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Gitsi E, Livadas S, Argyrakopoulou G. Nutritional and exercise interventions to improve conception in women suffering from obesity and distinct nosological entities. Front Endocrinol (Lausanne) 2024; 15:1426542. [PMID: 39006367 PMCID: PMC11239444 DOI: 10.3389/fendo.2024.1426542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Infertility among women, particularly those living with obesity, presents a multifaceted challenge with implications for reproductive health worldwide. Lifestyle interventions, mainly focusing on weight loss, have emerged as promising strategies to improve fertility outcomes in this population. This review aims to explore the effectiveness of various lifestyle interventions, encompassing dietary modifications and exercise regimens, in enhancing fertility outcomes among women with obesity and associated conditions such as polycystic ovary syndrome, congenital adrenal hyperplasia, type 2 diabetes mellitus, premenopause, hypothyroidism and eating disorders. Methodology of study search encompass a broad spectrum, ranging from interventions targeting weight management through slow or rapid weight loss to dietary approaches emphasizing whole food groups, specific nutrients, and dietary patterns like low-carbohydrate or ketogenic diets, as well as the Mediterranean diet. By synthesizing existing findings and recommendations, this review contributes to the understanding of lifestyle interventions in addressing infertility, with an emphasis on the population of women of reproductive age with excess weight and known or unknown infertility issues, while promoting their integration into clinical practice to optimize reproductive health and overall well-being.
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Affiliation(s)
- Evdoxia Gitsi
- Diabetes and Obesity Unit, Athens Medical Center, Athens, Greece
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Wang Y, Chen J, Dong H, Ma RL, Zou Y, Wang W, Zheng Q, Feng Y, Tan Z, Zeng X, Zhao Y, Deng Y, Wang Y, Gu B, Sun A. Effect of Consultation Number on the Assessment and Treatment of Polycystic Ovary Syndrome. Int J Womens Health 2024; 16:527-541. [PMID: 38558831 PMCID: PMC10979685 DOI: 10.2147/ijwh.s445568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background The basic medical education stage is not enough to support physicians to fully diagnose and evaluate polycystic ovary syndrome (PCOS). The study aims to discover the difference in treatment choice between participants with different annual consultation number of PCOS, to promote lifelong learning, and drive balanced development within healthcare. Methods This is a multicenter cross-sectional survey. Participants' basic information, knowledge of PCOS and treatment options were collected online. According to the annual consultation number of patients with PCOS, physicians were divided into three groups: 0-50 people/yr, 50-200 people/yr, and >200 people/yr, and the results were derived from χ2 test, Fisher exact test, and multivariate logistic regression analysis. Results The study analyzed 1689 questionnaires, and 1206 physicians (71.4%) received less than 50 women per year, 388 physicians (30.0%) with an annual number of 50-200 women, and 95 physicians (5.6%) with patient turnover for more than 200 people. Reproductive endocrinologists generally have higher access to the clinic. As the number of visits increases, more and more physicians would perceive patients as more likely to have abnormal blood glucose and heavy weight. Physicians with large numbers of consultations are more likely to use Asian or Chinese standards to assess obesity. The multivariate analysis involved variables such as age, hospital level, specialty, and patient turnover annually, and more young doctors actively assessed lipid profile (odds ratio (OR) 1.56, 95% confidence interval (CI) (1.16, 2.16)), and primary hospitals (OR 0.65 CI (0.44, 0.89)) chose OGTT for blood glucose assessment less than tertiary hospitals. Physicians in secondary hospitals are more aggressive in evaluating androgens. Conclusion Our survey found differences in endocrine assessment, metabolic screening, and treatment in PCOS women in terms of the number of obstetrician-gynecologists who received different patient consultation numbers. The importance of continuing education for physicians is emphasized, to promote lifelong learning.
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Affiliation(s)
- Yue Wang
- National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Jie Chen
- National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Han Dong
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Jinzhou, Jinzhou, Liaoning, 121000, People’s Republic of China
| | - Rui-Lin Ma
- National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Ying Zou
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, 410008, People’s Republic of China
| | - Wei Wang
- Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
| | - Qingmei Zheng
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266500, People’s Republic of China
| | - Ying Feng
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Zhangyun Tan
- Department of Obstetrics and Gynecology, Xinhui Maternity and Children’s Hospital, Nanning, Guangxi, 529100, People’s Republic of China
| | - Xiaoqin Zeng
- Department of Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Yinqing Zhao
- Department of Obstetrics and Gynecology, Xinhui Maternity and Children’s Hospital, Nanning, Guangxi, 529100, People’s Republic of China
| | - Yan Deng
- National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yanfang Wang
- National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Bei Gu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing, 100038, People’s Republic of China
| | - Aijun Sun
- National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100010, People’s Republic of China
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Jin Y, Sun F, Yang A, Yu X, Li Y, Liang S, Jing X, Wang K, Zhang L, Xiao S, Zhang W, Wang X, Zhao G, Gao B. Insulin-like growth factor binding protein-1 and insulin in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1279717. [PMID: 38174331 PMCID: PMC10762309 DOI: 10.3389/fendo.2023.1279717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Insulin-like growth factor binding protein-1 (IGFBP-1) is considered a decline in polycystic ovary syndrome (PCOS), but it remains controversial that whether such reduction is attributed to obesity. Aims This systematic review aims to explore whether IGFBP-1 is reduced in PCOS, and whether such reduction is associated with obesity. Results Our pooled study included 12 studies with a total of 450 participants. IGFBP-1 levels in PCOS were significantly lower than that in non-PCOS (SMD (95%CI)=-0.49(-0.89, -0.09), P=0.02). No significant difference in IGFBP-1 levels between patients with or without PCOS classified by BMI. Whilst, stratification by PCOS status revealed a significant decrease in IGFBP-1 in overweight (SMD (95%CI)=-0.92(-1.46, -0.37), P=0.001). When comparing fasting insulin in the same way, PCOS patients had significantly elevated fasting insulin level but not statistically declined IGFBP-1 after classified by BMI. Conclusion This meta-analysis provides evidence that the decrease of IGFBP-1 in PCOS was more strongly influenced by comorbid obesity than by PCOS itself. Additionally, contrast to previous findings that insulin significantly suppresses IGFBP-1, our results suggested that the suppression of PCOS-related hyperinsulinemia on IGFBP-1 seemed diminished. Overall, our work may provide a novel perspective on the mechanism between insulin and IGFBP-1 underlying PCOS development.
