The role of vitamin D in metabolic disturbances in polycystic ovary syndrome: a systematic review

Prevalence of hypovitaminosis D, and its association with hypoadiponectinemia and hyperfollistatinemia, in Saudi women with naïve polycystic ovary syndrome

•

Hypovitaminosis D is prevalent in Saudi women with polycystic ovarian syndrome (PCOS).

•

Serum 25(OH)D of PCOS patients were correlated positively with adiponectin and FSH.

•

Serum 25(OH)D of PCOS patients was correlated negatively with markers of insulin resistance.

•

Serum 25(OH)D of PCOS patients was correlated negatively with follistatin, LH, and androgens.

•

Hypovitaminosis D, with low adiponectin and excess follistatin, is being a risk in PCOS.

Aims

The association between vitamin D and polycystic ovary syndrome (PCOS) is an active area of growing research. However, data in Saudi Arabia are scarce. This study aimed to define serum 25-hydroxyvitamin D (25(OH)D) levels among Saudi women with naïve PCOS, and to investigate the associations of their 25(OH)D status with their serum adiponectin and follistatin levels, along with indices of insulin resistance and hormonal deteriorations.

Methods

In this case-control observational study, 63 women with PCOS and 65 age-and body mass index (BMI)-matched control women were assessed. PCOS was diagnosed based on the revised criteria of Rotterdam. Fasting serum levels of 25(OH)D, adiponectin, follistatin, insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), androgen (Δ₄-androstenedione), estradiol, progesterone, along with fasting plasma glucose (FPG), homeostasis model assessment-insulin resistance (HOMA-IR) index and lipid profile were measured in both groups.

Results

The prevalence of hypovitaminosis D (serum 25(OH)D <30 ng/ml) was higher in PCOS group than control group (77.8% vs. 12.3%). Serum adiponectin and FSH concentrations were significantly lower, while serum follistatin, LH, TT, Δ₄-androstenedione and insulin levels, as well as FPG and HOMA-IR were significantly higher in PCOS group than control group. In addition, 25(OH)D levels of PCOS women were significantly correlated positively with adiponectin and FSH levels, but negatively with follistatin, HOMA-IR, FPG, LH, testosterone, and Δ₄-androstenedione levels.

Conclusion

Hypovitaminosis D, coexisted and correlated with hypoadiponectinemia and hyperfollistatinemia, is being an alarming risk factor in Saudi women with PCOS. Further investigational and explanatory studies in large size samples are warranted to realize these findings and to improve both diagnostic and treatment tools in Saudi women with PCOS.

Effects of vitamin D on ovary in DHEA-treated PCOS rat model: A light and electron microscopic study

AIM

The aim of this study was to investigate the effects of vitamin D treatment on ovary in experimentally designed polycystic ovary syndrome of female rats using light and electron microscopic techniques.

METHODS

Twenty-four female pre-pubertal rats were divided into control, DHEA and DHEA+Vit.D groups. In DHEA group, the PCOS rat model was developed by 6mg/kg/day dehydroepiandrosterone administration as subcutaneously injections. In DHEA+Vit.D group, 6 mg/kg/day DHEA and 120ng/100g/week 1,25(OH)2D3 was performed simultaneously. Controls were injected with vehicle alone. At the end of the 28 days, blood samples were collected and the ovarian tissues were taken for histological examinations.

RESULTS

FSH, LH levels, LH/FSH ratio, and testosterone levels showed a significant increase in DHEA group when compared with the control group. Moreover, these measurements were lower in the treatment group than the DHEA group. In DHEA group, increased number of atretic follicles and cystic follicles were seen with light microscopic analysis. Cystic follicles with attenuated granulosa cell layers and thickened theca cell layers and lipid accumulation in interstitial cells were observed by electron microscope. It is observed that atretic and cystic follicles were decreased as a result of vitamin D treatment.

CONCLUSION

Our results indicate the curative role of vitamin D treatment on the androgen excess in PCOS rat model which causes abnormalities in ovarian morphology and functions. Vitamin D has positive effects on the hormonal and structural changes observed in PCOS, but it has been concluded that long-term use may be more beneficial.

Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment

PURPOSE OF REVIEW

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women and is associated with an increased prevalence of depression and anxiety symptoms. This review presents potential mechanisms for this increased risk and outlines treatment options.

RECENT FINDINGS

Women with PCOS have increased odds of depressive symptoms (OR 3.78; 95% CI 3.03-4.72) and anxiety symptoms (OR 5.62; 95% CI 3.22-9.80). Obesity, insulin resistance, and elevated androgens may partly contribute to this association. Therefore, in addition to established treatment options, treatment of PCOS-related symptoms with lifestyle modification and/or oral contraceptive pills may be of benefit. Screening for anxiety and depression is recommended in women with PCOS at the time of diagnosis. The exact etiology for the increased risk in PCOS is still unclear. Moreover, there is a paucity of published data on the most effective behavioral, pharmacological, or physiological treatment options specifically in women with PCOS.

VDR Gene variation and insulin resistance related diseases

Background

Vitamin D status may influence the risk of Insulin resistance related diseases such as Type 2 diabetes (T2DM), metabolic syndrome (MetS), and polycystic ovarian syndrome (PCOS). Several studies have assessed vitamin D receptor (VDR) gene polymorphism in relationship with these diseases; however, results remain inconsistent. Our study was conducted to elucidate whether VDR Gene polymorphisms could predict insulin resistance on a large scale.

Methods

A meta-analysis using MEDLINE and EMBASE, was performed up to December 16th, 2016. Studies reporting association of vitamin D gene polymorphism with incident T2DM, MetS and PCOS outcomes were included and sub-group analysis by pigment of skin and latitude were performed.

Results

A total of 28 articles based on four gene variation, and comprising 9232 participants with 5193 Insulin resistance related diseases patients were included. No significant associations of the VDR ApaI, BsmI, FokI and TaqI variant with Insulin resistance related diseases were found. However, sub-group analysis analysis showed that PCOS in TaqI (OR = 1.47, 95% CI = 1.03–2.09, P = 0.03) for T allele and MetS for G allele (OR = 1.41, 95% CI = 1.07–1.85, P = 0.01) in BsmI was significant association with VDR gene polymorphism. Simultaneously, sub-group analysis showed VDR ApaI rs7975232(G > T)variant was associated with insulin resistance related diseases in Asians (GG/GT + TT) (OR, 1.62; 95% CI, 1.03–2.53; P = 0.04) and population who lived in middle latitude district (30–60°) (GG/GT + TT) (OR, 1.22; 95% CI, 1.04–1.43; P = 0.02), VDR BsmI rs1544410 (A > G)and VDR Taq1rs731236 (T/C) variant were associated with insulin resistance related diseases in Caucasian (dark-pigmented).

Conclusion

The results suggested that the association between insulin resistance related diseases and VDR ApaI, BsmI, FokI variant was more obvious in dark-pigmented Caucasians and Asians but not in Caucasian with white skin.

Combining a nontargeted and targeted metabolomics approach to identify metabolic pathways significantly altered in polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a condition of androgen excess and chronic anovulation frequently associated with insulin resistance. We combined a nontargeted and targeted metabolomics approach to identify pathways and metabolites that distinguished PCOS from metabolic syndrome (MetS).

METHODS

Twenty obese women with PCOS were compared with 18 obese women without PCOS. Both groups met criteria for MetS but could not have diabetes mellitus or take medications that treat PCOS or affect lipids or insulin sensitivity. Insulin sensitivity was derived from the frequently sampled intravenous glucose tolerance test. A nontargeted metabolomics approach was performed on fasting plasma samples to identify differentially expressed metabolites, which were further evaluated by principal component and pathway enrichment analysis. Quantitative targeted metabolomics was then applied on candidate metabolites. Measured metabolites were tested for associations with PCOS and clinical variables by logistic and linear regression analyses.

