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Ojeda-Ojeda M, Martínez-García M, Alpañés M, Luque-Ramírez M, Escobar-Morreale HF. Association of TLR2 S450S and ICAM1 K469E polymorphisms with polycystic ovary syndrome (PCOS) and obesity. J Reprod Immunol 2016; 113:9-15. [DOI: 10.1016/j.jri.2015.09.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/15/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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Benelli E, Del Ghianda S, Di Cosmo C, Tonacchera M. A Combined Therapy with Myo-Inositol and D-Chiro-Inositol Improves Endocrine Parameters and Insulin Resistance in PCOS Young Overweight Women. Int J Endocrinol 2016; 2016:3204083. [PMID: 27493664 PMCID: PMC4963579 DOI: 10.1155/2016/3204083] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/24/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction. We evaluated the effects of a therapy that combines myo-inositol (MI) and D-chiro-inositol (DCI) in young overweight women affected by polycystic ovary syndrome (PCOS), characterized by oligo- or anovulation and hyperandrogenism, correlated to insulin resistance. Methods. We enrolled 46 patients affected by PCOS and, randomly, we assigned them to two groups, A and B, treated, respectively, with the association of MI plus DCI, in a 40 : 1 ratio, or with placebo (folic acid) for six months. Thus, we analyzed pretreatment and posttreatment FSH, LH, 17-beta-Estradiol, Sex Hormone Binding Globulin, androstenedione, free testosterone, dehydroepiandrosterone sulphate, HOMA index, and fasting glucose and insulin. Results. We recorded a statistically significant reduction of LH, free testosterone, fasting insulin, and HOMA index only in the group treated with the combined therapy of MI plus DCI; in the same patients, we observed a statistically significant increase of 17-beta-Estradiol levels. Conclusions. The combined therapy of MI plus DCI is effective in improving endocrine and metabolic parameters in young obese PCOS affected women.
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Affiliation(s)
- Elena Benelli
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Scilla Del Ghianda
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Caterina Di Cosmo
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Massimo Tonacchera
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
- *Massimo Tonacchera:
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103
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Calderón B, Gómez-Martín JM, Vega-Piñero B, Martín-Hidalgo A, Galindo J, Luque-Ramírez M, Escobar-Morreale HF, Botella-Carretero JI. Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight. Andrology 2015; 4:62-7. [DOI: 10.1111/andr.12135] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/13/2015] [Accepted: 10/23/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Berniza Calderón
- Department of Endocrinology and Nutrition; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
| | - Jesús M. Gómez-Martín
- Department of Endocrinology and Nutrition; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
| | - Belén Vega-Piñero
- Department of Endocrinology and Nutrition; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
| | - Antonia Martín-Hidalgo
- Department of Biochemistry-Research; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de Obesidad y Nutrición (CIBERobn); Madrid Spain
| | - Julio Galindo
- Department of General Surgery; Hospital Universitario Ramón y Cajal; Madrid Spain
| | - Manuel Luque-Ramírez
- Department of Endocrinology and Nutrition; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM); Madrid Spain
| | - Héctor F. Escobar-Morreale
- Department of Endocrinology and Nutrition; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM); Madrid Spain
| | - José I. Botella-Carretero
- Department of Endocrinology and Nutrition; Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS); Madrid Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de Obesidad y Nutrición (CIBERobn); Madrid Spain
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Vassilatou E, Vassiliadi DA, Salambasis K, Lazaridou H, Koutsomitopoulos N, Kelekis N, Kassanos D, Hadjidakis D, Dimitriadis G. Increased prevalence of polycystic ovary syndrome in premenopausal women with nonalcoholic fatty liver disease. Eur J Endocrinol 2015; 173:739-47. [PMID: 26340970 DOI: 10.1530/eje-15-0567] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/04/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Limited data exist concerning the presence of polycystic ovary syndrome (PCOS) in premenopausal women with nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prevalence of PCOS in overweight and obese premenopausal women with NAFLD. DESIGN Prospective, observational, and cross-sectional study. METHODS We studied 110 apparently healthy, overweight, and obese (BMI: 25.1-49.1 kg/m(2)) premenopausal women (age: 18-45 years) reporting no or minimal alcohol consumption for NAFLD with abdominal ultrasonography after excluding causes of secondary liver disease and for PCOS (Rotterdam criteria) with clinical examination, biochemical evaluation, and pelvic ultrasonography. Insulin resistance (IR) was assessed by homeostasis model assessment of IR (HOMA-IR), and free androgen index was calculated. RESULTS NAFLD was detected in 71/110 women (64.5%). Women with NAFLD compared to women without NAFLD were more commonly diagnosed with PCOS (43.7% vs 23.1%, respectively, P=0.04), metabolic syndrome (30.2% vs 5.3%, respectively, P=0.003), and abnormal lipid profile (81.1% vs 51.3%, P=0.002). All women with abnormal glucose metabolism had NAFLD (P=0.01). Although PCOS was associated with NAFLD (OR 2.6, 95% CI: 1.1-6.2, P=0.04), in a multivariate analysis higher HOMA-IR values (OR 2.2, 95% CI: 1.1-4.4, P=0.02) and triglyceride levels (OR 1.01, 95% CI: 1.00-1.02, P=0.04) independently predicted NAFLD, after adjusting for age, BMI, and waist-to-hip ratio. CONCLUSIONS These findings indicate an increased prevalence of PCOS in overweight and obese premenopausal women with NAFLD, although it is not supported that the syndrome is primarily involved in NAFLD. Evaluation for PCOS may be considered in these women.
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Affiliation(s)
- E Vassilatou
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - D A Vassiliadi
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - K Salambasis
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - H Lazaridou
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - N Koutsomitopoulos
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - N Kelekis
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - D Kassanos
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - D Hadjidakis
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - G Dimitriadis
- Endocrine Unit2nd Department of Internal Medicine, Propaedeutic and Research Center3rd Department of Obstetrics and Gynecology2nd Department of Radiology2nd Department of Internal MedicineResearch Center, Athens University Medical School, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
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Luque-Ramírez M, Alpañés M, Sanchón R, Fernández-Durán E, Ortiz-Flores AE, Escobar-Morreale HF. Referral bias in female functional hyperandrogenism and polycystic ovary syndrome. Eur J Endocrinol 2015; 173:603-10. [PMID: 26243032 DOI: 10.1530/eje-15-0646] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/31/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Women with polycystic ovary syndrome (PCOS) seeking health care in the United States may be more obese and hyperandrogenic than those present in the general population. We aimed to assess the impact of referral bias on European women with functional androgen excess disorders. DESIGN Cross-sectional study. METHODS We studied two groups of patients: i) 368 consecutive patients referred to our clinic for the study of functional hyperandrogenism (FH) (referral patients); ii) 57 consecutive premenopausal patients identified by screening during blood donation (unselected patients). We compared the anthropometric data from the groups of patients with those of two control populations: iii) a group of unselected premenopausal healthy female blood donors (unselected controls); and iv) data available from the local general premenopausal female population. RESULTS Referral patients with FH were more hirsute, had a higher percentage of hyperandrogenemia, and fulfilled PCOS criteria more frequently than unselected patients. The prevalence of obesity in unselected controls was similar to that observed in the general population, whereas referral patients and unselected patients were more frequently obese. The prevalence of obesity was also higher among referral patients compared to unselected patients. CONCLUSION Referral bias influences the phenotype of patients with FH. Patients studied at the clinical setting may show more severe hyperandrogenic and obese phenotypes than patients from the general population, even though PCOS appears to be associated with weight excess also in the general European population. This fact should be considered when establishing reference values and control populations for clinical and research purposes.
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Affiliation(s)
- Manuel Luque-Ramírez
- DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Macarena Alpañés
- DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Raul Sanchón
- DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Elena Fernández-Durán
- DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Andrés E Ortiz-Flores
- DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Héctor F Escobar-Morreale
- DiabetesObesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Carretera de Colmenar km 9'1, E-28034 Madrid, SpainSection of Endocrinology and NutritionDepartment of Internal Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocr Rev 2015; 36:487-525. [PMID: 26426951 PMCID: PMC4591526 DOI: 10.1210/er.2015-1018] [Citation(s) in RCA: 546] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous and complex disorder that has both adverse reproductive and metabolic implications for affected women. However, there is generally poor understanding of its etiology. Varying expert-based diagnostic criteria utilize some combination of oligo-ovulation, hyperandrogenism, and the presence of polycystic ovaries. Criteria that require hyperandrogenism tend to identify a more severe reproductive and metabolic phenotype. The phenotype can vary by race and ethnicity, is difficult to define in the perimenarchal and perimenopausal period, and is exacerbated by obesity. The pathophysiology involves abnormal gonadotropin secretion from a reduced hypothalamic feedback response to circulating sex steroids, altered ovarian morphology and functional changes, and disordered insulin action in a variety of target tissues. PCOS clusters in families and both female and male relatives can show stigmata of the syndrome, including metabolic abnormalities. Genome-wide association studies have identified a number of candidate regions, although their role in contributing to PCOS is still largely unknown.
