Obese Polycystic Ovary Syndrome Research Articles

Polycystic Ovary Syndrome, Insulin Resistance, and Cardiovascular Disease.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age. It has been associated with metabolic, reproductive, and psychiatric disorders. Despite its association with insulin resistance (IR) and cardiovascular disease (CVD) risk factors, the association between PCOS and CVD outcomes has been conflicting. This review reports the updated evidence between PCOS, insulin resistance, and CVD events. IR is highly prevalent occurring in 50 to 95% of general and obese PCOS women. The etiology of PCOS involves IR and hyperandrogenism, which lead to CVD risk factors, subclinical CVD, and CVD outcomes. Multiple studies including meta-analysis confirmed a strong association between PCOS and CVD events including ischemic heart disease, stroke, atrial fibrillation, and diabetes, particularly among premenopausal women, and these associations were mediated by metabolic abnormalities. PCOS is highly familial and has substantial CVD risk and transgenerational effects regardless of obesity. A personalized approach to the CVD risk assessment and management of symptom manifestations should be conducted according to its phenotypes. Lifestyle modifications and reduction in environmental stressors should be encouraged for CVD prevention among PCOS women.

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.

MALAT1 expression in granulosa cells in PCOS patients with different phenotypes

Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine metabolic disorders. The lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) reportedly can regulate the reproductive system. Despite studies, the alteration of MALAT1 expression in granulosa cells (GCs) from PCOS patients was inconsistent. To evaluate MALAT1 expression in GCs in different PCOS subgroups and its association with PCOS phenotypes, we collected GCs from 110 PCOS cases and 71 controls, and examined MALAT1 expression by quantitative PCR. The results showed MALAT1 expression was upregulated in PCOS cases, especially in insulin resistant (IR) PCOS subgroup, obese PCOS subgroup and non-hyperandrogenic (NHA) PCOS subgroup. MALAT1 expression was positively correlated with BMI and several metabolic parameters in controls. Interestingly, MALAT1 expression was notably associated with some critical endocrine indexes for PCOS, including E2, FSH, LH and LH/FSH ratio. In different PCOS subgroups, we found significant positive correlations with LH/FSH ratio in IR-PCOS and PCOS with normal weight, and with serum T and LH level in NHA-PCOS subgroup. Integrated analysis with lncRNA target databases and PCOS-related databases revealed MALAT1 could participate in PCOS by influencing immune response and lipids metabolism in GCs. In conclusion, MALAT1 was differently expressed in GCs in PCOS, especially in IR, obese and NHA PCOS subgroups. MALAT1 was likely involved in metabolism and immune response in GCs in PCOS. However, more studies are necessary to establish this concept.

A Cross-Sectional Study of Protein Changes Associated with Dementia in Non-Obese Weight Matched Women with and without Polycystic Ovary Syndrome.

Dysregulated Alzheimer's disease (AD)-associated protein expression is reported in polycystic ovary syndrome (PCOS), paralleling the expression reported in type 2 diabetes (T2D). We hypothesized, however, that these proteins would not differ between women with non-obese and non-insulin resistant PCOS compared to matched control subjects. We measured plasma amyloid-related proteins levels (Amyloid-precursor protein (APP), alpha-synuclein (SNCA), amyloid P-component (APCS), Pappalysin (PAPPA), Microtubule-associated protein tau (MAPT), apolipoprotein E (apoE), apoE2, apoE3, apoE4, Serum amyloid A (SAA), Noggin (NOG) and apoA1) in weight and aged-matched non-obese PCOS (n = 24) and control (n = 24) women. Dementia-related proteins fibronectin (FN), FN1.3, FN1.4, Von Willebrand factor (VWF) and extracellular matrix protein 1 (ECM1) were also measured. Protein levels were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement. Only APCS differed between groups, being elevated in non-obese PCOS women (p = 0.03) relative to the non-obese control women. This differed markedly from the elevated APP, APCS, ApoE, FN, FN1.3, FN1.4 and VWF reported in obese women with PCOS. Non-obese, non-insulin resistant PCOS subjects have a lower AD-associated protein pattern risk profile versus obese insulin resistant PCOS women, and are not dissimilar to non-obese controls, indicating that lifestyle management to maintain optimal body weight could be beneficial to reduce the long-term AD-risk in women with PCOS.