RESULTS

This multiethnic, obese sample was matched by age (PCOS, 37±6; MetS, 40±6years) and body mass index (BMI) (PCOS, 34.6±5.1; MetS, 33.7±5.2kg/m²). Principal component analysis of the nontargeted metabolomics data showed distinct group separation of PCOS from MetS controls. From the subset of 385 differentially expressed metabolites, 22% were identified by accurate mass, resulting in 19 canonical pathways significantly altered in PCOS, including amino acid, lipid, steroid, carbohydrate, and vitamin D metabolism. Targeted metabolomics identified many essential amino acids, including branched-chain amino acids (BCAA) that were elevated in PCOS compared with MetS. PCOS was most associated with BCAA (P=.02), essential amino acids (P=.03), the essential amino acid lysine (P=.02), and the lysine metabolite α-aminoadipic acid (P=.02) in models adjusted for surrogate variables representing technical variation in metabolites. No significant differences between groups were observed in concentrations of free fatty acids or vitamin D metabolites. Evaluation of the relationship of metabolites with clinical characteristics showed 1) negative associations of essential and BCAA with insulin sensitivity and sex hormone-binding globulin and 2) positive associations with homeostasis model of insulin resistance and free testosterone; metabolites were not associated with BMI or percent body fat.

CONCLUSIONS

PCOS was associated with significant metabolic alterations not attributed exclusively to androgen-related pathways, obesity, or MetS. Concentrations of essential amino acids and BCAA are increased in PCOS, which might result from or contribute to their insulin resistance.

The effect of alfacalcidiol and metformin on metabolic disturbances in women with polycystic ovary syndrome

BACKGROUND

The aim of this randomized clinical trial (RCT) was to evaluate the effect of vitamin D supplementation in obese, insulin-resistant (IR) and vitamin D-deficient polycystic ovary syndrome (PCOS) women on metabolic abnormalities in comparison to the effect of metformin or combined metformin plus vitamin D therapy.

MATERIAL AND METHODS

Thirty-nine PCOS women who fulfilled the inclusion criteria were randomized into three groups and treated with alfacalcidiol, combined alfacalcidiol and metformin therapy and metformin for 6 months. Body weight, body mass index (BMI), waist circumference, total body fat and fat distribution were measured before and after 6 months of treatment. Plasma fasting glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and lipid profiles were measured at the same time.

RESULTS

There was a significant decrease in body weight, BMI, waist circumference, total body fat and serum glucose levels in the metformin group (p<0.05), whereas PCOS women treated with alfacalcidiol did not significantly change their anthropometric and metabolic parameters. A significant decrease in waist circumference (p<0.05) in the group treated with metformin and alfacalcidiol was detected without other significant metabolic changes (all p>0.05). There were no significant changes in metabolic parameters (p>0.05) after vitamin D therapy except for a slight but non-significant trend towards higher high-density lipoprotein (HDL) cholesterol levels (p=0.087).

CONCLUSION

We conclude that vitamin D supplementation has no significant effect on anthropometric and metabolic parameters in PCOS women. Metformin has been still the most effective modality for the treatment of metabolic changes in PCOS.

Vitamin D receptor polymorphisms and the polycystic ovary syndrome: A systematic review

Polycystic ovary syndrome (PCOS) is the most frequent endocrinological disorder that affects women of reproductive age, leading to metabolic alterations, such as hyperandrogenism, obesity, menstrual irregularities, insulin resistance, and polycystic ovaries. The etiology remains unclear, but several genetic and environmental factors have been correlated with manifestations of this syndrome. Vitamin D plays important roles in metabolic pathways affected by PCOS, including calcium homeostasis, the insulin pathway, and sex hormone synthesis. Vitamin D concentration has been related with the severity of this disorder, and vitamin D receptor polymorphisms have been shown in some studies to have an association with some of the patterns presented by PCOS. The objective of this study is to provide an up-to-date review about vitamin D receptor polymorphisms and their association with PCOS.

The role of stress in PCOS

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting a remarkable proportion of premenopausal women. Different studies have shown that stress is widely encountered in women with PCOS. Areas covered: As PCOS is a multifaceted disorder, 'stress' incorporates different translations. We performed a literature review, focusing on the most recent data, regarding the multipotent role of stress in the syndrome. Expert commentary: Stress is believed to be an important component of PCOS. It encompasses different definitions that are all equivalent, like metabolic, inflammatory, oxidative and emotional stress. However, the type of stress that distinguishes PCOS is metabolic stress. It becomes evident early in life and constitutes the pathophysiological heart of the syndrome. Metabolic stress along with the other types of stress are the progenitors of severe long-term health implications, which exacerbate further the reproductive, metabolic and psychological derangements of the syndrome, leading to an endless cycle of chronic illness.

