Predictors of insulin resistance and metabolic complications in polycystic ovarian syndrome in an eastern Indian population

Abdominal Obesity in Women with Polycystic Ovary Syndrome and Its Relationship with Diet, Physical Activity and Insulin Resistance: A Pilot Study

Abdominal obesity is a common feature of women with polycystic ovary syndrome (PCOS), and it is known to exacerbate insulin resistance (IR). Improper dietary and physical activity patterns are crucial environmental factors involved in the development of obesity, and they can significantly influence the central deposition of adipose tissue. Therefore, in this cross-sectional study, we aimed to evaluate the relationship between abdominal adiposity (measured by VAT (visceral adipose tissue), SAT (subcutaneous adipose tissue), VAT/SAT ratio (visceral to subcutaneous fat ratio), and WHR (waist-to-hip ratio)) and the prevalence and odds ratios of IR (measured by the homeostatic model assessment of insulin resistance (HOMA-IR), the homeostatic model assessment-adiponectin (HOMA-AD) and leptin to adiponectin ratio (L/A ratio)) in 56 PCOS women. Furthermore, we investigated the relationship between these abdominal obesity indices and diet and physical activity. An original food frequency questionnaire and Actigraph GT3X-BT were used to assess adherence to the diet recommended in IR and the level of physical activity, respectively. We observed a higher prevalence of IR among women with higher VAT, VAT/SAT, and WHR values compared to women with normal values of those abdominal obesity indices. Moreover, VAT/SAT seemed to be the best predictor of IR measured by HOMA-IR and HOMA-AD. However, VAT appeared to be the best and strongest predictor of IR measured by the L/A ratio. We also observed that higher adherence to the diet recommended in IR and higher levels of vigorous physical activity were associated with lower values of central fat accumulation indices and a greater chance of their normal values. Our findings indicate that central obesity increases the odds of IR and supports the beneficial role of diet and physical activity in the management of abdominal obesity in PCOS women.

Idiopathic hirsutism and dyslipidemia: A systematic review, meta-analysis, and meta-regressions

BACKGROUND

Despite existing several kinds of studies on idiopathic hirsutism (IH) and its association with metabolic disturbances, a limited number of studies have assessed lipid profiles in patients with IH with conflicting and inconclusive results. This study aimed to evaluate the lipid profiles in women with IH, compared to those of polycystic ovary syndrome (PCOS) and healthy controls.

MATERIALS AND METHODS

For this systematic review and meta-analysis, PubMed, Scopus, and EMBASE databases were searched to obtain studies published from inception to July 2021 investigating the lipid parameters, including triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in women with IH, compared to control groups. A meta-regression and subgroup analysis were conducted to explore heterogeneity sources. Publication bias was assessed by the Egger test.

RESULTS

Of 209 studies retrieved through searching databases and other sources, a total of 12 studies including 3913 participants were included for the meta-analysis. This meta-analysis showed higher standardized mean difference (SMD) of TC (SMD: 0.09 mg/dl; 95% CI: 0.001, 0.18) and lower SMD of HDL-C (SMD: -0.10 mg/dl; 95% CI: -0.18, -0.02) in women with IH, compared to those of the healthy controls, whereas there were no significant differences in the SMDs of TG and LDL-C between the study groups. This study also revealed no difference in the levels of lipid profiles of women with IH in comparison with PCOS patients, except for TG (SMD: -0.24 mg/dl; 95% CI: -0.46, -0.02). The results of subgroup analysis based on the study design revealed no significant differences in the SMD of lipid parameters between women with IH and healthy controls. We also found no significant difference in the levels of lipid profiles of women with IH versus PCOS patients, except for HDL-C in the subgroup of case-control studies (SMD: 0.18 mg/dl; 95% CI: 0.01, 0.34).

CONCLUSION

This study demonstrated that the majority of lipid parameters were not significantly different in women with IH, compared to those of healthy and PCOS controls.

Insulin resistance and idiopathic hirsutism: A systematic review, meta-analysis, and meta-regression

OBJECTIVES

This study aimed to evaluate the Standardized Mean Difference (SMD) of insulin resistance parameters in women with IH, compared to healthy and polycystic ovary syndrome (PCOS) controls.

MATERIALS AND METHODS

PubMed, Scopus, Web of Sciences, and Embase were searched for retrieving studies published up to November 2021 investigating the insulin resistance parameters in women with IH, compared to control groups. Meta-regression and subgroup analysis were conducted to evaluate the effect of potential confounders, such as age, BMI, and study design.