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Affiliation(s)
- Yuxin Jin
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Fei Sun
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Aili Yang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xinwen Yu
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yi Li
- Department of Gynaecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Shengru Liang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaorui Jing
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Kai Wang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Lan Zhang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Sa Xiao
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - WenCheng Zhang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaoguang Wang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Guohong Zhao
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Bin Gao
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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Herbert S, Woolf K. Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS). Nutrients 2023; 15:5069. [PMID: 38140328 PMCID: PMC10745999 DOI: 10.3390/nu15245069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder experienced by women. PCOS is a lifelong condition associated with reproductive, metabolic, and psychological presentations. PCOS is also linked with increased prevalence of cardiometabolic risk factors. While an association between body weight and PCOS has been noted, cardiometabolic risk factors are prevalent in individuals with PCOS across body weights. Currently, no consensus exists as to the most appropriate lifestyle strategy for mitigating cardiometabolic risk in PCOS. A large proportion of the literature is focused on weight loss for individuals with PCOS who are overweight or experience obesity, despite PCOS being prevalent across body sizes. The aim of this narrative review is to assess dietary and lifestyle interventions aimed at reducing cardiometabolic risk in individuals with PCOS across body sizes. A total of 51 articles are included in this review. Overall, randomized controlled trials are limited and most studies focus on weight loss, excluding individuals classified within a healthy body weight range. Studies that modified the dietary pattern without an energy deficit saw improvements in cardiometabolic risk. Thus, less restrictive dietary approaches may be effective at reducing cardiometabolic risk in this population. This review also highlights the need for more sustainable lifestyle interventions that meet the needs of individuals with PCOS of varying body weights.
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Affiliation(s)
| | - Kathleen Woolf
- Department of Nutrition and Food Studies, Steinhart School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA;
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Skowrońska M, Pawłowski M, Milewski R. A Literature Review and a Proposed Classification of the Relationships between Ovulatory Infertility and Lifestyle Factors Based on the Three Groups of Ovulation Disorders Classified by WHO. J Clin Med 2023; 12:6275. [PMID: 37834919 PMCID: PMC10573907 DOI: 10.3390/jcm12196275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Ovulatory infertility is a serious clinical problem whose direct causes are still largely unknown. In addition to pathologies that make it impossible for a couple to establish a pregnancy, there are a number of other factors that have a bearing on fertility, including lifestyle factors, and particularly diet. Although numerous studies have been performed linking such factors to ovulatory infertility, most of them lack the necessary clinical significance, instead focusing on observational data and suggesting or establishing associative relationships. This article consists of a literature review focusing on connections between lifestyle factors such as diet, physical exercise, oxidative stress, sleep, and supplementation, and ovulatory infertility. Special emphasis was given to issues such as obesity and insulin resistance and their mutual relationship with other factors linked to ovulatory infertility. In addition, based on the conclusions of the literature review, the authors have proposed a classification of relationships between ovulation disorders and lifestyle factors in ovulatory infertility within the framework of the WHO classification of ovulation disorders. Furthermore, areas that merit further research have been indicated as well as those that do not. WHO Group II disorders gained prominence in the results of the study as the number of links with lifestyle factors and ovulatory infertility found in the course of the review greatly exceeded those for Groups I and III. The data presented in the article show that the issues of proper diet and physical exercise are those that could benefit from robust clinical studies focused specifically on ovulation infertility, while studies concerning the relationship between oxidative stress, sleep, and supplementation and ovulatory infertility do not seem to be promising directions as far as clinical significance is concerned.