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Affiliation(s)
- Daniel A Dumesic
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Sharon E Oberfield
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Elisabet Stener-Victorin
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - John C Marshall
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Joop S Laven
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Richard S Legro
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
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Almenning I, Rieber-Mohn A, Lundgren KM, Shetelig Løvvik T, Garnæs KK, Moholdt T. Effects of High Intensity Interval Training and Strength Training on Metabolic, Cardiovascular and Hormonal Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Study. PLoS One 2015; 10:e0138793. [PMID: 26406234 PMCID: PMC4583183 DOI: 10.1371/journal.pone.0138793] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome is a common endocrinopathy in reproductive-age women, and associates with insulin resistance. Exercise is advocated in this disorder, but little knowledge exists on the optimal exercise regimes. We assessed the effects of high intensity interval training and strength training on metabolic, cardiovascular, and hormonal outcomes in women with polycystic ovary syndrome. MATERIALS AND METHODS Three-arm parallel randomized controlled trial. Thirty-one women with polycystic ovary syndrome (age 27.2 ± 5.5 years; body mass index 26.7 ± 6.0 kg/m2) were randomly assigned to high intensity interval training, strength training, or a control group. The exercise groups exercised three times weekly for 10 weeks. RESULTS The main outcome measure was change in homeostatic assessment of insulin resistance (HOMA-IR). HOMA-IR improved significantly only after high intensity interval training, by -0.83 (95% confidence interval [CI], -1.45, -0.20), equal to 17%, with between-group difference (p = 0.014). After high intensity interval training, high-density lipoprotein cholesterol increased by 0.2 (95% CI, 0.02, 0.5) mmol/L, with between group difference (p = 0.04). Endothelial function, measured as flow-mediated dilatation of the brachial artery, increased significantly after high intensity interval training, by 2.0 (95% CI, 0.1, 4.0) %, between-group difference (p = 0.08). Fat percentage decreased significantly after both exercise regimes, without changes in body weight. After strength training, anti-Müllarian hormone was significantly reduced, by -14.8 (95% CI, -21.2, -8.4) pmol/L, between-group difference (p = 0.04). There were no significant changes in high-sensitivity C-reactive protein, adiponectin or leptin in any group. CONCLUSIONS High intensity interval training for ten weeks improved insulin resistance, without weight loss, in women with polycystic ovary syndrome. Body composition improved significantly after both strength training and high intensity interval training. This pilot study indicates that exercise training can improve the cardiometabolic profile in polycystic ovary syndrome in the absence of weight loss. TRIAL REGISTRATION ClinicalTrial.gov NCT01919281.
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Affiliation(s)
- Ida Almenning
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Rieber-Mohn
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Margrethe Lundgren
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Shetelig Løvvik
- Department of Obstetrics and Gynecology, St. Olav’s Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsti Krohn Garnæs
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olav’s Hospital, Trondheim, Norway
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Abstract
American dietary patterns have shifted over the past 100 years, resulting in a diet based on animal foods and highly processed carbohydrates. This shift has produced the current epidemics of obesity, type 2 diabetes, heart disease, as well as many cancers. In addition, the Western diet is also negatively affecting the reproductive capacity of the population. The birth rate is in decline and infertility and subfecundity are on the rise secondary to both ovulatory infertility and declining sperm quality. Pregnancy outcomes and maternal morbidity and mortality are also being affected. This diet, high in fat and sugar, is also contributing to the epidemic levels of autism.
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Affiliation(s)
- Amanda McKinney
- Beatrice Community Hospital and Health Center, Beatrice, Nebraska (AM)
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109
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Kollmann M, Klaritsch P, Martins WP, Guenther F, Schneider V, Herzog SA, Craciunas L, Lang U, Obermayer-Pietsch B, Lerchbaum E, Raine-Fenning N. Maternal and neonatal outcomes in pregnant women with PCOS: comparison of different diagnostic definitions. Hum Reprod 2015. [PMID: 26223675 DOI: 10.1093/humrep/dev187] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Does the prevalence of adverse maternal and neonatal outcomes vary in women diagnosed with polycystic ovary syndrome (PCOS) according to different definitions? SUMMARY ANSWER A comparison of different criteria revealed that there is a substantial risk for perinatal complications in PCOS women, regardless of the used definition. WHAT IS KNOWN ALREADY Pregnant women with PCOS are susceptible to perinatal complications. At present, there are three main definitions for PCOS. So far, we are aware of only one study, which found that the elevated risk for complications varied widely depending on the different phenotypes and features but only considered a relatively small sample size for some of the phenotypes. STUDY DESIGN, SIZE, DURATION Retrospective matched cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS Data of primiparous women with PCOS according to ESHRE/ASRM 2003 criteria and healthy controls giving birth to neonates ≥500 g were included. A total of 885 women were analysed: out of 177 women with PCOS, 85 (48.0%) met the National Institutes of Health (NIH) 1990 criteria, another 14 (7.9%) featured the additional phenotypes defined by The Androgen Excess and PCOS Society (AE-PCOS) 2006 criteria, 78 (44.1%) were classified as PCOS exclusively by the ESHRE/ASRM 2003 definition, and 708 represented the control group. MAIN RESULTS AND THE ROLE OF CHANCE The prevalence of adverse maternal (49.4 versus 64.3 versus 60.3%, P = 0.313) and neonatal (27.1 versus 35.7 versus 23.1%, P = 0.615) outcomes did not differ within the three PCOS groups (ESHRE/ASRM, NIH, AE-PCOS, respectively). Compared with healthy controls, the risk for maternal complications was increased in PCOS patients [odds ratio (OR) 2.57; 95% confidence interval (CI) 1.82-3.64; P < 0.001] while there was no difference in neonatal complications (OR 0.83; 95% CI 0.56-1.21; P = 0.343). LIMITATIONS, REASONS FOR CAUTION A limitation of our study is its retrospective design and the relatively small sample size, particularly in the AE-PCOS subgroup. WIDER IMPLICATIONS OF THE FINDINGS Since women with PCOS have, regardless of the used definition, a high risk of maternal and neonatal complications they should be informed and advised to follow regular checks in units where problems can be detected early to allow specialized care. STUDY FUNDING/COMPETING INTERESTS Marietta Blau Grant (Austrian Agency for International Cooperation in Education and Research; OeAD-GmbH) and mobility scholarship (Medical University of Graz).
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Affiliation(s)
- M Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - P Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - W P Martins
- Department of Obstetrics and Gynaecology, Medical School of Ribeirao Preto, University of Sao Paulo, 14048-900 Ribeirao Preto, Brazil
| | - F Guenther
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - V Schneider
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - S A Herzog
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, 8036 Graz, Austria
| | - L Craciunas
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
| | - U Lang
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - B Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - E Lerchbaum
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
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Zheng Y, Stener-Victorin E, Ng EHY, Li J, Wu X, Ma H. How does acupuncture affect insulin sensitivity in women with polycystic ovary syndrome and insulin resistance? Study protocol of a prospective pilot study. BMJ Open 2015; 5:e007757. [PMID: 25941189 PMCID: PMC4420969 DOI: 10.1136/bmjopen-2015-007757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Hyperinsulinaemia and insulin resistance (IR) are key features of polycystic ovary syndrome (PCOS) and metabolic syndrome. The effect of 5 weeks of acupuncture treatment has been investigated in a completed prospective pilot trial (Clinicaltrials.gov: NCT01457209), and acupuncture with electrical stimulation applied to insulin-resistant rats with dihydrotestosterone-induced PCOS was shown to improve insulin sensitivity. Therefore, we now aim to conduct a prospective pilot study to evaluate whether using the same acupuncture treatment protocol given over a longer period of time (6 months) than in the previous pilot trial will improve insulin sensitivity in women with PCOS and IR. Our hypothesis is that acupuncture with combined manual and low-frequency electrical stimulation of the needles will improve insulin sensitivity in women with PCOS and IR. METHODS/ANALYSIS This is a prospective pilot trial. A total of 112 women with PCOS and IR will be recruited and categorised according to their body mass index (BMI) as normal weight (BMI=18.5-23 kg/m(2)) or as overweight/obese (BMI>23 kg/m(2)). Acupuncture will be applied three times per week for 6 months at 30 min per treatment. The primary outcome will be the change in insulin sensitivity before and after 6 months of acupuncture treatment, as measured by an oral glucose tolerance test. ETHICS/DISSEMINATION Ethical approval of this study has been granted from the ethics committee of the First Affiliated Hospital of Guangzhou Medical University (No. 2013039). Written and informed consent will be obtained from each patient before any study procedure is performed, according to good clinical practice. The results of this trial will be disseminated in a peer-reviewed journal and presented at international congresses. TRIAL REGISTRATION NUMBERS NCT02026323 and ChiCTR-OCH-13003921.
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Affiliation(s)
- Yanhua Zheng
- Research Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China
- Department of Traditional Chinese Medicine, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, Hong Kong
| | - Juan Li
- Research Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoke Wu
- Department of Gynecology, First Affiliated Hospital National Key Discipline, Specialty and Trial Base Heilongjiang University of Chinese Medicine, China
| | - Hongxia Ma
- Research Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The aims of this study were to provide an estimate of the prevalence of PCOS in clinical practice; compare the risk of established cardiovascular risk factors, cardiovascular disease, and other comorbid conditions in women with PCOS to that of age- and race-matched controls; and explore the total costs of care that can be attributed to PCOS. METHODS Louisiana Medicaid claims data were used to identify women with PCOS or its defining features and a control group in a ratio of 1:3. The prevalence of PCOS, cardiovascular risk factors (diabetes, dyslipidemia, dysmetabolic syndrome, glucose intolerance, hypertension, and obesity), key comorbidities (anxiety, bipolar disorders, depression, eating disorders, infertility, obstructive sleep apnea), and diagnosed cardiovascular disease were measured. RESULTS During 2010, the prevalence of PCOS was 0.88%. Women with PCOS were more likely to have a diagnosis of diabetes (odds ratio [OR], 4.35; 95% confidence interval [CI], 3.63-5.21), dyslipidemia (OR, 3.56; 95% CI, 3.04-4.19), dysmetabolic syndrome (OR, 23.46; 95% CI, 13.64-40.36), glucose intolerance (OR, 5.46; 95% CI, 3.10-9.60), hypertension (OR, 2.76; 95% CI, 2.41-3.18), obesity (OR, 5.79; 95% CI, 5.07-6.62), infertility (OR, 23.42; 95% CI, 10.63-51.61), obstructive sleep apnea (OR, 6.47; 95% CI, 3.62-11.55), anxiety (OR, 1.76; 95% CI, 1.53-2.04), bipolar disorders (OR, 1.94; 95% CI, 1.55-2.44), and depression (OR, 2.22; 95% CI, 1.94-2.54) than did controls. Average total costs of care for the year was $5551 in the PCOS group and $3496 in the control group. After controlling for the effects of other variables, the average total cost of care for PCOS was $637 higher than that of the control group. Other variables that contributed significantly to the total costs of care included race, age, acute myocardial infarction, transient ischemic attack, peripheral artery disease, anxiety, depression, bipolar disorders, hypertension, diabetes, and dyslipidemia. CONCLUSIONS Although the clinical burden of PCOS is high, it is diagnosed less frequently in clinical practice compared with systematic screening studies. This is concerning considering that PCOS is associated with cardiovascular risk factors and other comorbidities. Mean total costs of care for the PCOS group was higher than the mean total costs of care for the control group. Polycystic ovary syndrome is independently associated with an increase in mean total costs of care.
