Obese Polycystic Ovary Syndrome Patients Research Articles

Impact of short-term ketogenic diet on sex hormones and glucose-lipid metabolism in overweight or obese patients with polycystic ovary syndrome.

This study evaluates the clinical effects of a ketogenic diet (KD) versus a traditional comprehensive intervention, including lifestyle changes and oral contraceptives, in overweight or obese polycystic ovary syndrome (PCOS) patients. A retrospective analysis of 70 overweight/obese PCOS patients (body mass index [BMI] ≥24 kg/m2) treated between December 2022 and December 2023 was conducted. The patients were categorized into two groups based on their past treatment modality: Group 1 received a KD treatment (N = 35), and Group 2 underwent comprehensive intervention (N = 35), with both treatments lasting 3 months. Changes in body weight, BMI, sex hormone levels, glucose-lipid metabolism indicators, and liver and kidney function were compared. Both groups experienced significant reductions in body weight and BMI after treatment (p < 0.05), with the KD group showing a greater reduction (p < 0.05). luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), and total testosterone (TT) levels decreased significantly in both groups (p < 0.05). The KD treatment led to significant reductions in fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride (TG), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) (p < 0.05), while the comprehensive intervention resulted in decreased FBG and ALT, and increased high-density lipoprotein-cholesterol (HDL-c) (p < 0.05). Additionally, the KD group had a greater reduction in FBG, and showed decreases in TG and AST, which remained unchanged in the comprehensive intervention group (p < 0.05). The short-term KD treatment provides significant weight loss and effectively improves hormone regulation and glucose-lipid metabolism in overweight or obese PCOS patients, offering a valuable therapeutic option for managing the condition.

Evaluation of Biochemical Serum Markers for the Diagnosis of Polycystic Ovary Syndrome (PCOS) in Obese Women in Kazakhstan: Is Anti-Müllerian Hormone a Potential Marker?

Background: Polycystic Ovarian Syndrome (PCOS) is a common endocrine condition that affects 8-13% of women of reproductive age. In Kazakhstan, the prevalence of this syndrome is particularly high compared with other countries and the global average. Currently, the diagnosis of PCOS is based on internationally established Rotterdam criteria, using hyperandrogenism as a key parameter. These criteria are applied to diagnose PCOS in all female patients, although obese patients may have excess testosterone produced by adipose tissue. To avoid possible misdiagnosis, an additional criterion, especially for the diagnosis of PCOS in obese women, could be considered. The aim of this study was to identify whether anti-Müllerian hormone (AMH) or other biochemical criteria can be used for this purpose. Methods: A total of 138 women were recruited for this study and grouped into control (n = 46), obese subjects without PCOS (n = 67), and obese patients with PCOS (n = 25). The health status, anthropometric parameters, and serum indicators for glucose, glycosylated hemoglobin, and hormone levels were examined for all subjects. Statistical data were analyzed using GraphPad Prism 10 software for interpretation of the data. Results: Serum AMH, testosterone, and LH were positively correlated in obese PCOS patients, while AMH and FSH were negatively correlated. Compared with other biochemical indicators, the serum AMH and testosterone levels in obese PCOS patients were significantly higher than those in non-PCOS patients (regardless of obesity), and AMH was also positively correlated with testosterone. Conclusions: AMH appears to be a reliable criterion in addition to testosterone for the diagnosis of PCOS in obese women.