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Affiliation(s)
| | - Michał Pawłowski
- Department of Biostatistics and Medical Informatics, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Robert Milewski
- Department of Biostatistics and Medical Informatics, Medical University of Bialystok, 15-089 Bialystok, Poland;
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Weng Y, Zhang Y, Wang D, Wang R, Xiang Z, Shen S, Wang H, Wu X, Wen Y, Wang Y. Exercise-induced irisin improves follicular dysfunction by inhibiting IRE1α-TXNIP/ROS-NLRP3 pathway in PCOS. J Ovarian Res 2023; 16:151. [PMID: 37525261 PMCID: PMC10388501 DOI: 10.1186/s13048-023-01242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Excessive production of androgen drives oxidative stress (OS) and inflammasome activation in ovarian granulosa cells (GCs). Therefore, the induced follicular developmental disorder is the major cause of infertility in women with polycystic ovary syndrome (PCOS). Exercise-induced upregulation of irisin is capable of regulating metabolism by reducing OS and inflammation. Exercise has been shown to alleviate a range of PCOS symptoms, including maintaining a normal menstrual cycle, in several clinical trials. METHODS Female Sprague-Dawley (SD) rats and primary ovarian cells were treated with two different androgens, dehydroepiandrosterone (DHEA) and dihydrotestosterone (DHT), to simulate a hyperandrogenic environment, followed by eight weeks of exercise training and irisin intervention. The levels of reactive oxygen species (ROS), tissue inflammation and fibrosis were examined using hematoxylin and eosin (H&E) staining, western blot, quantitative real-time PCR (qRT-PCR), dichlorofluorescein diacetate (DCF-DA) probe detection, immunofluorescence staining, immunohistochemistry, and Sirius red staining. RESULTS Exercise for eight weeks improved polycystic ovarian morphology and decreased the levels of inflammation, OS, and fibrosis in PCOS rats. Hyperandrogen increased ROS production in ovarian cells by inducing endoplasmic reticulum stress (ERS) and activating the inositol-requiring enzyme 1α (IRE1α)-thioredoxin-interacting protein (TXNIP)/ROS-NOD-like receptor family pyrin domain containing 3 (NLRP3) signaling pathway, further enhancing the levels of inflammation. Irisin suppressed the expression of IRE1α and its downstream targets, thus improving the ovarian dysfunction of PCOS rats induced by hyperandrogen. CONCLUSION Exercise can alleviate various phenotypes of PCOS rats induced by DHEA, and its therapeutic effect may be mediated by secreting beneficial myokines. IRE1α may be an important target of irisin for reducing OS and inflammation, thereby improving ovarian fibrosis.
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Affiliation(s)
- Yajing Weng
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Yaling Zhang
- School of Medicine, Jiaxing University, Jiaxing, 314001, China
| | - Daojuan Wang
- Department of Pain, Medical School, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210008, China
| | - Rong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Zou Xiang
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Shanmei Shen
- Department of Endocrinology, Medical School, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210093, China
| | - Hongwei Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China.
| | - Yanting Wen
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China.
| | - Yong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China.
- Nanjing University (Suzhou) High-Tech Institute, Suzhou, 215123, China.
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Mussawar M, Balsom AA, Totosy de Zepetnek JO, Gordon JL. The effect of physical activity on fertility: a mini-review. F S Rep 2023; 4:150-158. [PMID: 37398617 PMCID: PMC10310950 DOI: 10.1016/j.xfre.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/15/2023] [Accepted: 04/08/2023] [Indexed: 07/04/2023] Open
Abstract
Although lifestyle factors such as diet, cigarette smoking, and alcohol consumption are increasingly recognized as important contributors to the risk of subfertility, the role of exercise in fertility remains less clear. As such, it is challenging for healthcare providers to deliver clear, evidence-based recommendations to patients regarding the optimal frequency and intensity with which they should exercise to maximize their chances of conception. Therefore, this review provides a critical overview of the available research for various patient populations.
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Affiliation(s)
- Minhal Mussawar
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Ashley A. Balsom
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | | | - Jennifer L. Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Butt MS, Saleem J, Zakar R, Aiman S, Khan MZ, Fischer F. Benefits of physical activity on reproductive health functions among polycystic ovarian syndrome women: a systematic review. BMC Public Health 2023; 23:882. [PMID: 37173672 PMCID: PMC10176874 DOI: 10.1186/s12889-023-15730-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately 6-26%, affecting 105 million people worldwide. This systematic review aimed to synthesize the evidence on the effects of physical activity on reproductive health functions among PCOS women. METHODS The systematic review includes randomization-controlled trials (RCTs) on physical exercise and reproductive functions among women with PCOS. Studies in the English language published between January 2010 and December 2022 were identified via PubMed. A combination of medical subject headings in terms of physical activity, exercise, menstrual cycle, hyperandrogenism, reproductive hormone, hirsutism, and PCOS was used. RESULTS Overall, seven RCTs were included in this systematic review. The studies investigated interventions of physical activity of any intensity and volume and measured reproductive functions and hormonal and menstrual improvement. The inclusion of physical activity alone or in combination with other therapeutic interventions improved reproductive outcomes. CONCLUSION The reproductive functions of women with PCOS can be improved with physical activity. Furthermore, physical activity can also reduce infertility, as well as social and psychological stress among women. PROSPERO SYSTEMATIC REVIEW REGISTRATION CRD42020213732.