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112
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Serum metabolomics study of polycystic ovary syndrome based on UPLC-QTOF-MS coupled with a pattern recognition approach. Anal Bioanal Chem 2015; 407:4683-95. [DOI: 10.1007/s00216-015-8670-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 12/24/2022]
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113
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Prevalence of vitamin D deficiency in Slovak women with polycystic ovary syndrome and its relation to metabolic and reproductive abnormalities. Wien Klin Wochenschr 2015; 128:641-8. [PMID: 25787215 DOI: 10.1007/s00508-015-0768-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/11/2015] [Indexed: 12/17/2022]
Abstract
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.
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114
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Valderhaug T, Hertel J, Nordstrand N, Dale P, Hofsø D, Hjelmesæth J. The association between hyperandrogenemia and the metabolic syndrome in morbidly obese women. Diabetol Metab Syndr 2015; 7:46. [PMID: 26015809 PMCID: PMC4443598 DOI: 10.1186/s13098-015-0040-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/05/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Female abdominal obesity is associated with hyperandrogenemia (HA), but few studies have addressed the possible association between HA and metabolic syndrome (MetS) among obese women. Some studies indicate that insulin resistance may cause HA through different mechanisms. On the other hand, a bidirectional relationship between HA and insulin resistance has been suggested. Thus, we aimed to investigate if morbidly obese women with HA had higher odds of MetS and its components than those without HA (controls), independent of polycystic ovarian syndrome (PCOS) status. METHODS This cross-sectional study comprised 1900 consecutive treatment seeking morbidly obese women <50 years. Free testosterone index (FTI) >0.6 defined HA. Women with previously diagnosed PCOS and those with oligo- / anovulation combined with clinical or biochemical hyperandrogenism were defined as having PCOS. Multiadjusted associations between HA and MetS were assessed by logistic regression analysis. RESULTS Out of 1900 morbidly obese women, 1089 (57 %), 846 (45 %) and 312 (16 %) had MetS, HA and PCOS, respectively. Compared with controls (without HA), women with HA were younger (34 [1] years vs. 39 [2], p < 0.001) had a higher prevalence of MetS (62 % vs. 53 %, p < 0.001), type 2 diabetes (18 % vs. 15 %, p = 0.045), low HDL-cholesterol (65 % vs. 48 %, p < 0.001) and hypertriglyceridemia (48 % vs. 41 %, p = 0.004), but a lower prevalence of raised blood pressure (53 % vs. 59 %, p = 0.014). Multivariable analyses showed that HA was associated with increased odds of MetS (OR 1.61 [95 % CI 1.27, 2.02]), dysglycemia (1.65 [1.28, 2.11]), low HDL-cholesterol (1.58 [1.27, 1.97]), and hypertriglyceridemia (1.43 [1.15, 1.79]). After stratification for the presence of PCOS, the results remained largely unchanged in women without PCOS; MetS (1.52 [1.18, 1.96), dysglycemia (1.71 [1.30, 2.25]), low HDL-cholesterol (1.55 [1.22, 1.98]) and hypertriglyceridemia (1.36 [1.06, 1.74]). CONCLUSION Morbidly obese women with HA had an approximately 1.5-fold increased odds of having MetS even in the absence of PCOS. Randomized controlled clinical trials, including therapeutic strategies to lower free testosterone levels, are however necessary to explore any cause-and-effect relationship.
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Affiliation(s)
- T.G. Valderhaug
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- />Division of Medicine, Department of Endocrinology, Akershus University Hospital HF, Sykehusveien 25, 1478 Nordbyhagen, Norway
- />Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J.K. Hertel
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - N. Nordstrand
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - P.O. Dale
- />Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - D. Hofsø
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - J. Hjelmesæth
- />Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- />Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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115
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Zhang D, Zhang L, Yue F, Zheng Y, Russell R. Serum zonulin is elevated in women with polycystic ovary syndrome and correlates with insulin resistance and severity of anovulation. Eur J Endocrinol 2015; 172:29-36. [PMID: 25336505 DOI: 10.1530/eje-14-0589] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evidence suggests that increased gut permeability may be associated with polycystic ovary syndrome (PCOS). Human zonulin is currently the only physiological mediator known to reversibly regulate gut permeability by disassembling intestinal tight junctions. So far, no data on serum zonulin levels in patients with PCOS are available. This study aimed to determine circulating serum zonulin levels in women with PCOS and discuss the relationship between zonulin, insulin resistance, and menstrual disorders in this group. DESIGN A case-control study. METHODS The study includes 78 women recently diagnosed with PCOS and 63 age-matched healthy controls recruited. Serum zonulin levels were determined by ELISA. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda and DeFronzo's insulin sensitivity index (ISI). RESULTS PCOS women had higher serum zonulin levels (P=0.022). After adjustment for age and BMI, zonulin levels significantly correlated with HOMA-IR and ISI. Furthermore, PCOS women with more severe menstrual disorders had significantly higher zonulin levels and displayed an inverse correlation between zonulin and the number of menstrual cycles per year (r=-0.398, P<0.001). CONCLUSIONS Serum zonulin, a biomarker for gut permeability, is increased in PCOS women and correlates with insulin resistance and severity of menstrual disorders. It suggests that alterations in gut permeability may play a role in the pathophysiology of PCOS, and serum zonulin might be used as a biomarker for both risk stratification and therapeutic outcomes in PCOS women.
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Affiliation(s)
- Dongmei Zhang
- Department of EndocrinologyXiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, ChinaSchool of NursingUniversity of California Los Angeles, Los Angeles, California, USA
| | - Li Zhang
- Department of EndocrinologyXiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, ChinaSchool of NursingUniversity of California Los Angeles, Los Angeles, California, USA
| | - Fangzhi Yue
- Department of EndocrinologyXiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, ChinaSchool of NursingUniversity of California Los Angeles, Los Angeles, California, USA
| | - Yingying Zheng
- Department of EndocrinologyXiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, ChinaSchool of NursingUniversity of California Los Angeles, Los Angeles, California, USA
| | - Ryan Russell
- Department of EndocrinologyXiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, ChinaSchool of NursingUniversity of California Los Angeles, Los Angeles, California, USA
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Alebić MŠ, Bulum T, Stojanović N, Duvnjak L. Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria. Endocrine 2014; 47:625-30. [PMID: 24522614 DOI: 10.1007/s12020-014-0182-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
Polycystic ovary syndrome (PCOS) women are more insulin resistant than general population. Prevalence data on insulin resistance (IR) in PCOS vary depending on population characteristics and methodology used. The objectives of this study were to investigate whether IR in PCOS is exclusively associated with body mass and to assess the prevalence of IR in lean and overweight/obese PCOS. Study included 250 consecutive women who attended a Department of Human Reproduction diagnosed as having PCOS according to the Rotterdam criteria. Control group comprised 500 healthy women referred for male factor infertility evaluation during the same period as the PCOS women. PCOS women (n = 250) were more insulin resistant than controls (n = 500) even after adjustment for age and body mass index (BMI) (P = 0.03). Using logistic regression analysis, BMI ≥ 25 kg/m(2) (OR 6.0; 95 % CI 3.3-11.0), PCOS (OR 2.2; 95 % CI 1.4-3.5) and waist circumference ≥ 80 cm (OR 2.0; 95 % CI 1.1-3.8) were identified as independent determinants of IR (P < 0.001). IR was more prevalent in overweight/obese controls (n = 100) than in lean PCOS women (n = 150), 31 versus 9.3 %, but less prevalent than in overweight/obese PCOS (n = 100), 31 versus 57 %. The prevalence of IR between lean controls (5 %) and lean PCOS (9.3 %) did not significantly differ. Both PCOS-specific and obesity-related IR independently contribute to IR in PCOS. Using HOMA-IR cutoff value of 3.15 specific for Croatian women in our clinical setting, the assessed prevalence of IR in lean and overweight/obese PCOS women was 9.3 and 57 %, respectively.