8421 The Effect of Dietary Glycotoxins on Insulin Resistance in Polycystic Ovary Syndrome

Abstract Disclosure: A. Weidner: None. K. Vann: None. J. Zhang: None. A. Roy: None. O. Astapova: None. Polycystic ovary syndrome (PCOS) is a chronic systemic disorder that affects both metabolism and reproduction. PCOS is characterized by hyperandrogenism and insulin resistance, which are closely intertwined in this disease pathophysiology. PCOS affects an estimated 10% of people with ovaries and increases risk of endometrial cancer, type 2 diabetes, and major cardiovascular events. Furthermore, treatment options are generally poorly tolerated. Despite its prevalence, severity, and enormous public health burden, the etiology of PCOS is not well-understood. Insulin resistance likely plays a central role in PCOS pathogenesis, and often leads to hyperinsulinemia as the pancreas attempts to compensate for insulin’s decreased efficacy in the body. Moreover, the Western diet is becoming increasingly rich in advanced glycation end products (AGEs): non-enzymatically modified biomolecules that have recently been found to have a harmful effect on insulin sensitivity and are associated with diabetes, aging, and oxidative stress. Serum AGE levels have been reported to be higher in both lean and obese PCOS patients, regardless of PCOS subtype. We have also found higher levels of AGE precursors in the serum of our chronic dihydrotestosterone-induced mouse model of PCOS. Using this mouse model, we have shown that ovarian granulosa cells (GCs) remain insulin-sensitive despite systemic insulin resistance and hyperinsulinemia, manifested by impaired glucose tolerance and increased HOMA-IR. To assess whether GCs respond to insulin through alternative receptor pathways, we knocked down insulin receptor in human granulosa-derived KGN cells and found that insulin-stimulated AKT phosphorylation was only minimally reduced, suggesting that insulin may signal in large part through the insulin-like growth factor 1 receptor (IGF1R) in these cells. Therefore, we believe that compensatory hyperinsulinemia plays a key role in chronic GC hyperstimulation, possibly by rerouting the insulin signal through IGF1R to overcome the resistance to insulin receptor activation, suggesting a mechanism for AGE toxicity in PCOS. We hypothesize that in PCOS, this results in impaired GC function and exacerbation of ovarian dysfunction. We will use our PCOS mouse model to study the effects of a reduced-AGE diet in ameliorating the reproductive and metabolic phenotype of an androgenized PCOS mouse. In preliminary experiments, we have found that a low-AGE diet results in lower fasting glucose in C57BL/6J mice after only 4 weeks. We expect that reproductive symptoms, such as estrous cyclicity, and metabolic symptoms, such as GTT and circulating insulin, will improve in our PCOS mouse model when mice are fed a low-AGE diet throughout development and adulthood. This project has significant clinical implications, as reducing dietary AGEs could provide an effective, tolerable, non-drug therapy option for patients with PCOS. Presentation: 6/3/2024

Effects of inulin on intestinal flora and metabolism-related indicators in obese polycystic ovary syndrome patients

ContextPolycystic ovary syndrome (PCOS), a common endocrine disorder in women of reproductive age, is closely associated with chronic low-grade inflammation and metabolic disturbances. In PCOS mice, dietary inulin has been demonstrated to regulate intestinal flora and inflammation. However, the efficacy of dietary inulin in clinical PCOS remains unclear.ObjectiveThe intestinal flora and related metabolic indexes of obese patients with polycystic ovary syndrome (PCOS) after 3 months of inulin treatment were analyzed.Setting and designTo analyze the intestinal flora and related metabolic indexes in healthy controls and obese patients with polycystic ovary syndrome after 3 months of inulin treatment.ResultsThe results showed that dietary inulin improved sex hormone disorders, reduced BMI and WHR levels in obese women with PCOS. In addition, the inulin intervention reduced plasma TNF-α, IL-1β, IL-6, and MCP-1levels. Inulin intervention increased the abundance of Actinobacteria, Fusobacteria, Lachnospira, and Bifidobacterium, as well as decreased the ratio of F/B and the abundance of proteobacteria, Sutterella, and Enterobacter. Correlation analyses showed a strong relationship among plasma inflammatory factors, sex steroid hormones, and the intestinal flora of patients.ConclusionsDietary inulin may improve obese PCOS women disease through the gut flora–inflammation–steroid hormone pathway.The clinical trial registration number: ChiCTR-IOR-17012281.

1,25-Dihydroxyvitamin D3 Regulates the Inositol-Requiring Transmembrane Kinase Endoribonuclease-1α/X-Box-Binding Protein 1 Spliced Pathway to Alleviate Palmitic Acid-Induced Apoptosis in KGN Cells

In a pivotal study on polycystic ovary syndrome, 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] was found to significantly mitigate palmitic acid-induced apoptosis in ovarian granulosa cells, which is crucial for oocyte development. The study used a high-fat cell model with palmitic acid to simulate the elevated free fatty acids found in obese polycystic ovary syndrome patients. Findings revealed that pretreatment with 1,25-(OH)2D3 reversed the detrimental effects of palmitic acid, including decreased cell viability and increased apoptosis, by modulating the inositol-requiring transmembrane kinase endoribonuclease-1α/ X-box-binding protein 1 spliced pathway. These results suggest a promising role for vitamin D in treating polycystic ovary syndrome and offer a new theoretical basis for its application in reproductive health.

The Comparison of Irisin, Subfatin, and Adropin in Normal-Weight and Obese Polycystic Ovary Syndrome Patients.

A combination of genetic and environmental factors contribute to the highly common, complex, and varied endocrine condition known as polycystic ovary syndrome (PCOS) in women. PCOS primarily affects women between the ages of 15 and 35 who are in the early to late stages of pregnancy. Thus, this study aimed to evaluate the serum levels of irisin, subfatin, and adropin in PCOS with and without obesity compared to the control group. The present cross-sectional study was conducted in 2022 at Al-Nahrain University/Department of Chemistry (Baghdad, Iraq). The serum levels of irisin, subfatin, and adropin were measured with the enzyme-linked immunosorbent assay (ELISA) method. Body mass index, lipid profile, insulin, fasting glucose, follicle-stimulating hormone, and luteinizing hormone levels were also evaluated. The data were analyzed using one-way analysis of variance (ANOVA) by GraphPad Prism software version 8.0.2. A P<0.05 was considered statistically significant. The study population comprised PCOS patients (n=90, divided into 45 obese and 45 normal weight) and healthy women (n=30). According to the results, the serum levels of irisin were significantly higher (P<0.001) in obese and normal-weight PCOS patients than controls. While adropin and subfatin were significantly lower in PCOS than controls (P<0.001). Moreover, there are higher levels of serum insulin, fasting glucose, and luteinizing hormone in PCOS women than in healthy women. According to the findings, PCOS patients had a higher level of irisin than the controls. In addition, decreased subfatin and adropin levels were observed in PCOS patients compared with healthy women. Further research is required to confirm these results in the future.