Alterations in nonesterified free fatty acid trafficking rather than hyperandrogenism contribute to metabolic health in obese women with polycystic ovary syndrome

To determine whether alterations in non-esterified free fatty acids (NEFA) dynamics or degree of hyperandrogenism (HA) contribute to the difference in insulin sensitivity between metabolically healthy (MHO-PCOS) and metabolically unhealthy (MUO-PCOS) obese PCOS women. Prospective cross-sectional study. One hundred-and-twenty-five obese PCOS women. Consecutive obese (BMI≥30 kg/m2) oligo-ovulatory PCOS women (n=125) underwent oGTT and a subgroup of 16 participants underwent modified frequently samples intravenous glucose tolerance test (mFSIVGTT), to determine insulin action and NEFA dynamics. Degree of IR in adipose tissue (AT) basally (Adipo-IR) and dynamically (NEFAnadir, TIMEnadir, and %NEFAsupp); lipolysis rate (SNEFA) and NEFA uptake rate (KNEFA); whole-body insulin action (AIRg, Si, Sg, and DI); and HA (hirsutism score, testosterone [total, free], DHEAS). 85 (68%) subjects were MUO-PCOS and 40 (32%) MHO-PCOS by HOMA-IR. MUO-PCOS and MHO-PCOS did not differ in mean age, BMI, WHR, HA and lipoprotein levels. By mFSIVGTT, 8 MUO-PCOS subjects had lesser Si, KNEFA, and %NEFAsupp, and greater TIMEnidar, NEFAnidar and Adipo-IR, than 8 MHO-PCOS, but similar fasting NEFA and SNEFA. MUO-PCOS had higher HOMA-β% and fasting insulin than MHO-PCOS. In bivalent analysis, Si correlated strongly and negatively with NEFAnadir, weakly and negatively with TIMEnadir, and positively with KNEFA and NEFAsupp, in MUO-PCOS only. Independent of age and BMI, MUO-PCOS women have reduced NEFA uptake and altered insulin-mediated NEFA suppression, but no difference in HA, than MHO-PCOS. Altered insulin-mediated NEFA suppression, rather than HA or lipolysis rate, contributes to variations in insulin sensitivity among obese PCOS women.

Evaluation of potential association of metabolic syndrome in obese and non-obese PCOS women

BackgroundPolycystic ovary syndrome is an escalating endocrinal and reproductive disorder among women of reproductive age and is considered the foremost health burden. Therefore, the present study is an attempt to estimate the potential association of metabolic syndrome in obese and non-obese PCOS women. A total of 250 PCOS women ranging in age from 18 to 45 years and living in the Chandigarh Capital Region were selected from the OPD, PGIMER, Chandigarh, (North India). Rotterdam Criteria (2003) was employed to diagnose polycystic ovary syndrome among women.ResultsThe prevalence of metabolic syndrome (MS) as assessed by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) was found to be 30% (4% in non-obese and 26% in obese) in PCOS women. Waist circumference > 88 cm is the most prevalent feature in PCOS women (67.2%) followed by HDL < 50 mg/dL (56.8%). The multivariate logistic regression analysis exhibited that visceral adiposity index (VAI) was a significant determinant of metabolic syndrome in obese (OR = 1.17, p < 0.01) and non-obese (OR = 1.2, p < 0.01) PCOS women. Results of ROC analysis further established visceral adiposity index as a potential determinant in metabolic syndrome in both the groups of PCOS women. In obese PCOS women, the W/H ratio also depicted accuracy in predicting metabolic syndrome risk.ConclusionsVisceral adiposity index is a significant tool to assess the metabolic syndrome in both groups, i.e., obese and non-obese. However, the waist/hip ratio can be considered as a predictive tool in obese women only. Thus, it could be used as a significant and inexpensive tool in clinical practices for early detection of metabolic syndrome in PCOS women.

Association of Fat Mass and Skeletal Muscle Mass with Cardiometabolic Risk Varied in Distinct PCOS Subtypes: A Propensity Score-Matched Case-Control Study.