Correlation of Vitamin D with metabolic parameters in polycystic ovarian syndrome

BACKGROUND

Polycystic ovarian syndrome (PCOS) and hypovitaminosis D are the two most common endocrine disorders in young women leading to many adverse metabolic consequences. We evaluated the correlation of 25-hydroxy Vitamin D (25OHD) with metabolic parameters and insulin resistance in PCOS.

MATERIALS AND METHODS

We included 100 PCOS patients (age 18-40 years, duration >6 months) serially, in this cross-sectional study. We excluded patients with past use of insulin sensitizers and hormone therapy. All patients underwent a physical examination, body fat estimation, and a single fasting blood sample was analyzed for the biochemical parameters. The patients were divided into 2 groups as per the 25OHD level: Group 1 (Deficient, <30 ng/mL) and Group 2 (normal). The data were analyzed using appropriate statistical methods, and a P < 0.05 was considered statistically significant.

RESULTS

The study population had a mean age of 28.6 ± 6.3 years, body mass index (BMI) 30.4 ± 6.1 kg/m² and body fat of 39.1 ± 13%. A total of 90 women had 25OHD deficiency, and hypovitaminosis D was observed more in younger, obese patients. Patients with hypovitaminosis D had a higher BMI (P = 0.0124), low- high-density lipoprotein (P = 0.0094), calcium (P ≤ 0.0001), and elevated testosterone (P = 0.0412) in comparison with normal 25OHD patients. None of the metabolic parameters showed significant correlation with 25OHD (P > 0.05).

CONCLUSION

Hypovitaminosis D is very common in PCOS patients and exacerbates the metabolic abnormalities. It is essential to screen all the PCOS patients for 25OHD deficiency, and further large-scale studies are required to confirm our findings.

Nutrients as novel therapeutic approaches for metabolic disturbances in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women. This disease is characterized by infertility, menstrual dysfunction, and hyperandrogenism. Also, PCOS is often associated with hyperlipidemia and impaired glucose tolerance, conditions that are associated with cardiovascular disorder, type 2 diabetes, cancer and hypertension. Evidence supports that some nutrients may affect the hormonal and metabolic disturbances of PCOS. Here in this study, we aimed to review the available literature that assessed the nutrients such as inostol, isoflavonids, resveratrol, vitamin D, and PUFA (polyunsaturated fatty acids), known to influence the hormonal and metabolic disturbances of PCOS, along with the strategies and future directions of nutrient supplementations in such patients.

Vitamin D Status Relates to Reproductive Outcome in Women With Polycystic Ovary Syndrome: Secondary Analysis of a Multicenter Randomized Controlled Trial

CONTEXT

Experimental evidence supports a relevance of vitamin D (VitD) for reproduction; however, data in humans are sparse and inconsistent.

OBJECTIVE

To assess the relationship of VitD status with ovulation induction (OI) outcomes in women with polycystic ovary syndrome (PCOS).

DESIGN

A retrospective cohort.

SETTING

Secondary analysis of randomized controlled trial data.

PARTICIPANTS

Participants in the Pregnancy in PCOS I (PPCOS I) randomized controlled trial (n = 540) met the National Institutes of Health diagnostic criteria for PCOS.

INTERVENTIONS

Serum 25OHD levels were measured in stored sera.

MAIN OUTCOME MEASURES

Primary, live birth (LB); secondary, ovulation and pregnancy loss after OI.

RESULTS

Likelihood for LB was reduced by 44% for women if the 25OHD level was < 30 ng/mL (<75 nmol/L; odds ratio [OR], 0.58 [0.35-0.92]). Progressive improvement in the odds for LB was noted at thresholds of ≥38 ng/mL (≥95 nmol/L; OR, 1.42 [1.08-1.8]), ≥40 ng/mL (≥100 nmol/L; OR, 1.51 [1.05-2.17]), and ≥45 ng/mL (≥112.5 nmol/L; OR, 4.46 [1.27-15.72]). On adjusted analyses, VitD status was an independent predictor of LB and ovulation after OI.

