian syndrome and one of the ovulation drugs. It aids in promoting the development of eggs, the expansion of follicles, and the doubling of their quantity. 13 The goal of the current research was to evaluate the levels of the hormones leptin and ghrelin with specific biochemical characteristics in obese women with polycystic ovarian syndrome in Fallujah, as the levels of these hormones declined while those of diagnostic markers rose. Methodology Exclusion criteria Smoking, Diabetes mellitus and non-pregnant. Collection of specimens The samples used in this study were taken between October 15, 2024, and January 15, 2025, from the labs of the Fallujah Teaching Hospital in the Anbar Governorate as well as a few private laboratories connected to Fallujah city. Seventy samples of obese women between the ages of 18 and 45 who were of reproductive age were included in the research. The two groups were divided as follows: • Control group: 35 women who were randomly chosen from among Fallujah city’s population and in excellent health had their blood samples taken. • Patient group : Thirty-five obese women with polycystic ovarian syndrome had their blood samples taken. Following testing for the illness and a referral to a specialized physician following an ultrasound examination (sonar), their infection was verified as having the condition. Estimation of hormone levels in blood serum The competitive concept is the foundation of the hormone test, which measures insulin, LH, SHBG, leptin, and ghrelin. The enzyme competes with the hormone-bound antibodies in the samples to bind to the antibodies when samples are added to wells coated with hormone-bound antibodies. As the concentration of hormones in the sample increases and the enzyme unbound to the washing process is eliminated, TMB solution is added and incubated for a predetermined amount of time to produce a change in blue color. Following the addition of the stopping solution to halt the reaction, the samples’ absorbance is measured at 450 nm. According to the manufacturer Monobind Inc., USA, these hormones were tested in blood serum using the ELISA test technique, using a measuring kit for each measurement. Serum Glucose level estimation Serum glucose level was measured by the Spanish company BioSystems, using a test kit equipped with the enzymatic method followed by Young (2001). 14 Statistical analysis The t-test was used to assess the variance between two groups at a probability threshold of (P ≤ 0.001) in the Completely Randomized Design-CRD technique of the Statistical Package for the Social Sciences-SPSS. Sensitivity and specificity were also determined by calculating the ROC and determining its values and calculating its values (Curve). The association between the variables under investigation was also discovered using the basic linear correlation coefficient. Results Determining the two research groups’ levels of biochemical variables and diagnostic markers Table 1 shows the mean ± standard deviation of biochemical parameters (Insulin, Glucose, LH, SHBG, Gherlin and Leptin) and diagnostic markers for each of the two research groups. Table 1. Control and patient groups of parameters. Groups/Parameter Mean ± SD P-Value Control No = 35 Patients No = 35 Insulin (μU/mL) 11.12 ± 6.93 25.80 ± 9.71 P ≤ 0.001 Glucose (mg/dl) 92.8 ± 7.11 112 ± 9.19 P ≤ 0.001 LH (μlU/mL) 4.71 ± 2.87 10.14 ± 3.61 P ≤ 0.001 SHBG (nmol/L) 22.14 ± 3.91 9.34 ± 0.61 P ≤ 0.001 Gherlin (ng/ml) 6.21 ± 2.31 3.82 ± 1.49 P ≤ 0.001 Leptin (ng/ml) 9.51 ± 1.51 16.76 ± 2.32 P ≤ 0.001 The present study’s findings indicated that all four levels—insulin, glucose, leptin, and LH—had significantly increased. At a probability threshold of P < 0.001, the blood serum of obese women with polycystic ovarian syndrome showed a substantial drop in both SHBG and Ghrelin when compared to the control group, which consisted of healthy individuals ( Figure 1 ). Figure 1. Hormone levels in the blood serum of obese women with polycystic ovarian syndrome compared to the control group of healthy individuals: a) Insulin b) Glucose c) LH d) SHBG e) Ghrelin f ) Leptin. ROC curve calculation The ROC curve was calculated for the diagnostic and biochemical variables of obese patients with PCOS, represented by (SHBG, Gherlin, Leptin) in addition to the healthy group, as shown in Table 2 . Table 2. Values of the area under the curve, specificity and sensitivity for the diagnostic and biochemical variables for the patient and healthy groups. Parameters AUC Cut off Sensitivity % Specificity % Accuracy P-value Ghrelin 1.000 ≤3.98 97.06 100.00 0.9706 12.54 100.00 97.06 0.9706 <0.001 SHBG 1.000 ≤10.67 100.00 100.00 1.0000 <0.001 The results of the hormone ghrelin showed that the value of the area under the curve (AUC) was (1) and (Cut off ) was (≤3.98) and the sensitivity ratio was (97) while the specificity ratio was (100). As for the hormone leptin, the value of the area under the curve (AUC) was (0.999) and (Cut off ) was (>12.54) and the sensitivity ratio was (100) while the specificity ratio was (97.06). As for SHBG, the value of the area under the curve (AUC) was (1) and (cut-off ) was (≤10.67) and the sensitivity was (100) while the specificity ratio was (100) at a probability level (P < 0.001) for the groups of patients and healthy people ( Figure 2 ). Figure 2. (A) ROC curve analysis of Leptin for the patient and healthy groups. (B) ROC curve analysis of Ghrelin for the patient and healthy groups. (C) ROC curve analysis of c- SHBG for the patient and healthy groups. Correlation between SHBG and levels of parameter under investigation The relationship between the SHBG level and the level of the data under study was studied, as shown in the Table 3 . Table 3. Shows the correlation relationships between the SHBG level and the level of the patient and healthy groups. SHBG Control Patients R p-value r p-value Ghrelin 0.148 0.404 -0.275 0.115 Leptin 0.048 0.786 -0.188 0.286 Discussion The continuous rise in the level of insulin and glucose hormones leads to dysfunction in cellular functions and the development of several diseases such as diabetes, obesity, and polycystic ovary syndrome. The reason for this increase may be attributed to the rise in several hormones related to metabolism in the body such as weight gain (obesity) in the abdominal area, high blood pressure, and insulin resistance. 15 The current study’s findings are consistent with those of researchers H. Zhao et al. 16 and A. Purwar et al., 17 who found that obese patients with PCOS had higher levels of the insulin hormone. They also concur with J. Gupta et al., 18 who found that the blood sugar levels of obese PCOS patients had clearly increased significantly. Patients with PCOS have insulin resistance (IR), which is defined by primary hyperinsulinemia (HI), a reduced insulin response in the body, and hyperglycemia. IR is caused by impaired insulin action in multiple target tissues in the body. HI-induced tissue IR is crucial in PCOS pathophysiology because the majority of the body’s systems and organs and tissues are impacted by PCOS, and insulin functions in these tissues in various ways to balance the body’s nutritional needs. 19 Insulin resistance in women with PCOS affects the body’s metabolism and the mitotic pathways in insulin target tissues (such as the liver, skeletal muscle, and adipose tissue) as well as non-traditional target tissues (such as the ovary and pituitary gland). 20 Additionally, inflammatory cytokines, lipid accumulation, hyperandrogenism, and other systemic factors all affect the IR process of peripheral tissues. 21 The LH hormone, which works in conjunction with FSH in controlling the menstrual cycle, also stimulates the release of the egg from the ovary in the middle of the menstrual period, which is known as ovulation, as LH levels rise rapidly just before ovulation in females. 22 The result of the rise in LH hormone is consistent with the result of E. Khashchenko et al. 23 and S. M. Alhassan et al. 24 The reason for the increase is due to the theca cells in the ovaries that enlarge as a result of increased LH stimulation, which also leads to the accumulation of follicular fluid that forms cystic structures along the periphery of the ovary, giving it the appearance of a string of pearls. Due to the increased follicles and the expression of essential enzymes involved in androgen synthesis, an excess amount of androgen is produced. 25 Ghrelin is one of the hormones that are related to polycystic ovary syndrome through its negative effect on the hypothalamic-pituitary-ovarian axis. It is likely that it regulates the ovarian secretion of androgens. It is believed that the abnormal activity of the corpus luteum in women with polycystic ovary syndrome is related to ghrelin. These relationships require further studies to determine the causal and inverse relationship and whether it actually plays a role in polycystic ovary syndrome. 26 In addition, studies have shown that ghrelin has effects on reproduction, as high levels of ghrelin inhibit the luteinizing hormone responsible for egg production in women. 27 Ghrelin is a hormone secreted during fasting or hunger and is related to food intake and energy balance. It enhances appetite and reduces fat utilization, thus increasing obesity. Ghrelin is produced mainly in the stomach and the main ghrelin binding sites are in the hypothalamus. It represents a signal to the endocrine glands that links the peripheral mechanisms for sensing calories with the brain centers and energy balance. When ghrelin is expressed in the stomach, its circulating level rises during fasting and falls after eating, suggesting that food intake or associated factors like insulin levels regulate ghrelin secretion. Given that the ovary has been shown to have a high density of ghrelin binding sites, the gonads may be a significant target for ghrelin activity. Additionally, in stimulatory circumstances, ghrelin inhibits steroidogenic enzymes. 