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Affiliation(s)
| | - Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Sobia Aiman
- Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | | | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Jurczewska J, Ostrowska J, Chełchowska M, Panczyk M, Rudnicka E, Kucharski M, Smolarczyk R, Szostak-Węgierek D. Physical Activity, Rather Than Diet, Is Linked to Lower Insulin Resistance in PCOS Women-A Case-Control Study. Nutrients 2023; 15:2111. [PMID: 37432289 DOI: 10.3390/nu15092111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 07/12/2023] Open
Abstract
Insulin resistance (IR) is a prominent feature of polycystic ovary syndrome (PCOS). The importance of lifestyle interventions in the management of PCOS is strongly highlighted and it is suggested that diet and physical activity may significantly influence insulin sensitivity. Therefore, we evaluated the link between diet and physical activity and various indices of insulin resistance, including adipokines secreted by the adipose tissue in 56 PCOS and 33 healthy control women. The original food frequency questionnaire and Actigraph GT3X-BT were used to assess the adherence to the diet recommended in IR and the level of physical activity, respectively. We observed that higher levels of physical activity were associated with lower HOMA-IR and a greater chance of its normal value in PCOS group. No such relationship was observed for other IR indices and adipokines or for the diet. However, we noted a strong correlation between HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) and HOMA-AD (Homeostatic Model Assessment-Adiponectin) in PCOS women. Additionally, when we used HOMA-AD we observed a higher prevalence of IR among PCOS women. Our study supports the beneficial role of physical activity in the management of insulin resistance in PCOS women. Moreover, our findings indicate that HOMA-AD may be a promising surrogate marker for insulin resistance assessment in women with PCOS.
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Affiliation(s)
- Justyna Jurczewska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciołka 27, 01-445 Warsaw, Poland
| | - Joanna Ostrowska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciołka 27, 01-445 Warsaw, Poland
| | - Magdalena Chełchowska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Science, Medical University of Warsaw, 00-581 Warsaw, Poland
| | - Ewa Rudnicka
- Department of Gynecological Endocrinology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland
| | - Marek Kucharski
- Department of Gynecological Endocrinology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland
| | - Roman Smolarczyk
- Department of Gynecological Endocrinology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciołka 27, 01-445 Warsaw, Poland
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Dietz de Loos A, Jiskoot G, van den Berg-Emons R, Louwers Y, Beerthuizen A, van Busschbach J, Laven J. The Effect of Tailored Short Message Service (SMS) on Physical Activity: Results from a Three-Component Randomized Controlled Lifestyle Intervention in Women with PCOS. J Clin Med 2023; 12:jcm12072466. [PMID: 37048550 PMCID: PMC10094796 DOI: 10.3390/jcm12072466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
This analysis of secondary outcome measures of a randomized controlled trial was conducted to study the effect of a one-year three-component (cognitive behavioural therapy, diet, exercise) lifestyle intervention (LSI), with or without additional Short Message Service (SMS) support, on physical activity and aerobic capacity in overweight or obese women with polycystic ovary syndrome (PCOS). Women diagnosed with PCOS and a BMI > 25 kg/m2 were randomly assigned to LSI with SMS support (SMS+, n = 60), LSI without SMS support (SMS-, n = 63) or care as usual (CAU, n = 60) in order to lose weight. Based on results from the International Physical Activity Questionnaire (IPAQ), we found a significant within-group increase after one year for SMS+ in the high physical activity category (+31%, p < 0.01) and sitting behaviour decreased (Δ -871 min/week, p < 0.01). Moreover, the peak cycle ergometer workload increased within SMS+ (Δ +10 watts, p < 0.01). The SMS+ group also demonstrated a significantly different increase in walking metabolic equivalent of task minutes (METmin)/week compared with CAU after one year (Δ 1106 METmin/week, p < 0.05). Apart from this increase in walking activity, no other between-group differences were found in this trial. Overall, based on within-group results, SMS support seemed to help with improving physical activity and aerobic capacity and decreasing sedentary behaviour.
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Affiliation(s)
- Alexandra Dietz de Loos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Geranne Jiskoot
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Rita van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Yvonne Louwers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Jan van Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Joop Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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Khamoshina MB, Artemenko YS, Bayramova AA, Ryabova VA, Orazov MR. Polycystic ovary syndrome and obesity: a modern paradigm. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-4-382-395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Polycystic ovary syndrome is a heterogeneous endocrine disease that affects women of childbearing age. The pathogenesis of polycystic ovary syndrome has not been fully studied to date, its paradigm considers the genetic determinism of the manifestation of hormonal and metabolic disorders, which are considered to be criteria for the verification of the disease (hyperandrogenism, oligo/anovulation and/or polycystic ovarian transformation during ultrasound examination (ultrasound). This review discusses the main ways of interaction between hyperandrogenism, insulin resistance and obesity and their role in the pathogenesis of polycystic ovary syndrome, as well as possible methods of treatment for this category of patients. The review analyzes the role of hyperandrogenism and insulin resistance in the implementation of the genetic scenario of polycystic ovary syndrome and finds out the reasons why women with polycystic ovary syndrome often demonstrate the presence of a «metabolic trio» - hyperinsulinemia, insulin resistance and type 2 diabetes mellitus. It is noted that obesity is not included in the criteria for the diagnosis of polycystic ovary syndrome, but epidemiological data confirm the existence of a relationship between these diseases. Obesity, especially visceral, which is often found in women with polycystic ovary syndrome, enhances and worsens metabolic and reproductive outcomes with polycystic ovary syndrome, as well as increases insulin resistance and compensatory hyperinsulinemia, which, in turn, stimulates adipogenesis and suppresses lipolysis. Obesity increases the sensitivity of tech cells to luteinizing hormone stimulation and enhances functional hyperandrogenism of the ovaries, increasing the production of androgens by the ovaries. Excess body weight is associated with a large number of inflammatory adipokines, which, in turn, contribute to the growth of insulin resistance and adipogenesis. Obesity and insulin resistance exacerbate the symptoms of hyperandrogenism, forming a vicious circle that contributes to the development of polycystic ovary syndrome. These data allow us to conclude that bariatric surgery can become an alternative to drugs (metformin, thiazolidinedione analogs of glucagon-like peptide-1), which has shown positive results in the treatment of patients with polycystic ovary syndrome and obesity.