CONCLUSIONS

In women with PCOS, serum 25OHD was an independent predictor of measures of reproductive success after OI. Our data identify reproductive thresholds for serum 25OHD that are higher than recommended for the nonpregnant population.

Fracture Risk Is Decreased in Women With Polycystic Ovary Syndrome: A Register-Based and Population-Based Cohort Study

Hyperandrogenism, obesity, and hyperinsulinemia may protect against osteoporosis, whereas amenorrhea, increased cortisol, and low growth hormone may be associated with higher fracture risk in polycystic ovary syndrome (PCOS). The objective of this study was to investigate fracture risk in PCOS. In the PCOS Denmark study, women with PCOS and/or hirsutism were identified in the Danish National Patient Register (1995-2012). Each patient was assigned three age-matched controls on the index date of PCOS diagnosis. Individuals with a previous endocrine diagnosis were excluded. Within PCOS Denmark, we embedded a well-characterized subcohort of patients, PCOS OUH, diagnosed with PCOS at Odense University Hospital (n = 1217). We identified incident fractures by International Classification of Diseases, 10th Revision (ICD-10) codes and used conditional Cox regression analyses to compare fracture risk. In the PCOS Denmark study, there were 19,199 women with PCOS and 57,483 controls were included, mean age 30.6 years (range, 12-60 years). Fracture rates were decreased in PCOS Denmark (10.3/1000 patient years) versus controls (13.6/1000 patient years). The adjusted ORs were 0.76 (95% CI, 0.71 to 0.80) for all fractures, 0.82 (95% CI, 0.74 to 0.92) for major osteoporotic fractures, and 0.57 (95% CI, 0.47 to 0.70) for fractures of head and face. The risk reduction was more pronounced below the age of 30 years at diagnosis. Women with PCOS had significant more hospital contacts due to strains and sprains. In the PCOS OUH subcohort, the risk reduction of fractures did not differ between PCOS women with elevated versus normal testosterone levels and the risk reduction was nominally smaller in overweight versus normal weight PCOS women. Women with PCOS had reduced risk of fractures, in particular of the appendicular skeleton. The risk reduction was greater in women with younger age at diagnosis suggesting that the skeletal effects of PCOS may be greater in women who have not yet reached peak bone mass. Reduced participation in sports activities was probably not the reason for the reduced risk of fractures.

Low vitamin D3 and high anti-Müllerian hormone serum levels in the polycystic ovary syndrome (PCOS): Is there a link?

OBJECTIVES

Low vitamin D serum level has been reported in women with polycystic ovary syndrome (PCOS) compared to controls. A few in vitro studies showed that the bioactive form of vitamin D is able to modulate the expression of the anti-Müllerian hormone (AMH) gene. However, in vivo studies failed to demonstrate clearly whether low vitamin D3 serum level is involved in the AMH excess of PCOS. This prospective study evaluates serum vitamin D3 and AMH levels in women with PCOS and in controls, before and after vitamin D supplementation.

MATERIALS AND METHODS

Among vitamin D deficient patients, 23 patients with PCOS were compared to 27 women with normal ovarian reserve (NOR). The vitamin D deficient patients received a vitamin D supplementation according to the depth of their insufficiency. For the 23 patients with PCOS and the 27 controls, serum AMH assay and serum calciotropic hormone assays [25-hydroxyvitamin D (25[OH]D), 1,25 dihydroxyvitamin D (1,25[OH]₂D) and parathyroid hormone (PTH)] were performed before and after supplementation.

RESULTS

Serum 25(OH)D levels before treatment were statistically lower in PCOS women than in NOR patients (P<0.05), even after adjustment for BMI, age and AMH level, but not after adjustment for waist circumference measurement. No difference in the serum AMH levels before and after treatment was observed neither in PCOS patients nor in NOR patients. In both groups, 25(OH)D serum levels were not related to serum AMH levels, serum 1,25(OH)₂D and serum PTH levels, before and after treatment.

CONCLUSION

We found no evidence that serum calciotropic hormones are linked to circulating AMH levels, particularly in PCOS.

Is there association between vitamin D levels, apelin 36, and visfatin in PCOS?

