Obesity, Insulin Resistance, and Hyperandrogenism Mediate the Link between Poor Diet Quality and Ovarian Dysmorphology in Reproductive-Aged Women.

Maryam Kazemi,Brittany Y Jarrett,Kathleen M Hoeger,Heidi Vanden Brink,Marla E Lujan,Steven D Spandorfer,Annie W Lin

doi:10.3390/nu12071953

Abstract

The relationship between diet quality and ovarian morphology has biological plausibility yet remains unclear and was therefore evaluated. In a multicenter cross-sectional analysis, four dietary patterns were scored for 111 consecutive reproductive-aged women (18–45 years) using (1) Healthy Eating Index (HEI-2015); (2) alternative HEI-2010; (3) alternate Mediterranean Diet (aMED); (4) and Dietary Approaches to Stop Hypertension (DASH) indices. Ovarian volume (OV) and follicle number per ovary (FNPO) were evaluated on transvaginal ultrasonography. Relationships between dietary and ovarian morphology indices were evaluated by linear regression and mediation analyses. Associations between aMED and DASH scores and OV/FNPO were completely mediated by obesity, insulin resistance, and hyperandrogenism (All: p < 0.05), unlike direct associations (All: p ≥ 0.89). Namely, a 1-standard deviation [SD] increase in aMED score was associated with decreases in OV (0.09 SD; 0.4 mL) through reducing waist circumference. Likewise, a 1 SD increase in aMED and DASH score was associated with decreases in OV (0.07 SD; 0.3 mL) by reducing glucose response to a 75 g glucose tolerance test. A 1 SD increase in DASH score was associated with decreased FNPO (0.07 SD; 2 follicles) by reducing free androgen index (All: p < 0.05). Adherence to aMED and DASH eating plans was indirectly associated with significant improvements in ovarian form, providing novel mechanistic insights for future interventions about contributions of diet quality on ovarian function.

Highlights

Dietary patterns are practical nutritional tools that reflect an individual’s usual dietary behaviors.The use of dietary patterns reduces the risk for collinearity, synergistic, and interactive effects among single dietary factors, accounting for complex interactions among multiple dietary factors that may influence the states of health and disease [1,2,3,4]
In addition to previous studies that have only examined linear associations between diet quality and reproductive health outcomes, we examined whether associations between diet quality and ovarian morphology were mediated by intermediate metabolic, endocrine, and/or clinical markers as our secondary objective
While we observed no direct associations between diet quality, as assessed by dietary patterns, and ovarian morphology on ultrasonography, our findings suggest that adherence to the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) eating plan are indirectly associated with improved ovarian morphology, as evidenced by lower follicle populations and ovarian size

Summary

Introduction

Dietary patterns are practical nutritional tools that reflect an individual’s usual dietary behaviors.The use of dietary patterns reduces the risk for collinearity, synergistic, and interactive effects among single dietary factors, accounting for complex interactions among multiple dietary factors that may influence the states of health and disease [1,2,3,4]. The link between dietary patterns and health outcomes in reproductive-aged women is less clear [9,10,11,12,13]. Previous studies in reproductive-aged women have mainly focused on maternal dietary patterns and pregnancy outcomes, including pregnancy rate [10,11], spontaneous abortion [9], time to pregnancy [12], preterm birth [14], and birth weight [15], but have yielded less consistent results, likely owing to variability in defining and assessing dietary patterns and challenges in the reproducibility of data-driven dietary patterns [16,17,18]. The relationship between major a-priori diet quality indices and reproductive health outcomes at earlier stages of the reproductive span remains poorly elucidated

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