(1) Background: polycystic ovarian syndrome (PCOS) is a heterogeneous syndrome with a constellation of cardiometabolic risk factors. We aimed to investigate if the association of body fat mass (BFM) and skeletal muscle mass (SMM) with cardiometabolic risk differed in PCOS subtypes. (2) Methods: 401 participants (245 PCOS and 156 controls) were assessed for anthropometric measurements, glucose-lipid profiles, reproductive hormones and body composition with propensity score-matched (PSM) analysis. The association of the cardiometabolic risk score (z score, calculated based on levels of obesity and gluco-lipid measurements) with BFM (estimated by trunk BFM/Height2) and SMM (estimated by SMM/Height2) was calculated. (3) Results: Trunk BFM/Height2 and SMM/Height2 were both positively associated with cardiometabolic risk in PCOS (trunk BFM/Height2, OR 2.33, 95% CI 1.49-3.65; SMM/Height2, OR 2.05, 95% CI 1.12-3.76). SMM/Height2 associated with increased cardiometabolic risk in obese PCOS (BMI ≥ 28 kg/m2, OR 2.27, 95% CI 1.15-4.47). For those with lower BMI (<28 kg/m2), trunk BFM/Height2 showed a higher OR in both groups (PCOS, OR 2.12, 95% CI 1.06-4.24; control 2.04, 95% CI 1.04-4.02). Moreover, distinct associations among BMI-stratified groups were validated in hierarchical clustering identifying metabolic and reproductive clusters. (4) Conclusions: BFM and SMM are synergistically associated with higher cardiometabolic risk in PCOS women. Although BFM contributes to increased cardiometabolic risk, SMM also plays a primary role in obese PCOS. Our results highlight the importance of body composition in the management of PCOS.

Lipid accumulation product is an effective predictor of metabolic syndrome in non-obese women with polycystic ovary syndrome.

To explore the correlation of lipid accumulation product (LAP) with metabolic syndrome (MS) and to assess the predictive value of LAP for MS risk in polycystic ovary syndrome (PCOS) with different body mass index (BMI). A total of 242 PCOS patients and 150 controls were recruited and divided into normal-weight, overweight, and obese groups, then further divided into MS and without MS subgroups. Clinical and anthropometric variables and laboratory results were recorded. LAP was calculated from waist circumference (WC) and triglyceride using sex-specific formulae. Logistic regression analysis and receiver operating characteristic (ROC) curve were applied to determine and analyze the predictive value of LAP for MS. The prevalence of MS among PCOS patients was 45.04%, which was significantly higher than that of the controls (10%). Stratified by BMI, the incidence of MS in the normal-weight, overweight, and obese PCOS groups were 15.58%, 41.43%, and 71.58%, respectively. Logistic regression analysis indicated that LAP was an independent risk factor for MS in both normal-weight and overweight groups; however, the results were not significant in the obese group. ROC curve analysis showed that LAP had an outstanding discrimination index for MS in normal-weight (AUC=0.960, cut-off value=42.5) and overweight (AUC=0.937, cut-off value=47.93) PCOS patients, with a sensitivity of 0.917/0.931 (normal-weight/overweight) and a specificity of 0.969/0.854 (normal-weight/overweight), respectively. Normal-weight and overweight PCOS patients also have a fairly high incidence of MS and should receive as much attention as obese patients. Compared to applying multiple clinical indicators, LAP is more convenient and facilitates acquiring early and accurate diagnoses of MS among non-obese PCOS patients using fewer MS markers.

Association of Neuregulin-4 levels and body mass index with hyperandrogenism in Polycystic Ovary Syndrome patients

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disease that affects approximately 15% of women of childbearing age worldwide. It is one of the causes of infertility and is characterized by hirsutism, acne, persistent or interrupted anovulation, and hyperandrogenemia. Neuregulin-4 (NRG-4) is an adipokine hormone from the protein neuregulin family. Its level is greater in PCOS than in control women, and Neuregulin-4 is linked to body fat percentage and liver fat, as well as insulin resistance (IR). Objectives: To estimate the serum NRG-4 levels in women diagnosed with (PCOS), to compare it with, non-PCOS healthy control and to explore the effect of hyperandrogenism on the obtained result. Patients and Methods: A case-control study was conducted in the Gynecology and the Infertility Clinics in Kut - Zahraa Hospital, Medical City, from September to December 2022. The study included 120 women aged (18-42) years, 60 of whom were diagnosed with polycystic ovaries, and the other 60 were in the control group. Results: Women with PCOS had a significantly higher NRG-4, LH, LH/FSH ratio, testosterone, free testosterone, and Dehydroepiandrosterone sulfate (DHEA-S) than the control groups. In this study, NRG-4 was significantly higher in obese and overweight PCOS women than in normal-weight women. Conclusion: The mean serum NGR-4 concentration is significantly increased in women with PCOS and could be a part of metabolic syndrome. NGR-4 levels were associated with obesity, hyperandrogenism (testosterone, free testosterone, and DHAES) and may have a role in the development of PCOS. Received: May,, 2022 Accepted: Oct, 2023 Published: Jan.2024

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.