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Baioccato V, Quinto G, Rovai S, Conte F, Dassie F, Neunhäeuserer D, Vecchiato M, Palermi S, Gasperetti A, Bullo V, Camozzi V, Vettor R, Ermolao A, Mioni R. Do Androgenic Pattern, Insulin State and Growth Hormone Affect Cardiorespiratory Fitness and Strength in Young Women with PCOS? Biomedicines 2022; 10:biomedicines10092176. [PMID: 36140277 PMCID: PMC9496105 DOI: 10.3390/biomedicines10092176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
In this study, cardiorespiratory fitness (CRF) and strength level were assessed in women with and without polycystic ovary syndrome (PCOS), matched for age, body composition, androgenic pattern and insulinemic pattern. Patients with and without PCOS were evaluated at the Endocrinology Unit and Sport Medicine Division to assess endocrinological (insulinemic, androgenic pattern and growth hormone), anthropometric (with DEXA) and functional parameters (with cardiopulmonary exercise test and handgrip test), as well as physical activity level (with the Global Physical Activity Questionnaire). A total of 31 patients with PCOS and 13 controls were included. No statistically significant differences were found between groups in terms of age, body mass index, body composition, androgenic pattern, insulin state, growth hormone and physical activity level. The PCOS group demonstrated significantly better cardiorespiratory fitness (VO2max per kg (30.9 ± 7.6 vs. 24.8 ± 4.1 mL/kg/min; p = 0.010), VO2max per kg of fat-free mass (52.4 ± 8.9 vs. 45.3 ± 6.2 mL/kg/min; p = 0.018)), strength levels (handgrip per kg (0.36 ± 0.09 vs. 0.30 ± 0.08; p = 0.009), handgrip per kg of fat-free mass (13.03 ± 2.32 vs. 11.50 ± 1.91; p = 0.001)) and exercise capacity (METs at test (14.4 ± 2.72 vs. 12.5 ± 1.72 METs; p = 0.019)). In this study, women with PCOS showed a better cardiorespiratory fitness and strength than the control group. The only determinant that could explain the differences observed seems to be the presence of the syndrome itself. These results suggest that PCOS per se does not limit exercise capacity and does not exclude good functional capacity.
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Affiliation(s)
- Veronica Baioccato
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
- Correspondence: (V.B.); (G.Q.); (M.V.)
| | - Giulia Quinto
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
- Correspondence: (V.B.); (G.Q.); (M.V.)
| | - Sara Rovai
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
| | - Francesca Conte
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
| | - Francesca Dassie
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera Padova, University of Padova, 35122 Padova, Italy
| | - Daniel Neunhäeuserer
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
- Correspondence: (V.B.); (G.Q.); (M.V.)
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Gasperetti
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
| | - Valentina Bullo
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
| | - Valentina Camozzi
- Endocrinology Division, Department of Medicine, Padova University Hospital, 35128 Padova, Italy
| | - Roberto Vettor
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera Padova, University of Padova, 35122 Padova, Italy
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, Padova University Hospital, Regional Centre for Exercise Prescription in Chronic Diseases, 35128 Veneto, Italy
| | - Roberto Mioni
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera Padova, University of Padova, 35122 Padova, Italy
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Rivas Vázquez I, Soto González M. Eficacia del ejercicio terapéutico en el síndrome del ovario poliquístico. Una revisión sistemática. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2022.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhao J, Ketlhoafetse A, Liu X, Cao Y. Comparative effectiveness of aerobic exercise versus Yi Jin Jing on ovarian function in young overweight/obese women with polycystic ovary syndrome: study protocol for a randomized controlled trial. Trials 2022; 23:459. [PMID: 35658926 PMCID: PMC9164314 DOI: 10.1186/s13063-022-06377-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/02/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common heterogeneous endocrine disease among women of childbearing age, characterized by androgen excess and ovarian dysfunction. Aerobic exercise is an important solution used to manage PCOS, due to its multiple benefits. Yi Jin Jing is an important component of traditional Chinese exercise (TCE), based on the root of traditional Chinese medicine theory (TCM), which focuses on keeping the body as a whole in a harmonious state. However, to date there is no literature on the benign effects of Yi Jin Jing on PCOS. The primary purpose of this protocol is to assess the effectiveness of aerobic exercise versus Yi Jin Jing, on the management of ovarian function in young overweight/obese women with PCOS. METHODS The study will conduct a controlled randomized, superiority trial with three-arm parallel groups, recruiting 90 women diagnosed with PCOS, ages between 18 and 35 years, with a body mass index (BMI) ≥ 23 kg/m2. Women will be randomly assigned to either control group (combined oral contraceptives) or one of the intervention groups (Yi Jin Jing group or aerobic exercise group) with an allocation rate of 1:1:1. After randomization, the intervention will be conducted within a 12-week period. The primary outcome would be anti-Mullerian hormone (AMH) level; the secondary outcomes would be biochemical profiles, ovarian volume, antral follicle count, BMI, menstrual frequency, and homeostasis model assessment of insulin resistance (HOMA-IR). Outcome measures would be collected during baseline and end of treatment. Reporting of the study will follow the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement. DISCUSSION This proposed study will be the first randomized clinical trial to evaluate the comparative effectiveness of aerobic exercise versus Yi Jin Jing on the management of ovarian function in young overweight/obese women with PCOS. The results may provide a new evidence-based management strategy for young women with PCOS. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900022385 . Registered on 9 April 2019.