BMI and Polycystic Ovary Syndrome: Demographic Trends in Weight and Health.

Introduction Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women in adolescence and reproductive age. The distribution of PCOS across different body mass index (BMI) categories can vary, and research has shown associations between PCOS and weight status. This study tries to evaluate the distribution of PCOS in relation to BMI in women attending the PCOS clinic in a tertiary hospital in eastern India. Methodology This hospital-based cross-sectional study was carried out in the gynecology outpatient departmentof a tertiary care center. The study population included all the women in the age group between 15 and 45 years diagnosed as having PCOSusing the Rotterdam definition. The various physical, clinical, and biochemical parameters were measured in the study population and compared among the obese and lean PCOS patients. Results and discussion A total of 143 women were included in the study. The mean age of the study population was 26.8 years. Among these, the underweight and normal weight patients were categorized as lean PCOS patients, 35 in number (24.5%), and overweight and obese patients were categorized as obese PCOS patients, 108 in number (75.5%). All the physical parametermeasures like age (mean = 28.05, SD = 5.722), height (mean = 153.384, SD = 6.679), weight (mean = 68.182, SD = 11.501), waist circumference (mean = 95.135, SD = 10.291), hip circumference (mean = 101.47, SD = 9.320), waist-to-hip ratio (mean = 0.940, SD = 0.0831), and neck circumference (mean = 34.85, SD = 2.445) were significantly higher in the obese group as compared to the lean group. Menstrual irregularity was significantly more common in the obese PCOS patients as compared to the lean PCOS group (p = 0.02). There was a significant difference (p < 0.05) between the obese and lean PCOS patients when the biochemical parameters like fasting insulin, fasting glucose, and homeostatic model assessment of insulin resistance (HOMA-IR) were compared. There is a strong link between obesity, insulin resistance, and PCOS. Obesity can exacerbate insulin resistance, a common feature of PCOS, leading to increased levels of insulin and androgens. Conclusion The demographic distribution of PCOS in relation to BMI is essential for tailoring interventions and treatments.

Clinical observation of laparoscopic sleeve gastrectomy and metformin treatment in obese PCOS patients.

To observe the basic metabolic characteristics of obese patients with polycystic ovarian syndrome (PCOS), and observe and compare the effect of laparoscopic sleeve gastrectomy and metformin treatment after 3 months. In January to December 2018, the Second Hospital of Hebei Medical University selected 104 women who were classified as obese with a body mass index (BMI) of 28 kg/cm2 or higher and had PCOS. They were divided into obese PCOS group (53 cases) and obese non-PCOS group (51 cases). 1. There was no significant difference in waist circumference and WHR between patients who are obese with PCOS and patients who are obese without PCOS (P > 0.05). Obese PCOS patients were significantly higher in anti-Müllerian hormone (AMH), LH/FSH, T, FAI, homa-ir, triglyceride (TG), low density lipoprotein (LDL), Apo-B and uric acid than the group of non-PCOS patients who were obese. (P<0.05). The SHBG levels of obese patients with PCOS were obviously lower when contrasted with the levels in obese patients without PCOS (P < 0.05). 2. Body weight, BMI, INS, homa-ir and TG of obese PCOS patients were significantly decreased 3 months after laparoscopic sleeve gastrectomy compared with that before surgery (P < 0.05). After three months of medical treatment with metformin, the patients' homeostatic model assessment of insulin resistance (HOMA-IR) was obviously reduced when contrasted with the pre-treatment HOMA-IR levels (P < 0.05), and there was no significant difference in the improvement degree of homa-ir between the two groups (P > 0.05). 1. Obese patients with PCOS demonstrated higher expression of AMH, LH/FSH, T, SHBG, and FAI when contrasted with the control group. Additionally, they experienced more severe insulin resistance and lipid metabolism disorders. 2. The weight and BMI of obese PCOS patients were significantly decreased after weight loss, while IR and blood lipid were significantly improved, while IR was improved in metformin group, and no significant discrepancy was observed in the degree of improvement of insulin resistance between both groups.