AIM

We aimed to evaluate vitamin D, apelin-36, and visfatin levels in patients with polycystic ovary syndrome (PCOS).

MATERIAL AND METHOD

The study was completed in six months, including a total of 110 patients who were admitted to the obstetrics and gynecology polyclinic. Patients with a diagnosis of PCOS were divided into two subgroups according to their vitamin D levels. Thirty-four patients had <10 ng/ml of vitamin D deficiency and 21 patients had 10-30 ng/ml of vitamin D insufficiency, with each being defined as a subgroup.

RESULTS

Average apelin-36 and visfatin levels in PCOS patients were 2.52 ± 0.68 nmol/L and 72.63 ± 22:31 ng/ml, in the control group they were 0.92 ± 0.33 nmol/L, 24.66 ± 6 ng/ml, respectively. The difference found in PCOS patients was statistically significant (p = 0.0001, p = 0.0001).

CONCLUSION

In conclusion, the present study shows that in PCOS patients with low levels of vitamin D, insulin resistance is greater and apelin-36 serum levels were significantly higher. Although there are different opinions in the literature on this subject, we believe that when vitamin D levels are brought to an optimal level in PCOS patient, it can prevent the negative effects of adipokines in the pathogenesis of PCOS.

Effect of combined oral contraceptive use on serum 25-hydroxy vitamin D levels and ultrasound parameters in patients with polycystic ovary syndrome

PURPOSE

To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS).

METHODS

PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment.

RESULTS

The median 25(OH)D levels were 9.40 (range 4.40-24.50) μg/l and 7.00 (5.00-13.50) μg/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055).

CONCLUSION

This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.

Vitamin D Deficiency among Adolescent Females with Polycystic Ovary Syndrome

STUDY OBJECTIVE

Studies have suggested that low vitamin D levels may play a role in the pathogenesis of polycystic ovary syndrome (PCOS). The aim of our study was to compare 25-hydroxyvitamin D [25(OH)D] levels in adolescent females with and without PCOS.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective chart review at a tertiary care medical center for female adolescents aged 12-21 years with serum 25(OH)D measurements within a 5-year period. Participants were categorized as having PCOS or as controls based on National Institutes of Health PCOS diagnostic criteria.

MAIN OUTCOME MEASURE

Exact logistic regression analysis was done to compare normal (≥30 ng/mL) vs low (<30 ng/mL) serum 25(OH)D levels in the PCOS and control groups.

RESULTS

Two hundred ninety-nine charts were reviewed and 107 participants were included in the study. Of the included participants, 37 were in the PCOS group and 70 were in the control group, with a mean age of 15.2 years. In the PCOS group, 97.2% were obese and vitamin D deficiency was noted among 62.2% females. The mean serum 25(OH)D level was 18.4 and 21.6 ng/mL in PCOS and control groups, respectively. The difference in mean 25(OH)D levels between the 2 groups was not statistically significant (P > .05) when controlled for ethnicity, body mass index percentile, and season.

CONCLUSION

In our study, there was no statistically significant difference in mean 25(OH)D levels between PCOS and control groups. The majority of participants in PCOS group were obese. Further studies in adolescent females with PCOS and normal body mass index could be helpful in delineating the role of vitamin D in the pathogenesis of PCOS.

Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis

Vitamin D deficiency (VDD) is common in women with and without polycystic ovary syndrome (PCOS) and may be associated with metabolic and endocrine disorders in PCOS. The aim of this meta-analysis is to assess the associations of serum vitamin D levels with metabolic and endocrine dysregulations in women with PCOS, and to determine effects of vitamin D supplementation on metabolic and hormonal functions in PCOS patients. The literature search was undertaken through five databases until 16 January 2015 for both observational and experimental studies concerning relationships between vitamin D and PCOS. A total of 366 citations were identified, of which 30 were selected (n = 3182). We found that lower serum vitamin D levels were related to metabolic and hormonal disorders in women with PCOS. Specifically, PCOS patients with VDD were more likely to have dysglycemia (e.g., increased levels of fasting glucose and homeostatic model assessment-insulin resistance index (HOMA-IR)) compared to those without VDD. This meta-analysis found no evidence that vitamin D supplementation reduced or mitigated metabolic and hormonal dysregulations in PCOS. VDD may be a comorbid manifestation of PCOS or a minor pathway in PCOS associated metabolic and hormonal dysregulation. Future prospective observational studies and randomized controlled trials with repeated VDD assessment and better characterization of PCOS disease severity at enrollment are needed to clarify whether VDD is a co-determinant of hormonal and metabolic dysregulations in PCOS, represents a consequence of hormonal and metabolic dysregulations in PCOS or both.