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Affiliation(s)
- Miro Šimun Alebić
- Department of Human Reproduction, Merkur University Hospital, Zagreb, Croatia
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117
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Kelley CE, Brown AJ, Diehl AM, Setji TL. Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. World J Gastroenterol 2014; 20:14172-84. [PMID: 25339805 PMCID: PMC4202347 DOI: 10.3748/wjg.v20.i39.14172] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/11/2014] [Accepted: 04/30/2014] [Indexed: 02/07/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance (IR), early diabetes, hypertension and dyslipidemia. Recent studies have demonstrated an association between PCOS and another metabolic complication: nonalcoholic fatty liver disease (NAFLD). NAFLD occurs as a result of abnormal lipid handling by the liver, which sensitizes the liver to injury and inflammation. It can progress to nonalcoholic steatohepatitis (NASH), which is characterized by hepatocyte injury and apoptosis. With time and further inflammation, NASH can progress to cirrhosis. Thus, given the young age at which NAFLD may occur in PCOS, these women may be at significant risk for progressive hepatic injury over the course of their lives. Many potential links between PCOS and NAFLD have been proposed, most notably IR and hyperandrogenemia. Further studies are needed to clarify the association between PCOS and NAFLD. In the interim, clinicians should be aware of this connection and consider screening for NAFLD in PCOS patients who have other metabolic risk factors. The optimal method of screening is unknown. However, measuring alanine aminotransferase and/or obtaining ultrasound on high-risk patients can be considered. First line treatment consists of lifestyle interventions and weight loss, with possible pharmacologic interventions in some cases.
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118
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Plosker S. Effect of gastric bypass surgery on endocrine and metabolic abnormalities in polycystic ovary syndrome-preliminary findings and future challenges. Surg Obes Relat Dis 2014; 10:792-4. [PMID: 25264333 DOI: 10.1016/j.soard.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/04/2014] [Accepted: 05/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Shayne Plosker
- University of South Florida Morsani College of Medicine, Tampa, Florida
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119
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Harris LA, Selgrade JF. Modeling endocrine regulation of the menstrual cycle using delay differential equations. Math Biosci 2014; 257:11-22. [PMID: 25180928 DOI: 10.1016/j.mbs.2014.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/18/2014] [Accepted: 08/21/2014] [Indexed: 11/29/2022]
Abstract
This article reviews an effective mathematical procedure for modeling hormonal regulation of the menstrual cycle of adult women. The procedure captures the effects of hormones secreted by several glands over multiple time scales. The specific model described here consists of 13 nonlinear, delay, differential equations with 44 parameters and correctly predicts blood levels of ovarian and pituitary hormones found in the biological literature for normally cycling women. In addition to this normal cycle, the model exhibits another stable cycle which may describe a biologically feasible "abnormal" condition such as polycystic ovarian syndrome. Model simulations illustrate how one cycle can be perturbed to the other cycle. Perturbations due to the exogenous administration of each ovarian hormone are examined. This model may be used to test the effects of hormone therapies on abnormally cycling women as well as the effects of exogenous compounds on normally cycling women. Sensitive parameters are identified and bifurcations in model behavior with respect to parameter changes are discussed. Modeling various aspects of menstrual cycle regulation should be helpful in predicting successful hormone therapies, in studying the phenomenon of cycle synchronization and in understanding many factors affecting the aging of the female reproductive endocrine system.
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Affiliation(s)
- Leona A Harris
- Department of Mathematics and Statistics, The College of New Jersey, Ewing, NJ 08628, United States.
| | - James F Selgrade
- Department of Mathematics and Biomathematics Program, North Carolina State University, Raleigh, NC 27695-8205, United States.
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120
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Livadas S, Kollias A, Panidis D, Diamanti-Kandarakis E. Diverse impacts of aging on insulin resistance in lean and obese women with polycystic ovary syndrome: evidence from 1345 women with the syndrome. Eur J Endocrinol 2014; 171:301-9. [PMID: 25053727 DOI: 10.1530/eje-13-1007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) represents a moving spectrum of hormonal to metabolic abnormalities, as women with the syndrome are aging. Hormonal abnormalities, anovulation, and hyperandrogenic signs were predominant during the early years of PCOS and fade away with the years. Metabolic abnormalities and insulin resistance (IR) remain throughout the PCOS life cycle; however, it is unclear as to how they change, as women with the syndrome are aging. OBJECTIVE To evaluate the changes in IR and its associations with clinical, biochemical, hormonal, and ultrasound findings in a large cohort of women with PCOS and controls, as they are aging. DESIGN A cross-sectional study was carried out to evaluate the diverse impacts of aging on IR. SETTING An outpatient clinic was chosen for the study. PARTICIPANTS A total of 1345 women with PCOS (Rotterdam criteria) and 302 controls of Caucasian origin and Greek ethnicity comprised the study group. MAIN OUTCOME AND MEASURES The impact of age on IR, as calculated using homeostasis model assessment of IR (HOMA-IR) index, and several PCOS characteristics were evaluated. RESULTS In PCOS, age (-0.045±0.008) was negatively, and BMI positively (0.18±0.007) associated with HOMA-IR (R(2)=0.36). When data were stratified with regard to the BMI status, a negative association of age with HOMA-IR was found in lean, normal, and overweight patients (r: -0.266, -0.233, -0.192, P<0.001), which was neutralized in obese patients (r: -0.009, P: NS). Free androgen index and BMI were positively associated with HOMA-IR in all age quartiles. When mean HOMA-IR values were plotted according to BMI subgroups at different age quartiles, a significant gradual decrease in HOMA-IR was observed in normal (P<0.001) and overweight (P: 0.004), but not obese, women (P: 0.202) across age quartiles. CONCLUSIONS Aging increases IR in obese but not in lean and overweight women with PCOS. As BMI and androgens are positively associated with HOMA-IR and androgens decline through time, it appears that if women with PCOS do not become obese they may exhibit a better metabolic profile during their reproductive years.
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Affiliation(s)
- Sarantis Livadas
- Endocrine UnitThird Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, GreeceDivision of Endocrinology and Human ReproductionSecond Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Kollias
- Endocrine UnitThird Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, GreeceDivision of Endocrinology and Human ReproductionSecond Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Panidis
- Endocrine UnitThird Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, GreeceDivision of Endocrinology and Human ReproductionSecond Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evanthia Diamanti-Kandarakis
- Endocrine UnitThird Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, GreeceDivision of Endocrinology and Human ReproductionSecond Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Androulakis II, Kandaraki E, Christakou C, Karachalios A, Marinakis E, Paterakis T, Diamanti-Kandarakis E. Visceral adiposity index (VAI) is related to the severity of anovulation and other clinical features in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2014; 81:426-31. [PMID: 24601936 DOI: 10.1111/cen.12447] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/08/2014] [Accepted: 02/28/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The clinical phenotype of polycystic ovary syndrome (PCOS) includes reproductive and hormonal aberrations. Visceral adiposity index (VAI) is an indicator which could connect hyperandrogenism and anovulation. The objective was to evaluate the relationship between VAI, menstrual disorders and hormonal, biochemical and ultrasound parameters in women with PCOS. PATIENTS One hundred and ninety-three women with PCOS diagnosed with Rotterdam criteria. MEASUREMENTS We correlated VAI with metabolic and clinical features of the syndrome and with indices of inflammation and insulin sensitivity. In addition, we classified the patients into four groups according to the severity of menstrual disorders: Group A (n = 42), with severe menstrual disorders, Group B (n = 83), with mild menstrual disorders, Group C (n = 58), without menstrual disorders and Group D (n = 10) with women with sychnominorroia. RESULTS In women with PCOS studied, VAI significantly positively correlated with body weight, fasting glucose, insulin, homeostasis model assessment (HOMA) score, white blood cells, platelets, uric acid, free testosterone, oestradiol, total cholesterol, γ-GT, SGPT. Furthermore, a significant inverse correlation between VAI and SHBG, Matsuda index and menstrual cycles per year was documented. From the comparison of the four groups, PCOS women with menstrual disorders had significantly higher VAI and HOMA indices when compared to PCOS without menstrual disorders. CONCLUSIONS Visceral adiposity index is increased in patients with PCOS in concordance with the severity of anovulation, insulin resistance and inflammation. This index could be a very easy and helpful clinical tool in daily practice to predict insulin resistance in women with PCOS.
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Affiliation(s)
- Ioannis I Androulakis
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
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Escobar-Morreale HF, Alvarez-Blasco F, Botella-Carretero JI, Luque-Ramirez M. The striking similarities in the metabolic associations of female androgen excess and male androgen deficiency. Hum Reprod 2014; 29:2083-91. [DOI: 10.1093/humrep/deu198] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Hendrix AO, Selgrade JF. Bifurcation analysis of a menstrual cycle model reveals multiple mechanisms linking testosterone and classical PCOS. J Theor Biol 2014; 361:31-40. [PMID: 25079709 DOI: 10.1016/j.jtbi.2014.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/11/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
Abstract
A system of 16 differential equations is described which models hormonal regulation of the menstrual cycle focusing on the effects of the androgen testosterone (T) on follicular development and on the synthesis of luteinizing hormone (LH) in the pituitary. Model simulations indicate two stable menstrual cycles - one cycle fitting data in the literature for normal women and the other cycle being anovulatory because of no LH surge. Bifurcations with respect to sensitive model parameters illustrate various characteristics of polycystic ovarian syndrome (PCOS), a leading cause of female infertility. For example, varying one parameter retards the growth of preantral follicles and produces a "stockpiling" of these small follicles as observed in the literature for some PCOS women. Modifying another parameter increases the stimulatory effect of T on LH synthesis resulting in reduced follicular development and anovulation. In addition, the model illustrates how anovulatory and hyperandrogenic cycles which are characteristic of PCOS can be reproduced by perturbing both pituitary sensitivity to T and the follicular production of T. Thus, this model suggests that for some women androgenic activity at the levels of both the pituitary and the ovaries may contribute to the etiology of PCOS.
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Affiliation(s)
- Angelean O Hendrix
- Department of Mathematics, North Carolina State University, Raleigh, NC 27695-8205, United States.
| | - James F Selgrade
- Department of Mathematics, North Carolina State University, Raleigh, NC 27695-8205, United States; Biomathematics Program, North Carolina State University, Raleigh, NC 27695, United States.