Dried Zingiber officinale Alleviates Dehydroepiandrosterone‐Induced Ovarian Granulosa Cell Apoptosis via the Reactive Oxygen Species‐Mediated Pathway

Polycystic ovary syndrome (PCOS), a prevalent reproductive endocrine disorder, frequently coincides with insulin resistance, lipid dysregulation, and cellular apoptosis. In this study, we aimed to evaluate the therapeutic potential of Dried Zingiber officinale (DZO), renowned for its antibacterial, antiviral, anti‐inflammatory, and antioxidant properties, in the context of PCOS. To this end, we induced a PCOS mouse model through the administration of dehydroepiandrosterone (DHEA) and a high‐fat diet (HFD), followed by DZO treatment to assess its effects on ovarian pathology, insulin resistance, and hormonal imbalances. The anti‐apoptotic effect of DZO on PCOS ovarian granulosa cells was confirmed through network pharmacological analysis, TUNEL staining, FITC‐PI staining, and protein blotting. Notably, DZO treatment significantly alleviated ovarian pathological changes in PCOS mice and normalized hormone levels, including testosterone, estradiol, and progesterone/follicle‐stimulating hormone ratios. Furthermore, our findings confirmed the anti‐apoptotic effect of DZO on PCOS ovarian granulosa cells. Mechanistically, DZO primarily exerted its therapeutic effects in PCOS by inhibiting apoptosis induced by the accumulation of reactive oxygen species (ROS). In conclusion, our study demonstrates the promising therapeutic role of DZO in the management of obese PCOS patients, particularly in reversing ROS‐mediated apoptosis in ovarian granulosa cells.

Action Mechanisms of Metformin Combined with Exenatide and Metformin Only in the Treatment of PCOS in Obese Patients.

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of reproductive age, whose clinical characteristics are hyperandrogenism (HA), ovulatory dysfunction, and polycystic ovary, often accompanied by insulin resistance (IR) and metabolic abnormalities. Glucagon-like peptide (GLP)-1 receptor agonists (GLP-1Ra), such as exenatide, can bind to specific receptors on tissues such as the ovaries to improve the clinical phenotype of PCOS, while insulin-sensitizing agents, such as metformin, can also benefit to metabolic abnormalities in PCOS. Liquid chromatography-mass spectrometry (LC/MS) metabolomics revealed differences between the mechanisms of exenatide and metformin treatment of PCOS to some extent. In this study, 50 obese subjects with PCOS were randomly divided into the exenatide combined with metformin group (COM group, n = 28) and the metformin group (MF group, n = 22) for 12-week treatment. Before and after, serum samples were subjected to LC/MS analysis. After treatment, there were 153 named differential metabolites in the COM group and 99 in the MF group. Most phosphatidylcholines (PC) and deoxycholic acid 3-glucuronide (DA3G) were significantly upregulated, while most glycerophosphoethanolamine (PE-NMe2), glycerophosphocholine (GPC), and threonine were downregulated in both groups. Only the decrease of neuromedin B, glutamate, and glutamyl groups and the increase of chenodeoxycholic acid sulfate docosadienoate (22: 2n6), and prostaglandin E2 have been observed in the COM group. In addition, salicylic acid and spisulosine increased and decanoylcarnitine decreased in the MF group. Both groups were enriched in glycerophospholipid, choline, and sphingolipid metabolism, while the COM group was especially superior in the glutamine and glutamate, bile secretion, and amino acid metabolism. Compared with metformin alone in the treatment of PCOS, the differential metabolites of the exenatide combined with metformin group are more extensive. The COM group may act on the hypothalamic-pituitary-gonadal axis (HPO) and its bypass, regulate multiple metabolism pathways such as phospholipids, amino acids, fatty acids, carnitine, bile acids, and glucose directly or indirectly in obese PCOS patients.

Altered Vitamin D Status and Bone Mineral Density in Obese and Non-obese Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study in Turkey.

Background Polycystic ovary syndrome (PCOS) is the most common endocrinological disease in women of reproductive age. In addition to providing the basis for comorbidities such as metabolic and cardiovascular diseases, it also affects bone metabolism. This study aimed to determine whether there is a relationship between bone mineral density (BMD), vitamin D status, insulin resistance, sex hormones, and calcium metabolism disorders in women with PCOS. Methodology Fifty-six non-obese women with PCOS, 67 obese women with PCOS, and 45 normal weight controls participated in the study. Circulating levels of gonadotropins, estradiol, prolactin, dehydroepiandrosterone sulfate, total testosterone, thyroid stimulating hormone, sex hormone-binding globulin, insulin, glucose, and calcium metabolism parameters were assessed. We used the Homeostatic Model Assessment-Insulin Resistance Index to detect insulin resistance. BMD values in the various body regions were measured by dual X-ray absorptiometry. Results Women with PCOS had significantly lower vitamin D values and lumbar spine BMD than controls (p <0.001 and p <0.05, respectively). Among the patients with PCOS subgroups, vitamin D deficiency (VDD) was more frequent in obese PCOS patients (67.1%) than in non-obese patients (58.9%). We found significantly lower BMD at all sites only in the subgroup of the non-obese PCOS women than in controls (p <0.001). Conclusions VDD is prevalent in PCOS women in those with obesity and hyperandrogenemia. Non-obese PCOS women have significantly lower BMD measurements than healthy controls, but obese PCOS women have BMD values comparable with normal-weight eumenorrheic controls. Body mass index is the most important factor determining BMD in women with PCOS.