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Affiliation(s)
- Jing Zhao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, 200437, China
| | - Antonnette Ketlhoafetse
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China
| | - Xiangyun Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China.
| | - Yang Cao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, 200437, China.
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Pandit U, Singh M, Ranjan R, Gupta V. The Effect of Exercise Training on Body Composition, Insulin Resistance and High Sensitivity C-reactive Protein (Hs-CRP) in Women With Polycystic Ovary Syndrome: A Pilot Study From North India. Cureus 2022; 14:e23994. [PMID: 35547420 PMCID: PMC9085451 DOI: 10.7759/cureus.23994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is defined as clinical or biochemical hyperandrogenism, oligo/amenorrhea, and polycystic ovaries with or without increased ovarian volume. The goal of this study was to assess the effect of a 20-week home-based aerobic exercise programme on body composition, insulin resistance, and hs-CRP levels in women with PCOS. Methods This 12-month prospective study included 60 female patients diagnosed with PCOS, aged 20 to 40 years. The participants were divided into 2 groups, one for the experiment and the other for the control. For each participant, the 12-hour fasting blood samples were taken on two occasions i.e., 24 hours before the first session and 48 hours after the last session to measure the fasting glucose, fasting insulin, and hs-CRP. The Statistical Package for Social Sciences (SPSS) was used to conduct the analysis, and an association was considered significant when the p-value was less than 0.05. Results In the present study, there was a dropout rate of 16.7% (5/30) in the study group and 23.3% (7/30) in the control group. The baseline characteristics were comparable (p>0.05) between the study group and the control group during the enrolment. The BMI (kg/m2) among the study group before the exercise programme was 22.8±1.8 and it was significantly reduced to 21.1±1.9 after the exercise programme (p<0.05). The HOMA-IR and hs-CRP (mg/L) levels among the study group before the exercise programme were 3.2±1.5 and 6.7±2.7 respectively, and these were significantly reduced to 1.9±1.6 and 4.2±1.3 respectively after the exercise programme (p<0.05). In contrast, paired T-test analysis showed no such significant difference (p<0.05) for all variables (Weight, BMI, Waist, Hip, fasting glucose, Fasting insulin, and hs-CRP) among the control group during the study period. Conclusion In a group of female PCOS patients, a 20-week home-based aerobic exercise programme reduced weight, BMI, HOMA-IR, and hs-CRP. Although more research on the effects of aerobic exercises in PCOS is needed, these findings support aerobic exercise's effectiveness in reducing inflammation and enhancing insulin sensitivity in these patients.
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Omega-3 supplementation in the treatment of polycystic ovary syndrome (PCOS) - a review of clinical trials and cohort. Endocr Regul 2022; 56:66-79. [PMID: 35180821 DOI: 10.2478/enr-2022-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women associated with cardiovascular disease and obesity. The possible benefits of omega-3 supplementation in this syndrome have been discussed much. This study is aimed to verify, based on the scientific data published, if there are any benefits in the omega-3 supplementation in the treatment of PCOS and to indicate its possible dosages for the treatment of polycystic ovary. The work consists of a systematic review of clinical trials and cohort of the MEDLINE/PubMed database from 2009 to October 2019. All studies that analyzed the omega-3 supplementation in women with PCOS were included. Cross-sectional studies, review articles, systematic reviews, meta-analysis, duplicates, studies in animals or cell culture, studies with omega-3 supplementation via food or associated with other supplementations were not included, except those involving vitamin E. In total, 21 articles were selected. Despite the heterogeneity of the studies selected, indirect benefits were observed mainly regarding the glycemic profile, such as insulin resistance reduction, lipid profile modulation (i.e. decrease in total cholesterol, triglycerides, and elevation of high-density lipoprotein), and the regulation of the androgenic profile. As for the anthropometric profile, the studies were scarce and most of them had no significant meaning. Regarding the antioxidant profile and inflammatory biomarkers, the findings differ among studies, but promising results were observed with different doses over 12 weeks of use, such as C-reactive protein (CRP) reduction. Thus, omega-3 fatty acids promote indirect benefits in the treating of women with PCOS. However, to reveal well-defined standards for dosage and supplementation time, further studies are needed.