RESULTS

A meta-analysis of 20 studies revealed that higher SMDs of fasting insulin (SMD: 0.58; 95% CI: 0.10, 1.06), HOMA-IR (SMD: 0.53; 95% CI: 0.09, 0.97), and FBS levels (SMD: 0.11; 95% CI: 0.03, 0.19) in women with IH than healthy. It also showed that the SMD of HOMA-IR was significantly lower in women with IH than PCOS patients (SMD: -0.49; 95% CI: -0.88, -0.09). A subgroup analysis of cross-sectional studies showed higher SMDs of fasting insulin (SMD: 0.86; 95% CI: 0.05, 1.68), HOMA-IR (SMD: 0.83; 95% CI: 0.01, 1.64), and FBS levels (SMD: 0.14; 95% CI: 0.00, 0.28) in women with IH than healthy, whereas there was no difference in the SMD of these metabolic parameters between IH and PCOS groups, except for SMD of HOMA-IR (SMD: -0.22; 95% CI: -0.42, -0.02).

CONCLUSIONS

The results of the study demonstrate that insulin resistance parameters are related to IH, although insulin resistance values in women with IH are not as high as in patients with PCOS. According to the results of the study, measuring these metabolic parameters can be beneficial to evaluate all hirsute women with IH.

Gender diversity of insulin sensitivity markers among patients of type 2 diabetes mellitus in northern India: A cross-sectional analytical study

BACKGROUND

Diabetes mellitus is a worldwide health problem with more than 80% diabetics living in LMIC. Biological and psychosocial factors are also responsible for gender diversity in T2DM which highlights the need for action to combat T2DM in India. The current study was undertaken to evaluate the gender diversity of insulin sensitivity markers among patients of T2DM in northern India and secondly, to assess and compare the quality of life among T2DM patients in northern India.

MATERIAL AND METHODS

It was a cross-sectional analytical study enrolling 78 patients from tertiary care teaching hospital, India. Inclusion criteria was patients within the age group of 18-60 years, diagnosed with T2DM and on insulin therapy. Case reporting form, anthropometric measures, laboratory investigations, and diabetes quality of life (DQoL) instruments were used for data collection for the period of 3 months.

RESULTS

The mean age of T2DM patients for males was 48.00 ± 9.92 years and for females was 49.96 ± 10.39 years. Male and female patients were 50% and 50%, respectively. WHR (P = 0.032), DBP (P = 0.000), body fat % (P = 0.04), and duration of diabetes (P = 0.001) had statistically significant association with insulin resistance (binary logistic regression analysis (P-value <0.05). Results show the statistically significant difference between means of WHR (t value = 4.702, P = 0.000) and body fat % (t value = 3.035, P = 0.000) in male and female T2DM patients (Independent't'-test) (P-value <0.05).

CONCLUSIONS

The study concludes that WHR, DBP, body fat %, and duration of diabetes were significant markers of insulin sensitivity. WHR and body fat % were the differential insulin sensitivity markers in male and female patients of T2DM in northern India. Diabetes adversely affects the quality of life in a nearly similar pattern in both male and female patients.

Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne: A Study and Literature Review

Female acne is often associated with clinical signs of hyperandrogenism or metabolic syndrome. Various hormonal and biochemical factors as well as Vitamin D deficiency play a role in the etiopathogenesis of acne, and it is important to be able to detect the altered marker(s) indicative of certain abnormalities in order to diagnose and treat the cause. However, interpretation of these markers can be difficult, as there is ambiguity as to what is considered "normal" or "abnormal." The aim of this study was to explore the associations that acne might have with certain clinical, hormonal, and biological factors among female patients with acne. Additionally, the available literature was reviewed in order to determine the prevalence of these associations, discussion of which is provided. The author's investigations reveal a very high prevalence of abnormal metabolic and hormonal statuses among women with acne, indicating the need for dermatologists to maintain a high index of suspician for other disorders, especially metabolic disorders (and in particular, polycystic ovary syndrome), when treating female patients with acne.

Role of androgen ratios in the prediction of the metabolic phenotype in polycystic ovary syndrome

OBJECTIVE

To identify the androgen ratio that best predicts insulin resistance and metabolic syndrome among women with polycystic ovary syndrome (PCOS).

METHODS

Data for 180 women with PCOS and 180 healthy controls were extracted from two previous studies in Iran (conducted during 2008-2010 and 2011-2013). The diagnosis of PCOS was based on the Rotterdam criteria. The serum concentration of different androgens was measured. Receiver operating characteristic curve analysis was used to assess the ability of various androgen ratios to predict insulin resistance and metabolic syndrome.