Relationship of vitamin D level with HOMA IR and LH in PCOS patients

Background: the most prevalent endocrine disorder in young women is polycystic ovary syndrome (PCOS). In many patients, vitamin D insufficiency aggravates the condition. Early diagnosis of insulin resistance and vitamin D insufficiency will simplify management and reduce morbidity in the future. This study analyzes the relationship between vitamin D levels and HOMA IR and LH in PCOS patients and compares the levels of LH and HOMA IR between obese and non-obese PCOS. Method: This study used a cross-sectional study on 48 women of reproductive age who were diagnosed with PCOS according to the Rotterdam criteria and who met the inclusion and exclusion criteria. Subjects were taken by consecutive sampling, measured levels of vitamin D, HOMA IR, and LH, then correlated and compared between obese and non-obese. Results: 48 samples were included in the study conducted within 3 months. A significant relationship was found between vitamin D and HOMA IR levels in PCOS patients with a p-value of 0.000. There was a significant relationship between vitamin D and LH levels in PCOS patients with a p-value of 0.000. There were significant differences in HOMA IR and LH levels in obese and non-obese PCOS patients, with higher HOMA IR in obese patients with a p-value of 0.001 and higher LH levels in non-obese PCOS patients with a p-value of 0.045. Conclusion: there was a significant relationship between vitamin D levels and HOMA IR and LH in PCOS patients and a significant difference in HOMA IR and LH in obese and non-obese PCOS patients.

Role of Vitamin D in the treatment of polycystic ovarian syndrome: A systematic review

8–13% of women in the reproductive age group are affected by Polycystic ovary syndrome (PCOS) and around 70% of cases stay undiagnosed worldwide. It is one of the most common causes of infertility nowadays. Polycystic ovarian morphology, hyperandrogenism, and ovulatory dysfunction are traits of PCOS. Insulin resistance is the primary finding in the pathophysiology of PCOS.Vitamin D is a fat-soluble vitamin that can be found as a dietary supplement. Hypovitaminosis is a risk for glucose intolerance so it has been found that supplementing vitamin D in females with PCOS lowers insulin resistance, total testosterone, and androstenedione levels and improves pressure profiles. Obese PCOS patients have been found to have lower vitamin D levels than PCOS patients who are not obese. This review aims at the pathophysiology of PCOS and the role of Vitamin D supplementation in PCOS patients.A literature search was performed to identify all relevant studies on PubMed, Google Scholar, Crossref, Medline, and Cochrane. The keyword used were; “Vitamin-D”, “Polycystic ovary syndrome (PCOS)”, “fertility”, “insulin resistance”, and “androgen hormones”. All relevant articles including review articles, original articles, case series, and case reports were reviewed.It was found that Vitamin D supplementation has beneficial effects on reproductive outcome, metabolic abnormalities and regulating menstrual cycle in PCOS patients. Understanding importance of Vitamin D level in treating PCOS patient is of great clinical significance in preventing disease progression.

Assessment of Cdx2 polymorphism in Iranian women with polycystic ovary syndrome

BackgroundWomen’s fertility is affected by polycystic ovarian syndrome (PCOS) as an endocrine disorder with characteristic symptoms such as insulin resistance, polycystic ovaries, menstrual irregularities, and obesity. In polycystic ovarian syndrome, the vitamin D endocrine system is regulated by the vitamin D receptor (VDR) associated with type II diabetes, endocrine dysfunctions, and insulin resistance. Therefore, the current paper deals with the investigation of the connection between Cdx2 VDR gene polymorphism and the biochemical factors in obese PCOS women.Material and methodsIn the current case–control study, 40 obese women without PCOS and 38 obese women with PCOS were enrolled in May–September 2016. Insulin, IGF1, FBS, and HOMA-IR were examined for the participants along with the allelic and genotypic frequency of Cdx2 polymorphism G/A (rs11568820) from Isfahan Fertility and Infertility Center, Iran. The ASM-PCR (multiplex allele-specific PCR) technique was utilized in this regard.ResultsThe age of PCOS women was less (P < 0.001) than the controls. In PCOS women, insulin, FBS, and HOMA-IR serum levels were higher than in the control women (all P values 0.05). For GG, AG, AA,A, and G Cdx2(A/G) genotypic/allelic frequencies were 84.2%, 15.8%, 0%, 7.9%, and 92.1% in cases and 87.5%, 12.5%, 0%, 6.3%, and 93.8% in controls, respectively. HOMA-IR (P = 0.047 and P = 0.033, respectively) and insulin than those with the AG genotype were in PCOS women with the GG Cdx2 genotype. The highest IGF-1 mean value (P = 0.020) was found for the AG genotype in PCOS. In our study, a significant relation was found only between PCOS and FBS, in terms of a logistic regression analysis of Cdx2 and parameters.ConclusionIn the present study, it was indicated that the GG genotype in PCOS subjects was associated with the IGF-1, HOMA-IR, and insulin. Similarly, no association was found between obese PCOS patients and Cdx2 in the 1a promoter area of the VDR gene in our study.