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Aye MM, Kilpatrick ES, Afolabi P, Wootton SA, Rigby AS, Coady AM, Sandeman DD, Atkin SL. Postprandial effects of long-term niacin/laropiprant use on glucose and lipid metabolism and on cardiovascular risk in patients with polycystic ovary syndrome. Diabetes Obes Metab 2014; 16:545-52. [PMID: 24401089 DOI: 10.1111/dom.12255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/31/2013] [Accepted: 12/19/2013] [Indexed: 01/10/2023]
Abstract
AIM This study investigated the effect of long-term niacin/laropiprant therapy on CV risk and IR in obese women with PCOS. METHODS In this double-blind randomized placebo-controlled trial, 13 and 12 PCOS women completed a 12 week course of niacin/laropiprant or placebo, respectively. Fasted subjects had an endothelial function test (EndoPat2000) and then consumed a mixed meal with blood sampled postprandially for 6 h before and after intervention. RESULTS By 12 weeks, niacin/laropiprant lowered low-density lipoprotein cholesterol (LDL-c) (13%) and increased HDL-c (17%). Despite a reduction in fasting triglycerides (21%), the drug had no effect on their postprandial rise (2.69 ± 1.44 vs. 2.49 ± 1.14 mmol/l, p = 0.72). However, following the mixed meal, plasma glucose area under the response curve increased from 13.1 ± 2.9 to 14.0 ± 2.8 mmol/l, p = 0.05, as a consequence of both increased insulin resistance [HOMA-IR: 2.2 (1.2, 4.2) vs. 3.8(1.3, 5.5), p = 0.02] and a reduced acute insulin response to glucose [424 (211, 975) vs. 257(122, 418) pmol/mmol, p = 0.04]. Niacin/laropiprant did not improve RHI (1.97 ± 0.40 vs. 2.05 ± 0.58, p = 0.33) or hsCRP. CONCLUSIONS In PCOS, niacin/laropiprant had a significant negative impact on postprandial glucose and no improvement in postprandial hypertriglyceridaemia, with at least the former mediated through increased IR and reduced β-cell function. This data may help explain why the improvement in fasting lipids has not translated into improved CV risk markers in PCOS.
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Affiliation(s)
- M M Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
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Lerchbaum E, Schwetz V, Giuliani A, Obermayer-Pietsch B. Influence of a positive family history of both type 2 diabetes and PCOS on metabolic and endocrine parameters in a large cohort of PCOS women. Eur J Endocrinol 2014; 170:727-39. [PMID: 24591551 DOI: 10.1530/eje-13-1035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE There is evidence suggesting a strong genetic background of polycystic ovary syndrome (PCOS). We aim to study the metabolic and endocrine characteristics of PCOS women with and without a family history (FHx) of type 2 diabetes mellitus (T2DM) and PCOS. DESIGN Cross-sectional study. METHODS We analysed the association of T2DM FHx and PCOS FHx with metabolic and endocrine parameters in 714 PCOS women. RESULTS A positive FHx of T2DM and PCOS were prevalent in 36.8 and 21.4% of PCOS women respectively. We found an independent association of T2DM FHx with central fat accumulation, obesity, prediabetes, metabolic syndrome (MS), insulin resistance, low HDL and elevated blood pressure (P<0.05 for all). PCOS FHx was independently associated with prediabetes (P<0.05). We observed an independent association of PCOS FHx with clinical and biochemical hyperandrogenism (P<0.05 for all), whereas there was no independent association of T2DM FHx with hyperandrogenism. PCOS women with a positive FHx of both T2DM and PCOS had an adverse metabolic and endocrine profile including a linear increase in risk of obesity, central fat accumulation, MS, prediabetes and low HDL (P<0.05 for all). CONCLUSIONS Our findings suggest that the assessment of FHx might allow risk stratification of PCOS women, which is important considering the high prevalence of PCOS.
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Affiliation(s)
- Elisabeth Lerchbaum
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
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126
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Anderson AD, Solorzano CMB, McCartney CR. Childhood obesity and its impact on the development of adolescent PCOS. Semin Reprod Med 2014; 32:202-13. [PMID: 24715515 DOI: 10.1055/s-0034-1371092] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity exacerbates the reproductive and metabolic manifestations of polycystic ovary syndrome (PCOS). The symptoms of PCOS often begin in adolescence, and the rising prevalence of peripubertal obesity has prompted concern that the prevalence and severity of adolescent PCOS is increasing in parallel. Recent data have disclosed a high prevalence of hyperandrogenemia among peripubertal adolescents with obesity, suggesting that such girls are indeed at risk for developing PCOS. Obesity may impact the risk of PCOS via insulin resistance and compensatory hyperinsulinemia, which augments ovarian/adrenal androgen production and suppresses sex hormone-binding globulin (SHBG), thereby increasing androgen bioavailability. Altered luteinizing hormone (LH) secretion plays an important role in the pathophysiology of PCOS, and although obesity is generally associated with relative reductions of LH, higher LH appears to be the best predictor of increased free testosterone among peripubertal girls with obesity. Other potential mechanisms of obesity-associated hyperandrogenemia include enhanced androgen production in an expanded fat mass and potential effects of abnormal adipokine/cytokine levels. Adolescents with PCOS are at risk for comorbidities such as metabolic syndrome and impaired glucose tolerance, and concomitant obesity compounds these risks. For all of these reasons, weight loss represents an important therapeutic target in obese adolescents with PCOS.
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Affiliation(s)
- Amy D Anderson
- Center for Research in Reproduction, University of Virginia School of Medicine
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127
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Rashidi H, Ramezani Tehrani F, Bahri Khomami M, Tohidi M, Azizi F. To what extent does the use of the Rotterdam criteria affect the prevalence of polycystic ovary syndrome? A community-based study from the Southwest of Iran. Eur J Obstet Gynecol Reprod Biol 2014; 174:100-5. [DOI: 10.1016/j.ejogrb.2013.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 11/25/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
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128
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Lam UD, Lerchbaum E, Schweighofer N, Trummer O, Eberhard K, Genser B, Pieber TR, Obermayer-Pietsch B. Association of MEP1A gene variants with insulin metabolism in central European women with polycystic ovary syndrome. Gene 2014; 537:245-52. [DOI: 10.1016/j.gene.2013.12.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 11/25/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
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Chin V, Censani M, Lerner S, Conroy R, Oberfield S, McMahon D, Zitsman J, Fennoy I. Gonadal dysfunction in morbidly obese adolescent girls. Fertil Steril 2014; 101:1142-8. [PMID: 24581575 DOI: 10.1016/j.fertnstert.2013.12.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe gonadal dysfunction and evaluate polycystic ovary syndrome (PCOS) and its association with metabolic syndrome (MeS) among girls in a morbidly obese adolescent population. DESIGN In a cross-sectional study of 174 girls, height, weight, waist circumference, Tanner stage, reproductive hormones, carbohydrate and lipid markers, drug use, and menstrual history were obtained at baseline. Exclusion criteria were menarcheal age <2 years, hormonal contraceptive or metformin use, Tanner stage <4, and incomplete data on PCOS or MeS classification. SETTING University medical center outpatient clinic. PATIENT(S) Ninety-eight girls ages 13-19.6 years, Tanner 5, average body mass index of 46.6 kg/m(2), menarche at 11.4 years, and average menarcheal age of 5 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Polycystic ovary syndrome and MeS. RESULT(S) Ninety-eight girls were divided into four groups: PCOS by National Institutes of Health criteria (PCOSN, n = 24), irregular menses only (n = 25), elevated T (≥55 ng/dL) only (n = 6), and obese controls (n = 43). Metabolic syndrome by modified Cook criteria affected 32 girls or 33% overall: 6 of 24 PCOSN, 7 of 25 irregular menses only, 4 of 6 elevated T only, and 15 of 43 obese controls. Polycystic ovary syndrome by National Institutes of Health criteria and its individual components were not associated with MeS after adjusting for body mass index. CONCLUSION(S) Unlike obese adults, PCOSN and its individual components were not associated with MeS in the untreated morbidly obese adolescent population.
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Affiliation(s)
- Vivian Chin
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Shulamit Lerner
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Donald McMahon
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jeffrey Zitsman
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Medical Center, New York, New York.
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Pasquali R, Gambineri A. Therapy in endocrine disease: treatment of hirsutism in the polycystic ovary syndrome. Eur J Endocrinol 2014; 170:R75-90. [PMID: 24272197 DOI: 10.1530/eje-13-0585] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hirsutism is a common medical complaint among women of reproductive age, and it affects the majority of women with the polycystic ovary syndrome (PCOS). Increased rate of androgen production and its availability in tissue represent the main pathophysiological mechanisms responsible for hirsutism. In addition, androgens may be generated de novo in the hair follicle; therefore, circulating androgen levels do not quantify the real exposure of the hair follicle to androgens, as a quota is locally generated. Hirsutism is a clinical sign and not a disease in itself; its presence does not therefore necessarily require treatment, particularly in mild-to-moderate forms, and when an affected woman does not worry about it. Physicians should decide whether hirsutism is to be treated or not by evaluating not only the severity of the phenomenon but also the subjective perception of the patient, which does not necessarily correspond to the true extent of hair growth. In any case, a physician should manage a woman with hirsutism only on the basis of a diagnosis of the underlying cause, and after a clear explanation of the efficacy of each therapeutic choice. Cosmetic procedures and pharmacological intervention are commonly used in the treatment of hirsutism and are discussed in this paper. Importantly, there are different phenotypes of women with hirsutism and PCOS that may require specific attention in the choice of treatment. In particular, when obesity is present, lifestyle intervention should be always considered, and if necessary combined with pharmacotherapy.