The pleiotropic effects of vitamin D in gynaecological and obstetric diseases: an overview on a hot topic

The traditionally recognized role of vitamin D consists in the regulation of bone metabolism and calcium-phosphorus homeostasis but recently a lot of in vitro and in vivo studies recognized several “noncalcemic” effects of vitamin D metabolites. Accumulating evidence suggests that the metabolic pathways of this vitamin may play a key role in the developing of gynaecological/obstetric diseases. VDR-mediated signalling pathways and vitamin D levels seem to (deeply) affect the risk of several gynaecological diseases, such as polycystic ovary syndrome (PCOS), endometriosis, and ovarian and even breast cancer. On the other hand, since also the maternal-fetal unit is under the influence of vitamin D, a breakdown in its homeostasis may underlie infertility, preeclampsia, and gestational diabetes mellitus (GDM). According to our literature review, the relationship between vitamin D and gynaecological/obstetric diseases must be replicated in future studies which could clarify the molecular machineries behind their development. We suggest that further investigation should take into account the different serum levels of this vitamin, the several actions which arise from the binding between it and its receptor (taking into account its possible polymorphism), and finally the interplay between vitamin D metabolism and other hormonal and metabolic pathways.

Prevalence of vitamin D deficiency in Slovak women with polycystic ovary syndrome and its relation to metabolic and reproductive abnormalities

OBJECTIVE

To investigate prevalence of vitamin D deficiency and its relation to clinical, anthropometrical, and biochemical findings in polycystic ovary syndrome (PCOS) and controls.

DESIGN

Case-control prospective observational study.

SETTINGS

Department of Internal medicine, L.P. University hospital.

PATIENT(S)

99 PCOS women and 66 controls.

MAIN OUTCOME MEASURE(S)

25-hydroxyvitamin D level (25(OH)D), anthropometric, endocrine, and metabolic parameters in both groups.

RESULTS

There was no significant difference in 25(OH)D levels between PCOS women and controls (24.79 ± 10.77 vs 25.07 ± 10.14 ng/ml, p = 0.868) and also in the prevalence of 25(OH)D deficiency in both groups (80 vs 70 %; p = 0.138). Vitamin D-deficient PCOS patients had significantly higher body mass index (BMI), fasting insulin, and homeostasis model assessment-insulin resistance (median [quartiles]: 2.24 [1.38; 3.51] vs 1.23 [0.79; 1.66]; p< 0.05, age-and BMI-adjusted p = 0.036) and borderline higher glycemia (4.7 ± 0.5 vs 4.5 ± 0.4 mmol/l; p = 0.05; p_adj = 0.95) compared with vitamin D-deficient controls. PCOS women with metabolic syndrome (MS) had lower serum 25(OH)D compared with those without MS (20.6 ± 8.3 vs 25.9 ± 11.3 ng/ml, p = 0.049). 25(OH)D correlated positively with high-density lipoprotein cholesterol in all subjects (r = 0.159, p = 0.043) and negatively with luteinizing hormone/follicle-stimulating hormone ratio (r = - 0.211, p = 0.037).

CONCLUSION

Insulin resistance and other metabolic abnormalities in PCOS women seem to be related to PCOS rather than to vitamin D deficiency.

Vitamin D is independently associated with depression in overweight women with and without PCOS

BACKGROUND

Depression, anxiety, and inflammation are common in polycystic ovary syndrome (PCOS). Inflammation may adversely impact on mood and vitamin D has been associated with both mood disorders and inflammation in the general population, but these relationships have not been studied in PCOS. The aim of this study was to investigate the association among 25 hydroxy-Vitamin D (25OHVD) status, anxiety, depression, and inflammation in women with and without PCOS.