RESULTS

Among women with PCOS, the testosterone-to-androstenedione ratio was the best predictor of insulin resistance (sensitivity 0.83, specificity 0.42) and metabolic syndrome (sensitivity 0.85, specificity 0.70). Among healthy controls, the ratio of free androgen index to testosterone was the best predictor of insulin resistance (sensitivity 0.84, specificity 0.33) and metabolic syndrome (sensitivity 0.91, specificity 0.17).

CONCLUSION

The prediction of insulin resistance and metabolic syndrome among women with PCOS was best accomplished with the testosterone-to-androstenedione ratio.

Evaluation of Relationship between Body Mass Index with Vitamin D Receptor Gene Expression and Vitamin D Levels of Follicular Fluid in Overweight Patients with Polycystic Ovary Syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder associated with reproductive disorders and metabolic dysfunctions including insulin resistance. The roles of vitamin D in the regulation of metabolic modulations specifically involving insulin and reproduction processing are introduced. In addition, obesity appears to be closely associated with severity of PCOS. The present study is to evaluate the effect of body mass index (BMI) on vitamin D levels in follicular fluid and vitamin D receptor (VDR) expression levels in granulos cells.

MATERIALS AND METHODS

A comparative study was conducted on 80 women with average age of 20-35 years referred for in vitro fertilization (IVF). Patients were divided into four groups, and serum levels of testosterone and insulin resistance (IR) were evaluated at the puncture time. Also, vitamin D levels of follicular fluid were evaluated. VDR gene expression was assayed by quantified-polymerase chain reaction (PCR) technique. Correlations were evaluated with calculation of the Spearman coefficient, and also independent relationships were assessed by means of multiple regression analysis.

RESULTS

Vitamin D levels of follicular fluid decreased in PCOS patients compared with non-PCOS. Also, over-weight individuals had lower vitamin D levels compared with normal-weight patients. Vitamin D levels of follicular fluid were highly correlated with BMI (r=-0.51, P<0.01). Homeostatic model assessment-IR (HOMA-IR) values were significantly higher in women of PCOS/overweight and PCOS/normal weight in comparison with women of non-PCOS/normal weight (P<0.01). The gene expression data of VDR in granulosa cells were significantly lower in the PCOS/overweight group compared with the non-PCOS/normal weight (P<0.01).

CONCLUSION

The findings indicated significant differences in VDR gene expression in granulosa cells and vitamin D of follicular fluid in PCOS/overweight patients.

A cross-sectional study to assess any possible linkage of C/T polymorphism in CYP17A1 gene with insulin resistance in non-obese women with polycystic ovarian syndrome

BACKGROUND & OBJECTIVES

Insulin resistance (IR) is a major confounding factor in polycystic ovarian syndrome (PCOS) irrespective of obesity. Its exact mechanism remains elusive till now. C/T polymorphism in the -34 promoter region of the CYP17 gene is inconsistently attributed to elucidate the mechanism of IR and its link to hyperandrogenemia in obese PCOS patients. In the present study we aimed to evaluate any association of this polymorphism with IR in non-obese women with PCOS.

METHODS

Polymorphism study was performed by restriction fragment length polymorphism (RFLP) analysis of the Msp A1 digest of the PCR product of the target gene in 75 PCOS cases against 73 age and BMI matched control women. Serum testosterone, BMI and HOMA-IR (homeostatic model of assessment-insulin resistance) were analyzed by standard techniques. A realistic cut-off value for the HOMA-IR was obtained through receiver operating characteristic (ROC) curve for exploring any possible link between IR and T/C polymorphism in the case group.

RESULTS

Significant increases in serum testosterone and HOMA-IR values were observed among the case group (P<0.001) without any significant elevation in BMI and FBG compared to controls. Cut-off value for IR in the PCOS patients was 1.40 against a maximum sensitivity of 0.83 and a minimum false positivity of 0.13. The analysis revealed an inconclusive link between the C/T polymorphic distribution and insulin resistant case subjects.

INTERPRETATION & CONCLUSIONS

The results showed that CYP17A1 gene was not conclusively linked to either IR or its associated increased androgen secretion in non-obese women with PCOS. We propose that an increased sensitivity of insulin on the ovarian cells may be the predominant reason for the clinical effects and symptoms of androgen excess observed in non-obese PCOS patients in our region.

Follicle-stimulating hormone associates with prediabetes and diabetes in postmenopausal women

AIMS

No study explores the association between follicle-stimulating hormone (FSH) and glucose metabolism in general women. We aim to investigate whether the variation of FSH is associated with prediabetes and diabetes in postmenopausal women.