Electroacupuncture ameliorates hepatic defects in a rat model of polycystic ovary syndrome induced by letrozole and a high-fat diet.

This study was designed to evaluate the effects of low-frequency electroacupuncture (EA) on glucose and lipid disturbances in a rat model of polycystic ovary syndrome (PCOS) characterized by insulin resistance (IR) and hepatic steatosis. The PCOS rat model was induced by continuous administration of letrozole (LET) combined with a high-fat diet (HFD). Female Sprague-Dawley rats were divided into the following four groups: control, control + EA, LET + HFD and LET + HFD + EA. EA was administered five or six times a week with a maximum of 20 treatment sessions. Body weight, estrous cyclicity, hormonal status, glucose and insulin tolerance, lipid profiles, liver inflammation factors, liver morphology and changes in the phosphatidylinositol 3-kinase (PI3-K)/Akt (protein kinase B) pathway were evaluated. The rat model presented anovulatory cycles, increased body weight, elevated testosterone, abnormal glucose and lipid metabolism, IR, liver inflammation, hepatic steatosis and dysregulation of the insulin-mediated PI3-K/Akt signaling axis. EA reduced fasting blood glucose, fasting insulin, area under the curve for glucose, homeostasis model assessment of IR indices, triglycerides and free fatty acids, and alleviated hepatic steatosis. Furthermore, low-frequency EA downregulated mRNA expression of tumor necrosis factor (TNF)-α and interleukin (IL)-6, upregulated mRNA expression of peroxisome proliferator-activated receptor (PPAR)-α, increased protein expression of phosphorylated (p)-Akt (Ser473), p-glycogen synthase kinase (GSK) 3β (Ser9) and glucose transporter 4 (GLUT4), increased the ratio of p-GSK3β to GSK3β and downregulated protein expression of GSK3β. An obese PCOS rat model with IR and hepatic steatosis was successfully established by the combination of LET and HFD. EA improved dysfunctional glucose and lipid metabolism in this PCOS-IR rat model, and the molecular mechanism appeared to involve regulation of the expression of key molecules of the PI3-K/Akt insulin signaling pathway in the liver.

Letrozole + Ziwu Liuzhu Transcutaneous Electrical Acupoint Stimulation Improves Ovulation-Induced Pregnancy Rate in Obese Women with Polycystic Ovary Syndrome: A Prospective Cohort Study.

This study investigated the effect of letrozole with/without meridian-infusion percutaneous electrical stimulation on the rates of ovulation-induced pregnancy in patients with obese polycystic ovary syndrome (obPCOS). Patients with obPCOS, ages 20-40, each with a body mass index (BMI) ≥24 kg/m2, and/or waist circumference ≥80 cm, and at least 1 side tubal patency were enrolled at the Guangdong Women and Children Hospital, Guangzhou, China. They were divided into 2 groups: ZLT [Ziwu Liuzhu + transcutaneous electrical acupoint stimulation] and control. Baseline conditions and pregnancy status were collected for all patients. Multivariate Cox regression analysis and sensitivity analysis of propensity score matching (PSM) were performed for the groups after multiple interpolations. From July 2021 to September 2022, 345 patients with obPCOS were recruited: 53 cases/69 cycles in the ZLT group and 292 cases/396 cycles in the control group. The 2 sets of baselines were flush. The anovulatory cycle rates were: ZLT, 2.89% (2/69); and control, 1.77% (7/396); P > 0.05. Multifollicle growth-cycle rates were: ZLT, 0% (0/69); and control, 0.76% (3/396); P > 0.05. Multivariate COX regression analysis showed adjusted hazard ratio (aHR) 95% confidence interval (CI): 2.11 (1.19, 3.73); P = 0.011. Multivariate Cox regression analysis with multiple imputation showed aHR 95% CI: 2.11 (1.19, 3.73); P = 0.013. In the overweight group (24-28 kg/m2), the pregnancy rate of the control and ZLT groups were 20.2% and 32.3%, respectively, aHR 95% CI: 1.76 (0.87,3.55); P = 0.113. In the obese cohort (≥ 28 kg/m2), the control and ZLT groups, pregnancy rates were 10.7% and 27.3%, respectively, aHR 95% CI: 3.46 (1.21, 9.92); P = 0.021; (Pfor interaction = 0.369). The caliper value was set as 0.2 for BMI and antral-follicle count, and PSM was performed at 1:1, aHR 95%CI: 2.45 (1.01, 5.96); P = 0.048. Letrazole + ZLT had a positive effect on ovulation-induced pregnancy rates in patients with obPCOS.