METHODS

Cross-sectional study in overweight or obese premenopausal women with (n = 50) and without (n = 23) PCOS. Primary outcome measures were 25OHVD, mood (Hospital Anxiety and Depression questionnaire), and inflammation (highly sensitive C-reactive protein (hsCRP)).

RESULTS

Vitamin D deficiency (25OHVD<50 nmol/L) (46% versus 39%, p = 0.311) and 25OHVD (50.4 ± 22.2 nmol/L versus 51.6 ± 19.0 nmol/L, p = 0.828) were not significantly different in women with and without PCOS. For all women combined, 25OHVD was the only significant independent predictor of depression (β = -0.063 ± 0.021, p = 0.005) and hsCRP (β = -0.041 ± 0.015, p = 0.010).

CONCLUSIONS

Vitamin D deficiency is common in both women with and without PCOS with no differences between the groups. Vitamin D is independently associated with depression and inflammation in overweight women both with and without PCOS. Further investigation to clarify the interrelationship among vitamin D, inflammation and depression is required to identify optimal prevention and treatment strategies for psychological and metabolic dysfunction in PCOS.

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.

Vitamin D deficiency in women with polycystic ovary syndrome

Objective

To investigate: the prevalence of vitamin D deficiency in Korean women with polycystic ovary syndrome (PCOS), and the relationship between vitamin D status and clinical or metabolic features in this group.

Methods

We recruited 38 women with PCOS using the Rotterdam criteria. A total of 109 premenopausal control women were matched with patients based on age and body mass index. Serum 25-hydroxy vitamin D concentrations less than 20 ng/mL were classified as frank vitamin D deficiency. Since vitamin D may play a significant role in metabolic disturbances in women with PCOS, correlations between clinical or metabolic parameters and vitamin D status were analyzed separately in patients and controls.

Results

Women with PCOS showed no differences in the level of 25-hydroxy vitamin D (19.6±6.6 ng/mL in patients vs. 20.1±7.4 ng/mL in controls, respectively, p=0.696) or prevalence of vitamin D deficiency (57.9% in patients vs. 56.5% in controls, respectively, p=0.880). In addition, we did not find any correlations between serum vitamin D level and clinical or metabolic profiles in either PCOS patients or controls.

Conclusion

Our study found no differences in the absolute level of serum vitamin D between PCOS patients and matched controls. Prevalence of vitamin D deficiency was equally common among both patients and controls. Additionally, we did not find any correlations between serum vitamin D level and clinical or metabolic profiles, suggesting that the role of vitamin D in the pathogenesis of PCOS is not yet clear.

High-dose vitamin D supplementation and measures of insulin sensitivity in polycystic ovary syndrome: a randomized, controlled pilot trial

OBJECTIVE

To determine the effects of high-dose vitamin D on insulin sensitivity in polycystic ovary syndrome (PCOS).

DESIGN

Randomized, placebo-controlled trial.

SETTING

Academic medical center.

PATIENT(S)

Twenty-eight women with PCOS.

INTERVENTION(S)

Vitamin D3, 12,000 IU, or placebo daily for 12 weeks.

MAIN OUTCOME MEASURE(S)

The primary outcome was quantitative insulin sensitivity check index. Secondary outcomes included glucose and insulin levels during a 75-g oral glucose tolerance test and blood pressure.

RESULT(S)

Twenty-two women completed the study. Compared with placebo, vitamin D significantly increased 25-hydroxyvitamin D (mean [95% confidence interval] in vitamin D group 20.1 [15.7 to 24.5] ng/mL at baseline and 65.7 [52.3 to 79.2] ng/mL at 12 weeks; placebo 22.5 [18.1 to 26.8] ng/mL at baseline and 23.8 [10.4 to 37.2] ng/mL at 12 weeks). There were no significant differences in quantitative insulin sensitivity check index and other measures of insulin sensitivity; however, we observed trends toward lower 2-hour insulin and lower 2-hour glucose. We also observed a protective effect of vitamin D on blood pressure.

CONCLUSION(S)

In women with PCOS, insulin sensitivity was unchanged with high-dose vitamin D, but there was a trend toward decreased 2-hour insulin and a protective effect on blood pressure.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00907153.