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Affiliation(s)
- Renato Pasquali
- Division of Endocrinology, Department of Medical and Surgical Science (DIMEC), S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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131
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Murri M, Insenser M, Escobar-Morreale HF. Metabolomics in polycystic ovary syndrome. Clin Chim Acta 2014; 429:181-8. [DOI: 10.1016/j.cca.2013.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/12/2013] [Accepted: 12/14/2013] [Indexed: 10/25/2022]
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133
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Peral B, Camafeita E, Fernández-Real JM, López JA. Tackling the human adipose tissue proteome to gain insight into obesity and related pathologies. Expert Rev Proteomics 2014; 6:353-61. [DOI: 10.1586/epr.09.53] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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134
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Kuliczkowska Plaksej J, Laczmanski L, Milewicz A, Lenarcik-Kabza A, Trzmiel-Bira A, Zaleska-Dorobisz U, Lwow F, Hirnle L. Cannabinoid receptor 1 gene polymorphisms and nonalcoholic Fatty liver disease in women with polycystic ovary syndrome and in healthy controls. Int J Endocrinol 2014; 2014:232975. [PMID: 25136364 PMCID: PMC4127238 DOI: 10.1155/2014/232975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/07/2014] [Accepted: 06/17/2014] [Indexed: 12/31/2022] Open
Abstract
Context. Polycystic ovary syndrome (PCOS) is frequently associated with nonalcoholic fatty liver disease (NAFLD). The endocannabinoid system may play a crucial role in the pathogenesis of NAFLD. Polymorphism of the cannabinoid receptor 1 gene (CNR1) may be responsible for individual susceptibility to obesity and related conditions. Objective. To determine the role of genetic variants of CNR1 in the etiopathology of NAFLD in women with PCOS. Design and Setting. Our department (a tertiary referral center) conducted a cross-sectional, case-controlled study. Subjects. 173 women with PCOS (aged 20-35) and 125 healthy, age- and weight-matched controls were studied. Methods. Hepatic steatosis was assessed by ultrasound evaluation. Single nucleotide polymorphisms of CNR1 (rs806368, rs12720071, rs1049353, rs806381, rs10485170, rs6454674) were genotyped. Results. Frequency of the G allele of rs806381 (P < 0.025) and the GG genotype of rs10485170 (P < 0.03) was significantly higher in women with PCOS and NAFLD than in PCOS women without NAFLD. Frequency of the TT genotype of rs6454674 was higher in PCOS women with NAFLD (not significantly, P = 0.059). In multivariate stepwise regression, allele G of rs806381 was associated with PCOS + NAFLD phenotype. Conclusion. Our preliminary results suggest the potential role of CNR1 polymorphisms in the etiology of NAFLD, especially in PCOS women.
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Affiliation(s)
- Justyna Kuliczkowska Plaksej
- Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, 4 Pasteura Street, 50-367 Wroclaw, Poland
- *Justyna Kuliczkowska Plaksej:
| | - Lukasz Laczmanski
- Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, 4 Pasteura Street, 50-367 Wroclaw, Poland
| | - Andrzej Milewicz
- Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, 4 Pasteura Street, 50-367 Wroclaw, Poland
| | - A. Lenarcik-Kabza
- Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, 4 Pasteura Street, 50-367 Wroclaw, Poland
| | - Anna Trzmiel-Bira
- Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, 4 Pasteura Street, 50-367 Wroclaw, Poland
| | - Urszula Zaleska-Dorobisz
- Department of Radiology, Wroclaw Medical University, 68 Curie-Sklodowskiej Street, 50-369 Wroclaw, Poland
| | - Felicja Lwow
- Department of Health Promotion, University School of Physical Education, 35 Paderewskiego Street, 51-612 Wroclaw, Poland
| | - Lidia Hirnle
- First Department of Gynaecology and Obstetrics, Wroclaw Medical University, 3 Chalubinskiego Street, 50-368 Wroclaw, Poland
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135
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Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6:1-13. [PMID: 24379699 PMCID: PMC3872139 DOI: 10.2147/clep.s37559] [Citation(s) in RCA: 551] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and polycystic ovaries. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include oligomenorrhea or amenorrhea, hirsutism, and frequently infertility. Risk factors for PCOS in adults includes type 1 diabetes, type 2 diabetes, and gestational diabetes. Insulin resistance affects 50%–70% of women with PCOS leading to a number of comorbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance, and diabetes. Studies show that women with PCOS are more likely to have increased coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS. Weight loss improves menstrual irregularities, symptoms of androgen excess, and infertility. Management of clinical manifestations of PCOS includes oral contraceptives for menstrual irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgen excess. Treatment options for infertility include clomiphene, laparoscopic ovarian drilling, gonadotropins, and assisted reproductive technology. Recent data suggest that letrozole and metformin may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications.
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Affiliation(s)
- Susan M Sirmans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA
| | - Kristen A Pate
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA
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136
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Hendrix AO, Hughes CL, Selgrade JF. Modeling Endocrine Control of the Pituitary–Ovarian Axis: Androgenic Influence and Chaotic Dynamics. Bull Math Biol 2013; 76:136-56. [DOI: 10.1007/s11538-013-9913-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
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Panidis D, Tziomalos K, Papadakis E. Metabolic syndrome in patients with the polycystic ovary syndrome. Expert Rev Endocrinol Metab 2013; 8:559-568. [PMID: 30736140 DOI: 10.1586/17446651.2013.853451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is frequently characterized by abdominal obesity and insulin resistance, which also represent the hallmarks of the metabolic syndrome (MetS). It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular disease (CVD) and accumulating data suggest that PCOS is also a risk factor for Type 2 diabetes mellitus and CVD. Accordingly, the association of PCOS with MetS has major health care implications given also the high prevalence of both disorders. We aimed to critically analyze the major studies that compared the prevalence of MetS between women with PCOS and controls, to discuss the anthropometric, endocrine and metabolic characteristics of PCOS, which are implicated in the pathogenesis of Mets in women with PCOS and to comment on the implications and management of MetS in this population. We thus summarize the evidence regarding the prevalence of MetS in PCOS and discuss the primary determinants driving this association. Current evidence shows that MetS is frequently observed in women with PCOS, but this appears to be mainly due to the more pronounced abdominal obesity in these women and not due to PCOS per se. Lifestyle changes are the treatment of choice for MetS in women with PCOS, whereas pharmacotherapy should be individualized.
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Affiliation(s)
- Dimitrios Panidis
- a Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Division of Endocrinology and Human Reproduction, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- b First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Efstathios Papadakis
- a Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Division of Endocrinology and Human Reproduction, Thessaloniki, Greece
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138
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Yildiz BO. Polycystic Ovary Syndrome: Is Obesity a Symptom? WOMENS HEALTH 2013; 9:505-7. [DOI: 10.2217/whe.13.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Bulent O Yildiz
- Hacettepe University School of Medicine, Division of Endocrinology & Metabolism, Hacettepe, 06100, Ankara, Turkey,
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139
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Ságodi L, Lombay B, Vámosi I, Barkai L. [Obesity, hormonal and metabolic abnormalities in adolescent girls with polycystic ovary syndrome]. Orv Hetil 2013; 154:1226-34. [PMID: 23895991 DOI: 10.1556/oh.2013.29669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome is associated with metabolic abnormalities, such as dyslipidemia, obesity, glucose intolerance, which are also components of the metabolic syndrome. Central obesity and insulin resistance appear to play an important role in the pathogenesis of polycystic ovary syndrome, perhaps via subsequent steroidogenic dysregulation. AIM The aim of the authors was to assess metabolic and hormonal abnormalities in adolescent girls with polycystic ovary syndrome. METHOD The study included 52 adolescents diagnosed with polycystic ovary syndrome based on the Rotterdam criteria. Anthropometric, hormonal and metabolic parameters were evaluated among all subjects. 20 healthy, age-matched, non-obese, regularly menstruating girls were used as controls. Of the 52 patients, 15 patients were born with low-birth-weight and 37 patients were born with normal birth weight. Oral glucose tolerance test was performed in all patients and controls. The age of patients was 16.8±3.1 years, and the age of controls was 16.95±2.1 years. RESULTS Among patients with polycystic ovary syndrome the prevalence of overweight and obesity was 35% (n = 18), while impaired fasting glucose occurred in one patient, impaired glucose tolerance in 8 patients, insulin resistance in 25 patients and metabolic syndrome in 12 patients. Serum triglyceride levels in patients and controls were 1.4±0.8 and 0.9±0.3 mmol/l, respectively (p<0.05), while fasting blood glucose, total cholesterol, HDL and LDL cholesterol were not different in the two groups. Metabolic abnormalities and obesity were more severe and more frequent in patients with low-birth-weight compared to those born with normal weight. There was a negative correlation between birth weight and body mass index SDS values and a positive correlation between fasting insulin levels and body mass index SDS (r = 0.37) in patients born with low-birth-weight. CONCLUSIONS Abnormal glucose metabolism is frequently present in adolescents with polycystic ovary syndrome. It is possible that early diagnosis of polycystic ovary syndrome in adolescence may prevent some of the long-term complications associated with this syndrome.
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Affiliation(s)
- László Ságodi
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Csecsemő- és Gyermekosztály Miskolc.