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.

Body mass index is a good predictor of metabolic abnormalities in polycystic ovary syndrome.

To assess which parameters among hyperandrogenism (total testosterone-tT-or free androgen index-FAI), sex hormone binding globulin (SHBG) or body mass index (BMI) could better predict a worse metabolic profile in women with polycystic ovary syndrome (PCOS). Five hundred and eighty-six women with PCOS and clinical or biochemical hyperandrogenism were included. Receiver Operating Characteristics (ROC) curves with tT, FAI, SHBG and BMI were performed for metabolic parameters and a cut-off with sensitivity and specificity was obtained for each parameter. The women were then divided into three groups and compared according to their BMI. Based on the ROC curves, tT proved not to be a good predictor of metabolic alterations. FAI and SHBG resulted to be good predictors of some markers of metabolic damage. The area under the curves (AUC) of SHBG were greater than those of FAI. SHBG levels affects the values of homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin, high density lipoproteins (HDL), low density lipoproteins (LDL), and total cholesterol also when corrected for BMI. However, the highest AUCs of the ROC curves were observed when BMI was used, which was significantly related to all the metabolic parameters analyzed. Dividing women according to their BMI, BMI between 25.00 and 30.00 kg/m2 had a worse metabolic profile but still in a normal range, while BMI≥30 kg/m2 women had a significant metabolic derangement. BMI is a good predictor factor of metabolic changes in PCOS women at any age, and obesity is associated to the appearance of metabolic complications. Overweight and obese PCOS women should be addressed to perform a complete metabolic assessment.

The effects of intermittent fasting diet alone or in combination with probiotic supplementation in comparison with calorie-restricted diet on metabolic and hormonal profile in patients with polycystic ovary syndrome: study protocol for a randomized clinical trial

IntroductionPolycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in females characterized by ovulatory dysfunction, hyperandrogenism, and other metabolic disorders. Both intermittent fasting and specific probiotics have been suggested to help improve patients with PCOS through changes in gut microbial composition, circadian clock, and metabolic regulation. Therefore, the present study aims to investigate the effects of intermittent fasting alone or in combination with probiotic supplementation compared to the calorie-restricted (CR) diet on anthropometric measures, metabolic status, inflammation, and oxidative stress in women with PCOS.MethodsWe will carry out a randomized clinical trial for 8 weeks. Participants will be randomly assigned (1:1:1) to one of the three groups: (1) a 14:10 early time-restricted feeding (TRF) diet with probiotic supplementation (n = 30); (2) a 14:10 early TRF diet with placebo supplementation (n = 30); (3) a CR diet (energy-restricted 25% of required calories) with placebo supplementation as a control group (n = 30). The primary outcomes will be changes in body weight and insulin resistance. However, glycemic control, lipid profile, metabolic parameters, sex hormone-binding globulin, dehydroepiandrosterone, anti-Mullerian hormone, free androgen index, hirsutism, acne, antioxidant and oxidant status, inflammation, anthropometric measures, mental health, sleep quality, appetite, eating behavior, food craving, and blood pressure are secondary outcomes. All outcomes of this study will be evaluated in pre- and post-intervention.DiscussionWe hypothesized that 10-h TRE administered alone or in combination with probiotic supplementation to overweight and obese PCOS subjects would lead to weight loss and improved metabolic, hormonal, inflammatory, and antioxidant markers compared to control subjects following a standard 3-meal-per-day CR diet.Ethical aspectsThe current trial received approval from the Medical Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (IR.TUMS.MEDICNE.REC.1401.425).Trial registrationIranian Registry of Clinical Trials IRCT20121110011421N5. Registered on 3 October 2022.