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17
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The Effect of Exercise on Cardiometabolic Risk Factors in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031386. [PMID: 35162403 PMCID: PMC8835550 DOI: 10.3390/ijerph19031386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 01/06/2023]
Abstract
Background: Polycystic Ovary Syndrome (PCOS), a common endocrine disorder in women of reproductive age, increases the risk for cardiometabolic morbidity. While regular exercise is effective in reducing cardiometabolic risk, women with PCOS may experience condition-specific barriers to exercise thereby limiting its efficacy. Aim: To determine the effect of exercise on cardiometabolic risk factors in women with PCOS. Methods: Five databases (Cochrane, EMBASE, Medline, Scopus and SPORTDiscus) were searched up to December of 2021. Eligible studies included: a randomised controlled design; participants with a diagnosis of PCOS; aerobic and/or resistance exercise intervention lasting ≥4 weeks; cardiometabolic outcomes. Meta-analyses were performed to determine the effect of exercise versus non-exercising control on cardiometabolic outcomes. Results: Of the 4517 studies screened, 18 studies were analysed involving 593 participants. When compared with control, exercise significantly improved cardiorespiratory fitness (weighted mean difference {WMD} = 4.00 mL/kg/min, 95% CI: 2.61 to 5.40, p < 0.001) and waist circumference (WMD = −1.48 cm, 95% CI: −2.35 to −0.62, p = 0.001). Systolic blood pressure, fasting blood glucose, insulin resistance, and lipid profiles remained unchanged. Conclusions: Regular exercise may improve cardiorespiratory fitness and waist circumference in women with PCOS. Further large-scale studies are required to determine whether exercise interventions improve various biochemical and anthropometric parameters in women with PCOS and more severe cardiometabolic abnormalities.
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18
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Gu Y, Zhou G, Zhou F, Wu Q, Ma C, Zhang Y, Ding J, Hua K. Life Modifications and PCOS: Old Story But New Tales. Front Endocrinol (Lausanne) 2022; 13:808898. [PMID: 35498415 PMCID: PMC9045543 DOI: 10.3389/fendo.2022.808898] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is defined as a kind of endocrine and metabolic disorder that affects female individuals of reproductive age. Lifestyle modifications, including diet modifications, exercise, and behavioral modification, appear to alleviate the metabolic dysfunction and improve the reproductive disorders of PCOS patients (particularly in obese women). Therefore, lifestyle modifications have been gradually acknowledged as the first-line management for PCOS, especially in obese patients with PCOS. However, the mechanism of lifestyle modifications in PCOS, the appropriate composition of diet modifications, and the applicable type of exercise modifications for specific female populations are rarely reported. We conducted a systematic review and enrolled 10 randomized controlled trials for inclusion in a certain selection. In this review, we summarized the existing research on lifestyle modifications in PCOS. We aimed to illustrate the relationship between lifestyle modifications and PCOS (referring to hyperandrogenism, insulin resistance as well as obesity) and also considered the priorities for future research. These results might be an invaluable tool to serve as a guide in lifestyle modifications as the intervention for PCOS and other related endocrine disorders.
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Affiliation(s)
- Yuanyuan Gu
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Guannan Zhou
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Fangyue Zhou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiongwei Wu
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Chengbin Ma
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Yi Zhang
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
- *Correspondence: Yi Zhang, ; Jingxin Ding, ; Keqin Hua,
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
- *Correspondence: Yi Zhang, ; Jingxin Ding, ; Keqin Hua,
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
- *Correspondence: Yi Zhang, ; Jingxin Ding, ; Keqin Hua,
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20
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Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women of reproductive age. Although its essential clinical manifestation includes a plethora of symptoms and signs, which largely reflects the underlying hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology, PCOS may also be associated with many metabolic derangements. These metabolic derangements happen to overlap with many of the core constituents of the metabolic syndrome (MBS)—increased insulin resistance, central obesity, and dyslipidemia. The two disorders also display similarly increased risks for certain metabolic and vascular diseases, such as type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Due to the many similarities between metabolic syndrome and PCOS, this review aims to examine the evidence concerning the overlapping features, the risks for comorbidities, possible shared mechanisms, and treatment strategies in patients with coexisting PCOS and MBS.