Insulin level, lipid profile, and HOMA index in lean and obese patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a prevalent endocrinopathy characterized by insulin resistance, hyperinsulinemia, and increased ovarian androgen production. While obesity has been linked to the pathogenesis of PCOS, the condition is also observed in individuals with normal BMI. This cross-sectional study aimed to evaluate the biochemical profile of lean and obese patients with PCOS. Fifty female patients with previously diagnosed PCOS were included in the study, attending the outpatient clinic at AL-Zahraa Teaching Hospital in Al-Najaf between September 2021 and March 2022. Blood samples were collected from each patient to assess insulin levels, lipid profiles, and fasting blood sugar. The results showed a comparable percentage of lean and obese PCOS patients, with a slightly higher proportion of obese individuals. Statistically significant differences were observed in obese patients with higher fasting blood sugar levels, insulin, HDL cholesterol, and triglycerides. Additionally, the HOMA index, an indicator of insulin resistance, was higher in obese individuals. Lean PCOS patients exhibited metabolic, hormonal, and hematopoietic dysregulations comparable to or less pronounced than those affecting the obese phenotype. Regardless of BMI, insulin resistance is part of PCOS and must be treated immediately.

Delta neutrophil index in obese and non-obese PCOS patients.

We aimed to evaluate the usefulness of delta neutrophil index (DNI), a new inflammatory marker, in polycystic ovary syndrome (PCOS). This retrospective case-control study was conducted at a tertiary health center. The DNI and other blood parameters obtained from the complete blood count examination of 227 individuals, consisting of 72 PCOS patients and 155 controls, were compared between the two groups. A receiver operating characteristic analysis was performed to examine the relationship between DNI and PCOS. DNI, white blood cell (WBC) count, and neutrophil count were significantly higher in the PCOS group than in the control group (P=0.028, 0.011, and 0.037; respectively). DNI and WBC counts were significantly higher in nonobese-PCOS patients (P=0.018 and 0.041; respectively). When the obese-PCOS and obese-control groups were compared, only neutrophil count was significantly higher in obese-PCOS patients (P=0.016). Significance was observed at cut-off values of 0.015 (area under the curve [AUC]=0.588) (P=0.034; sensitivity, 78%; specificity, 35%; Youden's index=0.133) for DNI: 9.35 (AUC=0.594) (P=0.022) for WBC; and 5.38 (AUC=0.628) (P=0.002) for neutrophils. Higher DNI in PCOS patients and similar results in the non-obese-PCOS group were observed when obese and non-obese-PCOS patients were considered separately. However, the lack of difference in the obese-PCOS group strengthens the hypothesis that there is obesity-independent inflammation in PCOS.

Relationship between blood uric acid levels and body composition in patients with polycystic ovary syndrome