The Effect of Thylakoid Membranes of Spinach Extract Supplementation on Atherogenic, Glycemic, and Anthropometric Indices and Renal Function in Obese PCOS Women under a Hypo-Caloric Diet: A Randomized, Double-Blind, Controlled Trial

The Effect of Thylakoid Membranes of Spinach Extract Supplementation on Atherogenic, Glycemic, and Anthropometric Indices and Renal Function in Obese PCOS Women under a Hypo-Caloric Diet: A Randomized, Double-Blind, Controlled Trial

The effects of weight loss on health-related quality of life in obese women with PCOS and controls

BackgroundPolycystic ovary syndrome (PCOS) is a complicated endocrine disorder with widespread symptoms that reduce women’s quality of life. The adverse effect of associated obesity on this reduction is unclear, therefore the impact of weight loss on health-related quality of life (HRQOL) in obese women with PCOS is unknown. This study aimed to compare the impact of weight loss following a 24-week dietary intervention on HRQOL in obese women with and without PCOS.MethodsIn a 24-week hypocaloric LGI (low glycemic index) diet intervention study, 286 women were recruited (140 PCOS, 146 controls) and 216 participants (PCOS = 105, non-PCOS = 111) completed the study. HRQOL was assessed using the SF-36 questionnaire (Short Form Health Survey). Physical activity was measured using the short form of the International Physical Activity Questionnaire (IPAQ). Anthropometric assessments, dietary intake, physical activity levels, and HRQOL scores, according to the Iranian version of SF-36, were compared at baseline and 24 weeks with intervention.ResultsAt the end of the intervention, there was no significant difference in the percentages of weight loss between the two groups (PCOS: 6.29 ± 3.32% vs. non-PCOS: 7 ± 3.62%, p = 0.1). At baseline, women with PCOS had lower mean scores in aspects of physical function (PF), general health perception (GH), role limitation due to emotional problem (RE), vitality (VT), mental health (MH), physical (PCS) and mental component summary scales (MCS), compared to non-PCOS (P < 0.01). At 24 weeks, the percentage of improvement in HRQOL in the non-PCOS group was higher compared to the PCOS group but this difference didn’t reach statistical significance except for PCS. In both groups, greater weight loss was associated with further improvement in the physical aspects of HRQOL and vitality. In the non-PCOS group, with trivial exception, greater weight loss was associated with greater improvement in the mental aspects of HRQOL.ConclusionsBoth obese PCOS and non-PCOS women achieved nearly similar levels of improvement in HRQOL due to weight loss induced by a hypocaloric LGI diet.Trial registrationThis study is registered in the Iranian Randomized Clinical Trials Registry (IRCT, code: IRCT2016092129909N1).

Successful Pregnancy in Morbidly Obese Women of Polycystic Ovary Syndrome With Various Treatment Options With Individual Consequences: Case Series

Objective: The objective of the study was to compare the effectiveness of different treatment options in the management of infertility across three cases in morbidly obese women with polycystic ovary syndrome (PCOS). Case study &amp; results: The first case is 30 years old with secondary infertility for two years with two abortions and a body mass index (BMI) is 69, she tried all lifestyle modifications with no response to weight reduction and she was conceived spontaneously without fertility treatment and subsequent antenatal care progressed without any complications until 36 weeks complicated with raised blood sugar beyond the normal level but not so high and intrauterine fetal death one week later ended by spontaneous normal vaginal delivery. The second case is 24 years old with BMI 66 is undergone weight reduction, ovulation induction with clomiphene citrate and gonadotropin injections with good ovulation response but no pregnancy, in vitro fertilization was performed but aborted at 8 weeks gestation, one year later after the use of metformin and ovulation induction with injections patient conceived and her pregnancy complicated by pre-eclampsia, gestational diabetes treated with insulin and preterm delivery. The third case is 40 years old with primary infertility for 5 years with BMI 70, she is known case diabetes mellitus 10 years back controlled with insulin, and hypertension on treatment, undergone bariatric surgery and one year later IVF was done after the failure of multiple ovulation induction, her diabetes mellitus and hypertension control well with treatment and delivered at 39 weeks by elective cesarean section with a birth weight of 4.5 kg. Discussion: PCOS is a genetic condition, worsened by obesity. The prevalence of obesity in PCOS women is up to 80%. There is a strong relationship between PCOS and obesity making the condition more complex. The majority of women with PCOS are either overweight or obese and the pathogenesis of obesity in PCOS has not yet been exactly identified. Obesity has adverse effects on fertility through anovulation, poor implantation, and quality oocyte. Conclusion: The ideal treatment of infertility in morbidly obese PCOS women has not been defined, but generally, before deciding which treatment option is preferred, proper weight loss and control of the metabolic state are carried out for successful pregnancy