28 Leptin is one of the proteins secreted by fat cells and plays a role in metabolism, as its secretion increases when one is full and decreases when one is hungry. It also plays a role in reproduction, in addition to its role in storing energy. It reduces appetite and increases energy consumption, and at its normal levels in the blood, it has a stimulating role on the hypothalamic-pituitary axis and ovary, while in the case of obesity, the increase in the hormone leptin has an inhibitory effect on the formation of follicles and leptin suppresses the increased IGF in the interstitial cells that are stimulated by the luteinizing hormone LH and is able to intervene naturally in the maturation of the egg and ovulation. Leptin levels may change in polycystic ovary syndrome 29 and the result of its increased levels in obese women with PCOS was consistent with the result of (Baldani et al). 30 Leptin affects the secretion of sex hormones necessary to initiate and maintain reproductive function 31 through its effect on the hypothalamus and thus negatively affects the regulation of the activity and secretion of the gonadal-releasing hormone (GnRH) and causes obstruction of the secretion of the FSH and LH hormones. Through several signaling pathways including neuropeptide Y, proopiomelanocortin, and kisspeptin, specifically the GnRH-kisspeptin pathway associated with fertility disorders, high levels of leptin also alter the sensitivity of the pituitary gland to GnRH, causing resistance to GnRH and thus negatively affecting the ovary, causing a disturbance in the production of sex steroid hormones from granulosa cells, which hinders the ovulation process and causes fertility disorders. 32 , 33 Although the present study demonstrated significant alterations in ghrelin and leptin levels among obese women with PCOS, the relationship of these metabolic hormones with Sex Hormone-Binding Globulin (SHBG) warrants further clarification. Previous studies have reported that SHBG is strongly influenced by metabolic and endocrine disturbances, particularly insulin resistance and adipokine dysregulation, which are key features of PCOS. Several researchers have shown an inverse association between ghrelin and SHBG. Reduced ghrelin levels observed in obesity and PCOS contribute to increased insulin resistance, which subsequently suppresses hepatic SHBG synthesis. Reported that women with PCOS who had lower ghrelin levels also exhibited significantly reduced SHBG, suggesting an indirect metabolic link mediated primarily through insulin resistance rather than a direct hormonal interaction Karkanaki A., et al. 34 Similarly, leptin shows a well-established negative correlation with SHBG. Hyperleptinemia in obese PCOS patients inhibits SHBG production both directly through its action on hepatocytes and indirectly through its strong association with hyperinsulinemia Casanueva F., et al. 35 Demonstrated that elevated leptin concentrations were significantly associated with lower SHBG levels, supporting the hypothesis that adiposity-related hormonal changes contribute to reduced SHBG in PCOS. These findings align with the known pathophysiology of PCOS, in which adipokine imbalance and metabolic dysfunction collectively down regulate SHBG, thereby intensifying androgen bioavailability and worsening clinical manifestations. Overall, the relationship between SHBG, ghrelin, and leptin in the context of PCOS reflects the complex metabolic-endocrine interactions that characterize the disorder. Alterations in these hormones may contribute to the progression of hyperandrogenism and reproductive dysfunction through their combined effects on insulin sensitivity, hepatic hormone-binding protein production, and ovarian steroidogenesis. Ethical approval Ethical approval for this study was obtained from the Ethical Committee of Al-Fallujah University College of Medicine (Reference No: [14]) dated [26\11\2025]. Written informed consent was obtained from all participants. Data availability The datasets generated and analyzed during this study are available in the Figshare repository at https://doi.org/10.6084/m9.figshare.31257583 36 under the Creative Commons Attribution 4.0 International license (CC BY 4.0) . The repository contains anonymized clinical and biochemical data related to obese women with polycystic ovary syndrome in Fallujah City, as well as the STROBE checklist associated with this study. Acknowledgements The authors acknowledge the College of Medicine, University of Fallujah, for its support and facilitating role in conducting this study. We also thank the management and staff of the collaborating laboratories for their cooperation, and we are grateful to the patients for their participation. We also appreciate all individuals who assisted in the practical work and data collection for this research. References 1. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 26 Feb 2026 ADD YOUR COMMENT Comment Author details Author details 1 Chemistry and Biochemistry, University of Fallujah, College of Medicine, Al-Fallujah, Al Anbar Governorate, 31002, Iraq 2 College of Applied Science, University of Fallujah College of Applied Sciences, Al-Fallujah, Al Anbar Governorate, Iraq Mohammed Amer Fayyadh Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Abdulhakeem Dahham Hussein Roles: Data Curation, Formal Analysis, Software, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 26 Feb 2026, 15:324 https://doi.org/10.12688/f1000research.174654.1 Copyright © 2026 Fayyadh MA and Hussein AD. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Fayyadh MA and Hussein AD. Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :324 ( https://doi.org/10.12688/f1000research.174654.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 26 Feb 2026 Views 0 Cite How to cite this report: Turki TG. Reviewer Report For: Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :324 ( https://doi.org/10.5256/f1000research.192577.r463212 ) The direct URL for this report is: https://f1000research.com/articles/15-324/v1#referee-response-463212 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 13 Mar 2026 Thualfiqar Ghalib Turki , Al-Qasim Green University-College of Biotechnology, Al Qasim, Iraq; Medical Laboratories Techniques Department, Islamic University of Najaf, Najaf, KUFA, Iraq Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.192577.r463212 The technical and linguistic standpoint, this manuscript is considered good and academically acceptable. However, the following points should be considered: 1. The researcher should add a standard curve to the ELISA tests to enhance ... Continue reading READ ALL The technical and linguistic standpoint, this manuscript is considered good and academically acceptable. However, the following points should be considered: 1. The researcher should add a standard curve to the ELISA tests to enhance the reliability of the research. 2. The sample size is relatively small compared to the prevalence of this disease. Regarding the exclusion of women with diabetes, the researcher should be aware that insulin resistance, as in the case of type 2 diabetes, is closely related to leptin resistance and obesity; therefore, this exclusion is unscientific. 3. Please ensure that the text was not written using artificial intelligence, as some references were missing when searched in Scholar, particularly references 14, 34, 35, and 36. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: biotechnology, endocrine, molecular biology, bioinformatic. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Turki TG. Reviewer Report For: Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :324 ( https://doi.org/10.5256/f1000research.192577.r463212 ) The direct URL for this report is: https://f1000research.com/articles/15-324/v1#referee-response-463212 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. 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Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 26 Feb 26 read Thualfiqar Ghalib Turki , Al-Qasim Green University-College of Biotechnology, Al Qasim, Iraq; Islamic University of Najaf, Najaf, Iraq Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Turki T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 13 Mar 2026 | for Version 1 Thualfiqar Ghalib Turki , Al-Qasim Green University-College of Biotechnology, Al Qasim, Iraq; Medical Laboratories Techniques Department, Islamic University of Najaf, Najaf, KUFA, Iraq 0 Views copyright © 2026 Turki T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The technical and linguistic standpoint, this manuscript is considered good and academically acceptable. However, the following points should be considered: 1. The researcher should add a standard curve to the ELISA tests to enhance the reliability of the research. 2. The sample size is relatively small compared to the prevalence of this disease. Regarding the exclusion of women with diabetes, the researcher should be aware that insulin resistance, as in the case of type 2 diabetes, is closely related to leptin resistance and obesity; therefore, this exclusion is unscientific. 3. Please ensure that the text was not written using artificial intelligence, as some references were missing when searched in Scholar, particularly references 14, 34, 35, and 36. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise biotechnology, endocrine, molecular biology, bioinformatic. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Turki TG. Peer Review Report For: Evaluation of Serum Ghrelin, Leptin, and Related Biochemical Parameters in Obese Women with Polycystic Ovary Syndrome in Fallujah City [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :324 ( https://doi.org/10.5256/f1000research.192577.r463212) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-324/v1#referee-response-463212 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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