Objective: To analyze the difference in blood uric acid levels between patients with polycystic ovary syndrome (PCOS) and healthy women of childbearing age, and to investigate the correlation between body composition and blood uric acid levels. Methods: A total of 153 eligible childbearing age patients with PCOS treated at Tianjin Medical University General Hospital from January 2018 to March 2022 were selected, and 153 healthy women with normal menstruation were selected as the control group. Fasting blood uric acid levels were measured by venous blood test, and body composition was measured by a body composition analyzer. Group comparisons were made to analyze the correlation between body composition and blood uric acid levels. Results: The incidence of hyperuricemia was higher in patients with PCOS than that in the control group [30.1% (46/153) vs 2.0% (3/153)], with a statistically significant difference (χ2=44.429, P<0.001). Blood uric acid level was also significantly higher in patients with PCOS than that in the control group [(371±98) vs (265±67) μmol/L; t=11.170, P<0.001]. Among PCOS patients, there were statistically significant differences in weight, body mass index (BMI), body fat mass, skeletal muscle mass, percent body fat, lean body weight, fat mass/lean body weight, percent skeletal muscle, and visceral fat level between the hyperuricemia group and the normal blood uric acid group (all P<0.001), but no significant difference was observed in waist-hip ratio (P=0.348). The following body composition indicators: weight, BMI, waist-hip ratio, body fat mass, skeletal muscle mass, percent body fat, visceral fat level, lean body weight, and fat mass/lean body weight in all subjects, the PCOS patients and the control group, were positively correlated with blood uric acid levels (all P<0.01). The blood uric acid level in PCOS obese patients was higher than that in non-obese PCOS patients, and the difference was statistically significant [(425±83) vs (336±91) μmol/L; t=6.133, P<0.001]. The blood uric acid level in central obesity PCOS patients was also higher than that in non-central obesity PCOS patients [(385±95) vs (299±79) μmol/L], the difference was statistically significant (t=4.261, P<0.001). The blood uric acid level in normal-weight obese PCOS patients was higher than that in normal-weight non-obese PCOS patients [(333±73) vs (277±54) μmol/L], and the difference was statistically significant (t=2.848, P=0.006). Blood uric acid levels in normal-weight [(315±74) vs (255±67) μmol/L], overweight [(362±102) vs (276±57) μmol/L], and obese PCOS patients [(425±83) vs (303±74) μmol/L] were all higher than those in the corresponding control groups, with statistically significant differences (all P<0.001). Conclusions: PCOS patients have a higher incidence of hyperuricemia than healthy women of childbearing age. Blood uric acid levels are closely correlated with body composition indicators, such as weight, BMI, waist-hip ratio, body fat mass, skeletal muscle mass, percent body fat, and visceral fat level. Body composition analysis of women with PCOS could help identify potentially obese people more accurately and carry out individualized treatment, thereby reducing the risk of metabolic abnormalities.

P-326 No higher incidence of chronic endometritis in infertile women with polycystic ovary syndrome: a propensity score-matched study

Abstract Study question Do infertile women with polycystic ovary syndrome(PCOS) have a higher incidence of chronic endometritis(CE) and need to screened for CE before assisted reproductive technology(ART)? Summary answer Under the diagnosis by CD138 immunohistochemical staining, no significant difference was found in the comparison of CE incidence between PCOS patients and non-PCOS patients. What is known already PCOS is the most common endocrinopathy among women of reproductive age and causes increased risks of embryo implantation failure and pregnancy loss. The chronic low-grade inflammation of the endometrium in PCOS women should not be ignored. CE is a local inflammation of the endometrium and also harms endometrial receptivity. Some specialists suggest that women at high risk of CE (such as endometrial polyps, repeated implantation failure, etc.) should be screened for CE before before ART. However, the risk of CE under the diagnosis by CD138 immunohistochemical staining for endometrial specimen in PCOS women has not been previously evaluated. Study design, size, duration We conducted a retrospective analysis of all infertile patients undergoing their first hysteroscopic operations during 2017-2022 from one tertiary hospital. All patients underwent hysteroscopy in the proliferative phase and endometrial biopsy for immunohistochemistry staining for CD138 was carried out. Cesarean section, intrauterine adhesion, recurrent spontaneous abortion or recurrent implantation failure and other diseases potentially related to chronic endometritis were strictly excluded. The CE incidence between PCOS patients and non-PCOS patients was compared. Participants/materials, setting, methods Endometrial biopsy and immunohistochemistry staining for CD138 was carried out among all patients. Demographic information were recorded. A propensity score matching (PSM) model was used to match the independent variables to balance the influence of confounding factors. Subgroup analysis according to different body mass index were also taken among PCOS patients and non-PCOS patients. Furthermore, a multivariate logistic model was used to explore the risk factors affecting CE incidence. Main results and the role of chance A total of 205 cases were allocated to the PCOS group, while 4021 cases were allocated to the non-PCOS group in the final analysis. After PSM, 197 PCOS patients were matched with 197 patients in the non-PCOS group. Significant differences were only found in the comparisons of PCOS-associated characteristics (P &amp;lt; 0.05) and the other baseline characteristics of the two groups were not significantly different(P &amp;gt; 0.05). No higher CE incidence in infertile women with PCOS was found either in total analysis or after PSM (P = 0.969, OR 1.01, 95% CI: 0.75-1.36; P = 0.385, OR 1.21, 95% CI: 0.75-1.36; respectively). Similar results were discovered in the subgroup of BMI≥28 kg/m2, BMI 24 -28kg/m2, and BMI＜24 kg/m2 (P = 0.301, OR 1.64, 95% CI: 0.64-4.19; P = 0.671, OR 1.13, 95% CI: 0.65-1.95; P = 0.427, OR 0.85, 95% CI: 0.58-1.27; respectively). Interestingly, a rising trend of CE incidence was found with the BMI increased in the PCOS group, even though no significant differences were found (BMI＜24 kg/m2: 28.80%; BMI 24 -28kg/m2: 36.66%; BMI≥28 kg/m2: 45.00%; respectively). Multivariate logistic regression showed that age, infertility duration, infertility type, PCOS, and obesity were not the independent risk factors affecting CE incidence. Limitations, reasons for caution Information bias cannot be ruled out because of the retrospective design of this study. Hence, we used PSM and regression analysis to minimize the impact of confounding variable. Besides, the sample size of patients with PCOS was limited. Therefore, a larger sample size will be used in our future study. Wider implications of the findings We firstly investigate the relationship between PCOS and CE diagnosed by CD138. The current evidence does not support PCOS women should screened for CE before ART. In the future, a larger sample of studies are needed to investigate the relationship between PCOS and CE, especially for obese PCOS patients. Trial registration number not applicable