METHODS

Our data were from survey on prevalence in East China for metabolic diseases and risk factors in 2014. Thousand six hundred and ten postmenopausal women at the age of 55-89 who were not using hormone replacement therapy were selected. Prediabetes and diabetes were defined according to American Diabetes Association 2014 criteria. FSH, luteinizing hormone, total testosterone and estradiol were measured by chemiluminescence. Multinomial logistic analyses were used for the association of FSH with prediabetes and diabetes, and linear regression for the association of FSH with fasting plasma glucose (FPG) and HbA1c.

RESULTS

Among the participants, 778 (48.3 %) had prediabetes and 121 (7.5 %) had newly diagnosed diabetes. In linear regression, after full adjustment for demographic variables, metabolic factors, E2 and LH, FSH was associated with FPG and HbA1c (P < 0.05). In logistic regression, increased quartiles of FSH were associated with significantly decreased odds ratios of prediabetes and diabetes (P for trend <0.01). This association was attenuated by waist circumference and HOMA-IR, but persisted in fully adjusted model (P for trend <0.05) in which, for the lowest compared with the highest quartile of FSH, the odds ratios of prediabetes and diabetes were 1.93 (95 % CI 1.21-3.08; P < 0.01) and 3.02 (95 % CI 1.10-8.31; P < 0.05), respectively.

CONCLUSIONS

Low FSH was associated with prediabetes and diabetes in postmenopausal women. The associations might be partially explained by adiposity and insulin resistance.

Renal Denervation: A Potential Novel Treatment for Type 2 Diabetes Mellitus?

Type 2 diabetes mellitus (T2DM) is a group of metabolic diseases of multiple etiologies. Although great progress has been made, researchers are still working on the pathogenesis of T2DM and how to best use the treatments available. Aside from several novel pharmacological approaches, catheter-based sympathetic renal denervation (RDN) has gained a significant role in resistant hypertension, as well as improvements in glycemic control in T2DM.In this article, we will summarize herein the role sympathetic activation plays in the progression of T2DM and review the recent clinical RDN experience in glucose metabolism.We performed systematic review in online databases, including PubMed, EmBase, and Web of Science, from inception until 2015.Studies were included if a statistical relationship was investigated between RDN and T2DM.The quality of each included study was assessed by Newcastle-Ottawa scale score. To synthesize these studies, a random-effects model or a fixed-effects model was applied as appropriate. Then, we calculated heterogeneity, performed sensitivity analysis, tested publication bias, and did meta-regression analysis. Finally, we identified 4 eligible articles.In most studies, RDN achieved via novel catheter-based approach using radiofrequency energy has gained a significant role in resistant hypertension, as well as improvements in glycemic control in T2DM. But the DREAMS-Study showed that RDN did not change median insulin sensitivity nor systemic sympathetic activity.Firstly, the current published studies lacked a proper control group, along with the sample capacity was small. Also, data obtained in the subgroups of diabetic patients were not separately analyzed and the follow-up period was very short. In addition, a reduction in blood pressure accounts for the improvements in glucose metabolism and insulin resistance cannot be excluded.If the favorable result of better glucose metabolism is confirmed in large-scale, randomized studies, RDN may emerge as a novel therapeutic option for patients with T2DM.

The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common endocrinopathy, associated with metabolic abnormalities. Metabolic features of various phenotypes of this syndrome are still debatable. The aim of present study hence was to evaluate the metabolic and hormonal features of PCOS phenotypes in comparison to a group of healthy control.

METHODS

A total of 646 reproductive-aged women were randomly selected using the stratified, multistage probability cluster sampling method. The subjects were divided into five phenotypes: A (oligo/anovulation + hyperandrogenism + polycystic ovaries), B (oligo/anovulation + hyperandrogenism), C (hyperandrogenism + polycystic ovaries) and D (oligo/anovulation + polycystic ovaries). Hormonal and metabolic profiles and the prevalence of metabolic syndrome among these groups were compared using ANCOVA adjusted for age and body mass index.

RESULTS

Among women with PCOS (n = 85), those of groups A and C had higher serum levels of insulin and homeostatic model assessment for insulin resistance (HOMA-IR), compared to PCOS women of group D. Serum concentrations of cholesterol, low density lipoprotein, triglycerides and glucose in group A were higher than in other phenotypes, whereas the metabolic syndrome was more prevalent among group B.

CONCLUSIONS

Women who had all three components of the syndrome showed the highest level of metabolic disturbances indicating that metabolic screening of the severest phenotype of PCOS may be necessary.