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140
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Teede HJ, Joham AE, Paul E, Moran LJ, Loxton D, Jolley D, Lombard C. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity (Silver Spring) 2013; 21:1526-32. [PMID: 23818329 DOI: 10.1002/oby.20213] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 11/15/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) affects 6-18% of women. The natural history of weight gain in women with PCOS has not been well described. Here we aimed to examine longitudinal weight gain in women with and without PCOS and to assess the association between obesity and PCOS prevalence. DESIGN AND METHODS The observational study was set in the general community. Participants were women randomly selected from the national health insurance scheme (Medicare) database. Mailed survey data were collected by the Australian Longitudinal Study on Women's Health. Data from respondents to survey 4, aged 28-33 years (2006, n = 9,145) were analyzed. The main outcome measures were PCOS prevalence and body mass index (BMI). RESULTS Self-reported PCOS prevalence was 5.8% (95% CI: 5.3%-6.4%). Women reporting PCOS had higher weight, mean BMI [2.5 kg/m(2) (95% CI: 1.9-3.1)], and greater 10-year weight gain [2.6 kg (95% CI: 1.2-4.0)]. BMI was the strongest correlate of PCOS status with every BMI increment increasing the risk of reporting PCOS by 9.2% (95% CI: 6%-12%). CONCLUSIONS This community based observational study with longitudinal reporting of weight shows that weight, BMI, and 10-year weight gain were higher in PCOS. We report the novel finding that obesity and greater weight gain are significantly associated with PCOS status. Considering the prevalence, major health and economic burden of PCOS, the increasing weight gain in young women, and established benefits of weight loss, these results have major public health implications.
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Affiliation(s)
- Helena J Teede
- Women's Public Health Research, Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
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Gomez-Meade CA, Lopez-Mitnik G, Messiah SE, Arheart KL, Carrillo A, de la Cruz-Muñoz N. Cardiometabolic health among gastric bypass surgery patients with polycystic ovarian syndrome. World J Diabetes 2013; 4:64-69. [PMID: 23772274 PMCID: PMC3680625 DOI: 10.4239/wjd.v4.i3.64] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/29/2013] [Accepted: 05/10/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine the effect of gastric bypass surgery on cardiometabolic health among women with polycystic ovarian syndrome (PCOS).
METHODS: Retrospective medical chart review identified women (n = 389) with PCOS who underwent Roux-en-Y gastric bypass surgery from 2001-2009 in one surgical practice. Separate repeated measures linear mixed models were fit using the MIXED procedure to assess mean change in cardiometabolic disease risk factors from before to 1-year after surgery and were evaluated by ethnicity [Hispanic, non-Hispanic black (NHB) and white (NHW)].
RESULTS: The majority of the sample was Hispanic (66%, 25% NHB, 9% NHW). Mean body mass index significantly improved 1 year post-surgery for all ethnic groups (45.5 to 35.5 kg/m2 for Hispanics, 46.8 to 37.7 kg/m2 for NHB and 45.7 to 36.7 kg/m2 for NHW, P < 0.001). Among Hispanic women mean total cholesterol (198.1 to 160.2 mg/dL), low-density lipoproteins (LDL) cholesterol (120.9 to 91.0 mg/dL), triglycerides (148.6 to 104.8 mg/dL), hemoglobin A1c (6.2% to 5.6%), alanine aminotransferase (28.1 to 23.0 U/L) and aspartate aminotransferase (23.5 to 21.6 U/L) decreased significantly (P < 0.001). Among NHB, mean total cholesterol (184.5 to 154.7 mg/dL), LDL cholesterol (111.7 to 88.9 mg/dL) and triglycerides (99.7 to 70.0 mg/dL) decreased significantly (P < 0.05). Among NHW, mean total cholesterol (200.9 to 172.8 mg/dL) and LDL cholesterol (124.2 to 96.6 mg/dL), decreased significantly (P < 0.05). Pairwise ethnic group comparisons of all cardiometabolic outcomes adjusted for age and type of surgery before and 1 year after surgery showed no statistical difference between the three groups for any outcome.
CONCLUSION: Cardiometabolic disease risk improvements vary by ethnicity and obesity may impact glucose tolerance and liver function changes more in Hispanic women with PCOS vs non-Hispanic women.
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142
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Baranova A, Tran TP, Afendy A, Wang L, Shamsaddini A, Mehta R, Chandhoke V, Birerdinc A, Younossi ZM. Molecular signature of adipose tissue in patients with both non-alcoholic fatty liver disease (NAFLD) and polycystic ovarian syndrome (PCOS). J Transl Med 2013; 11:133. [PMID: 23721173 PMCID: PMC3681627 DOI: 10.1186/1479-5876-11-133] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/27/2013] [Indexed: 12/16/2022] Open
Abstract
Background Polycystic ovarian syndrome (PCOS) is one of the most common reproductive disorders with strong association with both insulin resistance and non-alcoholic fatty liver disease (NAFLD). To untangle the complex relationship between PCOS and NAFLD, we analyzed serum biomarkers of apoptosis, some adipokines and mRNA profiles in the visceral adipose tissue of obese patients with NAFLD who were also diagnosed with PCOS and compared to a group with NAFLD only. Methods We included patients with biopsy-proven NAFLD and PCOS (N = 12) and BMI-matched biopsy-proven NAFLD patients without PCOS (N = 12). Expression levels of individual mRNAs and soluble serum biomarkers were compared by non-parametric Mann–Whitney test. The analysis also included Spearman rank correlation tests and multiple regression analysis. For co-correlated genes, the factor analysis was performed. Results The total serum levels of apoptotic biomarker M30 were significantly elevated in PCOS patients with liver steatosis as compared to non-PCOS NAFLD controls (P < 0.02), pointing that androgen-dependent proapoptotic PCOS environment that may directly contribute to NAFLD progression in these patients. Similarly, hyperandrogenism may explain the observed PCOS-specific decrease (P < 0.04) in adipose LDLR mRNA expression that may be connected to the proneness of PCOS patients to NAFLD. The levels of mRNA encoding angiogenesis-associated GSK-3B interacting protein ninein were also significantly increased in the adipose tissue of NAFLD patients with PCOS (P < 0.007). Furthermore, the levels of resistin positively correlated with expression levels of LDLR and prothrombin time (PT). Conclusion An androgen-dependent proapoptotic PCOS environment may directly contribute to NAFLD progression in these patients. Hyperandrogenism may explain an observed decrease in adipose LDLR mRNA expression. An inflammation-associated increase in the release of resistin into circulation might contribute to the prothrombotic state observed under conditions associated with insulin resistance, including PCOS. The studies of larger cohorts of NAFLD with and without PCOS patients are needed to further assess these potential interactions.
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Affiliation(s)
- Ancha Baranova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042, USA
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143
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Insenser M, Montes-Nieto R, Murri M, Escobar-Morreale HF. Proteomic and metabolomic approaches to the study of polycystic ovary syndrome. Mol Cell Endocrinol 2013; 370:65-77. [PMID: 23422073 DOI: 10.1016/j.mce.2013.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is considered a complex multifactorial disorder resulting from the interaction of genetic, environmental, and lifestyle influences. Nontargeted proteomics and metabolomics have been used in the past years with the aim of identifying molecules potentially involved in the pathophysiology of this frequent disorder. The biomolecules identified so far participate in many metabolic pathways, including energy metabolism (glucose and lipid metabolism), protein metabolic processes and protein folding, cytoskeleton structure, immune response, inflammation and iron metabolism, fibrinolysis and thrombosis, oxidative stress and intracellular calcium metabolism. These molecules provide key information about molecular functions altered in PCOS and raise questions concerning their precise role in the pathogenesis of this syndrome. The biomolecules identified by nontargeted proteomic and metabolomic approaches should be considered as candidates in future studies aiming to define specific molecular phenotypes of PCOS.
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Affiliation(s)
- María Insenser
- Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, E-28034 Madrid, Spain
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144
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Ságodi L, Kiss-Tóth E, Barkai L. [Role of genetic and environmental factors in the development of polycystic ovary syndrome]. Orv Hetil 2013; 154:650-7. [PMID: 23608312 DOI: 10.1556/oh.2013.29589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polycystic ovary syndrome is the most common heterogeneous endocrine abnormality in women in the reproductive age. The syndrome remains an enigmatic disorder because the aetiology is still unclear. Familial aggreagation is relatively common among patients with polycystic ovary syndrome suggesting a significant genetic component, although the way of inheritance has not been established firmly. The authors review the relevant medical literature and suggest that genetic and environmental factors play a role in the development of polycystic ovary syndrome. To date, no gene has been identified that causes or contributes substantially to the development of a polycystic ovary syndrome phenotype. Polycystic ovarian syndrome is considered to be an oligogenic disorder in which the interaction of a number of genetic and environmental factors determines the heterogeneous clinical and biochemical phenotype. To summarize current evidence the authors conclude, that when we are able to identify and then modify environmental determinants, then we will be able to safeguard better the health of those patients who are predisposed to disease development due to genotype or previous environmental effects.
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Affiliation(s)
- László Ságodi
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Csecsemő- és Gyermekosztály, Miskolc, Szentpéteri kapu 72-76. 3524. Miskolci Egyetem, Egészségügyi Kar, Preventív Egészségtudományi Tanszék, Miskolc.
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Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, Frearson M, Thondan M, Stepto N, Teede HJ. Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. J Acad Nutr Diet 2013; 113:520-45. [PMID: 23420000 DOI: 10.1016/j.jand.2012.11.018] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/08/2012] [Indexed: 12/20/2022]
Abstract
While lifestyle management is recommended as first-line treatment of polycystic ovary syndrome (PCOS), the optimal dietary composition is unclear. The aim of this study was to compare the effect of different diet compositions on anthropometric, reproductive, metabolic, and psychological outcomes in PCOS. A literature search was conducted (Australasian Medical Index, CINAHL, EMBASE, Medline, PsycInfo, and EBM reviews; most recent search was performed January 19, 2012). Inclusion criteria were women with PCOS not taking anti-obesity medications and all weight-loss or maintenance diets comparing different dietary compositions. Studies were assessed for risk of bias. A total of 4,154 articles were retrieved and six articles from five studies met the a priori selection criteria, with 137 women included. A meta-analysis was not performed due to clinical heterogeneity for factors including participants, dietary intervention composition, duration, and outcomes. There were subtle differences between diets, with greater weight loss for a monounsaturated fat-enriched diet; improved menstrual regularity for a low-glycemic index diet; increased free androgen index for a high-carbohydrate diet; greater reductions in insulin resistance, fibrinogen, total, and high-density lipoprotein cholesterol for a low-carbohydrate or low-glycemic index diet; improved quality of life for a low-glycemic index diet; and improved depression and self-esteem for a high-protein diet. Weight loss improved the presentation of PCOS regardless of dietary composition in the majority of studies. Weight loss should be targeted in all overweight women with PCOS through reducing caloric intake in the setting of adequate nutritional intake and healthy food choices irrespective of diet composition.