1679-P: L-arginine Ameliorates Polycystic Ovary Syndrome and Attenuates Intestinal Oxidative Stress by Regulating Gut Microbiota

More than half of Polycystic ovary syndrome (PCOS) women are overweight or obese, and weight gain amplifies and worsens the symptoms of PCOS. Hence, it is essential to further understand and treat PCOS women with obesity. Therefore, this study tried to use a multi-omics approach that integrates the gut microbiome, serum metabolomics, serum transcriptomics, and clinical indicators to distinguish obese PCOS from obese non-PCOS women. The stool and blood samples from 33 obese PCOS patients and 30 obese control women were collected. The sequencing results suggested there were significant differences in gut microbiome and metabolites between obese PCOS women and obese women. Of which, the level of L-arginine (Arg) in obese PCOS patients was significantly lower than that in the control group and associated with gut microbiota alterations. Further correlation analysis between metabolite and clinical phenotype showed that Arg was significantly correlated with the clinical phenotype of obese PCOS patients. In this study, C57BL/6 mice were treated with dehydroepiandrosterone (DHEA) with a high-fat diet (HFD) to induce obese PCOS mice models for 3 weeks. PCOS mice were randomly divided into four groups: Arg group, Arg + antibiotic cocktail (ABX) group, PCOS group, and PCOS + ABX group. After 3 weeks of Arg supplementation, the estrous cycle, ovarian morphology, intestinal oxidative stress and intestinal barrier integrity were improved in Arg group PCOS mice, while testosterone levels and insulin resistance levels were decreased. However, these improvements were not observed in the Arg plus ABX group, suggesting that ABX-mediated depletion of the gut microbiome would eliminate these improvements. Then the 16s rRNA sequencing was performed to determine the gut microbiota of the four groups. The results showed that Arg can ameliorate reproductive characteristics of PCOS and attenuate intestinal oxidative stress by regulating gut microbiota. Disclosure D.Dilimulati: None. M.Cai: None. Y.Zhang: None. S.Qu: None. M.Zhang: None.

1680-P: Methyl Dihydrojasmonate (MDJ) Induces Hallmarks of Polycystic Ovary Syndrome (PCOS) and Related Mechanisms in Female Mice

More than half of polycystic ovary syndrome (PCOS) are overweight or obese. Environmental endocrine-disrupting chemicals (EDCs) are one of the important pathogenic factors in PCOS women. Methyl dihydrojasmonate (MDJ) is a food flavor additive, which can enter the body through several paths. However, the impact of MDJ on obese PCOS patients is still unknown. Hence, the study aims to determine whether MDJ may induce hallmarks of PCOS as new EDCs. The blood samples (33 obese PCOS patients and 30 controls) were collected for metabonomic sequencing. Sequencing results that serum MDJ level was significantly increased in obese PCOS patients, and was closely associated with the clinical phenotype of PCOS. C57BL/6J female mice fed high-fat diets were randomly divided into four groups. The PCOS model was established by subcutaneous injection of dehydroepiandrosterone for 21 days. Different concentrations of MDJ group were gavage of MDJ (60, and 120 mg/kg/d), and the control group was gavage of corn oil, once daily from pregnancy to offspring 16 weeks old. After 16 weeks, different concentrations of MDJ treatment resulted in an irregular estrus cycle and disturbed ovarian development in female mice. Serum TT and insulin resistance levels were increased in the MDJ group. At the cellular level, different concentrations of MDJ (50, and 100 μg/L) intervention mouse-primary-granulosa-cells (mpGCs) and measured supernatant TT levels after 48h. In the mouse ovarian tissue and mpGCs, we found that the expression of key genes for steroid synthesis (Star, Cyp17a1, Hsd3b1, Lhcgr) was increased significantly, while the expression of Cyp19a1 decreased after different concentrations of MDJ treatments. In preliminary experiments, we found that long-term exposure to MDJ during pregnancy and growth can induce PCOS phenotype in C57BL/6J female mice. Ongoing studies will determine how MDJ induces the hallmarks of PCOS and related mechanisms, which may help reveal the pathogenesis of PCOS. Disclosure M.Cai: None. D.Dilimulati: None. Y.Zhang: None. X.Shao: None. S.Qu: None. M.Zhang: None. Funding National Key R&amp;D Program of China (2018YFC1314100); National Natural Science Foundation of China (81601269)