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Affiliation(s)
- Lisa J Moran
- The Robinson Institute, Research Centre for Reproductive Health, School of Paediatrics and Reproductive Health, University of Adelaide, Australia.
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146
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Murri M, Luque-Ramírez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF. Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis. Hum Reprod Update 2013; 19:268-88. [PMID: 23303572 DOI: 10.1093/humupd/dms059] [Citation(s) in RCA: 337] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Oxidative stress might be associated with polycystic ovary syndrome (PCOS), but relatively small studies published to date do not permit reaching a definitive conclusion. We aimed at conducting a systematic review and meta-analysis of studies evaluating circulating markers of oxidative stress in patients with PCOS. METHODS We conducted a systematic review of studies reporting circulating markers of oxidative stress in women with PCOS and controls published up to June 2012, using Entrez PubMed and EMBASE online facilities. Meta-analysis calculated standardized mean differences (SMDs) and 95% confidence intervals (95CI). RESULTS From 1633 potential studies identified electronically, 68 studies, including 4933 PCOS patients and 3671 controls, were selected. For each of nine circulating markers of oxidative stress, an individual meta-analysis was conducted. Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4). Similar results were found when restricting the analyses to studies in which patients and controls were matched for age and body mass index. CONCLUSIONS Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. This finding suggests that oxidative stress may participate in the pathophysiology of this common disorder.
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Affiliation(s)
- Mora Murri
- Diabetes, Obesity and Human Reproduction Research Group, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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147
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Witchel SF, Recabarren SE, Gonzalez F, Diamanti-Kandarakis E, Cheang KI, Duleba AJ, Legro RS, Homburg R, Pasquali R, Lobo R, Zouboulis CC, Kelestimur F, Fruzzetti F, Futterweit W, Norman RJ, Abbott DH. Emerging concepts about prenatal genesis, aberrant metabolism and treatment paradigms in polycystic ovary syndrome. Endocrine 2012; 42:526-34. [PMID: 22661293 PMCID: PMC3485440 DOI: 10.1007/s12020-012-9701-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 05/10/2012] [Indexed: 12/15/2022]
Abstract
The interactive nature of the 8th Annual Meeting of the Androgen Excess and PCOS Society Annual Meeting in Munich, Germany (AEPCOS 2010) and subsequent exchanges between speakers led to emerging concepts in PCOS regarding its genesis, metabolic dysfunction, and clinical treatment of inflammation, metabolic dysfunction, anovulation and hirsutism. Transition of care in congenital adrenal hyperplasia from pediatric to adult providers emerged as a potential model for care transition involving PCOS adolescents.
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Affiliation(s)
- Selma F Witchel
- Division of Endocrinology, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Sergio E Recabarren
- Laboratory of Animal Physiology and Endocrinology, Faculty of Veterinary Sciences, University of Concepcion, Casilla 537, Chillan, Chile.
| | - Frank Gonzalez
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46202.
| | | | - Kai I Cheang
- Department of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298-0111, USA.
| | - Antoni J Duleba
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Davis, California, USA.
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, H103, Hershey, Pennsylvania 17033, USA.
| | | | - Renato Pasquali
- Division of Endocrinology, Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, Italy.
| | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY.
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847 Dessau, Germany.
| | | | - Franca Fruzzetti
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy.
| | - Walter Futterweit
- Department of Endocrinology, Mount Sinai Medical Center, New York, NY.
| | - Robert J Norman
- The Robinson Institute, Norwich Centre, Ground Flr., 55 King William Rd, North Adelaide, SA 5006, Australia.
| | - David H Abbott
- Department of Obstetrics and Gynecology and Wisconsin National Primate Research Center, University of Wisconsin, 1223 Capitol Court, Madison, WI 53715, USA.
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Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33:981-1030. [PMID: 23065822 PMCID: PMC5393155 DOI: 10.1210/er.2011-1034] [Citation(s) in RCA: 1041] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is now recognized as an important metabolic as well as reproductive disorder conferring substantially increased risk for type 2 diabetes. Affected women have marked insulin resistance, independent of obesity. This article summarizes the state of the science since we last reviewed the field in the Endocrine Reviews in 1997. There is general agreement that obese women with PCOS are insulin resistant, but some groups of lean affected women may have normal insulin sensitivity. There is a post-binding defect in receptor signaling likely due to increased receptor and insulin receptor substrate-1 serine phosphorylation that selectively affects metabolic but not mitogenic pathways in classic insulin target tissues and in the ovary. Constitutive activation of serine kinases in the MAPK-ERK pathway may contribute to resistance to insulin's metabolic actions in skeletal muscle. Insulin functions as a co-gonadotropin through its cognate receptor to modulate ovarian steroidogenesis. Genetic disruption of insulin signaling in the brain has indicated that this pathway is important for ovulation and body weight regulation. These insights have been directly translated into a novel therapy for PCOS with insulin-sensitizing drugs. Furthermore, androgens contribute to insulin resistance in PCOS. PCOS may also have developmental origins due to androgen exposure at critical periods or to intrauterine growth restriction. PCOS is a complex genetic disease, and first-degree relatives have reproductive and metabolic phenotypes. Several PCOS genetic susceptibility loci have been mapped and replicated. Some of the same susceptibility genes contribute to disease risk in Chinese and European PCOS populations, suggesting that PCOS is an ancient trait.
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Abstract
There appears to be an epidemic of both obesity and polycystic ovary syndrome (PCOS) in the world today. However, obesity per se is not a part of the phenotype in many parts of the world. Obesity is likely not a cause of PCOS, as the high prevalence of PCOS among relatively thin populations demonstrates. However, obesity does exacerbate many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia. It is also associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in those women who do conceive. Although most treatments of obesity, with the exception of bariatric surgery, achieve modest reductions in weight and improvements in the PCOS phenotype, encouraging weight loss in the obese patient remains one of the front-line therapies. However, further studies are needed to identify the best treatments, and the role of lifestyle therapies in women of normal weight with PCOS is uncertain.
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Affiliation(s)
- Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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150
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Zwink N, Jenetzky E, Schmiedeke E, Schmidt D, Märzheuser S, Grasshoff-Derr S, Holland-Cunz S, Weih S, Hosie S, Reifferscheid P, Ameis H, Kujath C, Rißmann A, Obermayr F, Schwarzer N, Bartels E, Reutter H, Brenner H. Assisted reproductive techniques and the risk of anorectal malformations: a German case-control study. Orphanet J Rare Dis 2012; 7:65. [PMID: 22978793 PMCID: PMC3519554 DOI: 10.1186/1750-1172-7-65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 09/04/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of assisted reproductive techniques (ART) for treatment of infertility is increasing rapidly worldwide. However, various health effects have been reported including a higher risk of congenital malformations. Therefore, we assessed the risk of anorectal malformations (ARM) after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). METHODS Data of the German Network for Congenital Uro-REctal malformations (CURE-Net) were compared to nationwide data of the German IVF register and the Federal Statistical Office (DESTATIS). Odds ratios (95% confidence intervals) were determined to quantify associations using multivariable logistic regression accounting for potential confounding or interaction by plurality of births. RESULTS In total, 295 ARM patients born between 1997 and 2011 in Germany, who were recruited through participating pediatric surgeries from all over Germany and the German self-help organisation SoMA, were included. Controls were all German live-births (n = 10,069,986) born between 1997 and 2010. Overall, 30 cases (10%) and 129,982 controls (1%) were born after IVF or ICSI, which translates to an odds ratio (95% confidence interval) of 8.7 (5.9-12.6) between ART and ARM in bivariate analyses. Separate analyses showed a significantly increased risk for ARM after IVF (OR, 10.9; 95% CI, 6.2-19.0; P < 0.0001) as well as after ICSI (OR, 7.5; 95% CI, 4.6-12.2; P < 0.0001). Furthermore, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed strong associations with ART (ORs 4.9, 11.9 and 7.9, respectively). After stratification for plurality of birth, the corresponding odds ratios (95% confidence intervals) were 7.7 (4.6-12.7) for singletons and 4.9 (2.4-10.1) for multiple births. CONCLUSIONS There is a strongly increased risk for ARM among children born after ART. Elevations of risk were seen after both IVF and ICSI. Further, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed increased risks in each group. An increased risk of ARM was also seen among both singletons and multiple births.
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Affiliation(s)
- Nadine Zwink
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Dominik Schmidt
- Department of Pediatric Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Märzheuser
- Department of Pediatric Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stefan Holland-Cunz
- Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sandra Weih
- Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
| | - Stuart Hosie
- Department of Pediatric Surgery, Klinikum Schwabing, Technical University Munich, Munich, Germany
| | - Peter Reifferscheid
- Department of Child and Adolescent Medicine, Westküstenklinikum Heide, Heide, Germany
| | - Helen Ameis
- Department of Pediatric Surgery, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Christina Kujath
- Department of Pediatric Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Anke Rißmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University, Magdeburg, Germany
| | - Florian Obermayr
- Department of Pediatric Surgery and Urology, University Hospital for Child and Adolescent Medicine Tübingen, Tübingen, Germany
| | - Nicole Schwarzer
- SoMA e.V.; Self-help organisation for people with anorectal malformation, Munich, Germany
| | - Enrika Bartels
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Neonatology, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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