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Affiliation(s)
- Yun-Chiao Hsieh
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Livia ShangYu Wan Chair Professor of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
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21
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Diet and Nutrition in Gynecological Disorders: A Focus on Clinical Studies. Nutrients 2021; 13:nu13061747. [PMID: 34063835 PMCID: PMC8224039 DOI: 10.3390/nu13061747] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
A healthy lifestyle and a balanced diet play a paramount role in promoting and maintaining homeostatic functions and preventing an array of chronic and debilitating diseases. Based upon observational and epidemiological investigations, it is clear that nutritional factors and dietary habits play a significant role in gynecological disease development, including uterine leiomyoma, endometriosis, polycystic ovary syndrome, and gynecological malignancies. Diets rich in fruits and vegetables, Mediterranean diets, green tea, vitamin D, and plant-derived natural compounds may have a long-term positive impact on gynecological diseases, while fats, red meat, alcohol, and coffee may contribute to their development. Data regarding the association between dietary habits and gynecological disorders are, at times, conflicting, with potential confounding factors, including food pollutants, reduced physical activity, ethnic background, and environmental factors limiting overall conclusions. This review provides a synopsis of the current clinical data and biological basis of the association between available dietary and nutritional data, along with their impact on the biology and pathophysiology of different gynecological disorders, as well as an outlook on future directions that will guide further investigational research.
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22
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Dietz de Loos ALP, Jiskoot G, Timman R, Beerthuizen A, Busschbach JJV, Laven JSE. Improvements in PCOS characteristics and phenotype severity during a randomized controlled lifestyle intervention. Reprod Biomed Online 2021; 43:298-309. [PMID: 34238659 DOI: 10.1016/j.rbmo.2021.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION What is the effect of weight loss through different interventions (three-component lifestyle intervention with short message service [SMS+] versus three-component lifestyle intervention without SMS [SMS-] versus care as usual [CAU]) on polycystic ovary syndrome (PCOS) characteristics (ovulatory dysfunction, hyperandrogenism, polycystic ovarian morphology [PCOM]) and phenotype distribution? DESIGN Analysis of secondary outcome measures of a randomized controlled trial. Women diagnosed with PCOS (n = 183), who wished to become pregnant, with a body mass index above 25 kg/m², were assigned to a 1-year three-component (cognitive behavioural therapy, diet, exercise) lifestyle intervention group, with or without SMS, or to CAU (advice to lose weight). RESULTS The prevalence of biochemical hyperandrogenism was 30.9% less in the SMS- group compared with CAU after 1 year (P = 0.027). Within-group analyses revealed significant improvements in ovulatory dysfunction (SMS+: -39.8%, P = 0.001; SMS-: -30.5%, P = 0.001; CAU: -32.1%, P < 0.001), biochemical hyperandrogenism (SMS-: -27.8%, P = 0.007) and PCOM (SMS-: -14.0%, P = 0.034). Weight loss had a significantly favourable effect on the chance of having ovulatory dysfunction (estimate 0.157 SE 0.030, P < 0.001) and hyperandrogenism (estimate 0.097 SE 0.027, P < 0.001). CONCLUSIONS All groups demonstrated improvements in PCOS characteristics, although these were more profound within the lifestyle intervention groups. Weight loss per se led to an amelioration of diagnostic characteristics and in the phenotype of PCOS. A three-component lifestyle intervention aimed at a 5-10% weight loss should be recommended for all women with PCOS before they become pregnant.
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Affiliation(s)
- Alexandra L P Dietz de Loos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands.
| | - Geranne Jiskoot
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands; Department of Psychiatry, Section Medical Psychology and Psychotherapy Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands
| | - Reinier Timman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, Section Medical Psychology and Psychotherapy Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands
| | - Jan J V Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, Rotterdam CA 3000, the Netherlands
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Ozgen Saydam B, Yildiz BO. Weight management strategies for patients with PCOS: current perspectives. Expert Rev Endocrinol Metab 2021; 16:49-62. [PMID: 33719818 DOI: 10.1080/17446651.2021.1896966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. Overweight and obesity commonly accompany the syndrome at the clinic and are significant concerns for women with PCOS. AREAS COVERED Herein, we provide an overview of the relevant literature on weight management strategies in women with PCOS. We performed an electronic-based search using PubMed until February 2021. We aimed to summarize available evidence of different weight-reducing interventions in PCOS and outline the gaps in our current knowledge and recommend areas for further research. EXPERT OPINION PCOS is closely linked to obesity and increased adiposity enhances severity and expression of PCOS phenotype. Current data suggest that weight loss is associated with improved metabolic, endocrine, reproductive, cardiovascular and psychological features in overweight and obese women with PCOS. Lifestyle interventions including diet and exercise, anti-obesity medications and bariatric surgery have been used as therapeutic approaches for short-term management of obesity in PCOS with varying success rates. Large and sufficiently powered studies are required in order to determine long-term effects of weight management strategies and potential benefits beyond weight loss in the syndrome. This would allow informing the guidelines to make PCOS specific evidence-based recommendations.
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Affiliation(s)
- Basak Ozgen Saydam
- Yildirim Beyazit University, Yenimahalle Training and Research Hospital, Division of Endocrinology and Metabolism, Ankara, Turkey
| | - Bulent Okan Yildiz
- Hacettepe University School of Medicine, Division of Endocrinology and Metabolism, Ankara, Turkey
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Arjmand B, Alaei S, Heravani NF, Alavi-Moghadam S, Payab M, Ebrahimpour M, Aghayan HR, Goodarzi P, Larijani B. Regenerative Medicine Perspectives in Polycystic Ovary Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1341:125-141. [PMID: 33748932 DOI: 10.1007/5584_2021_623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common gynecologic endocrine disorder in women between the ages of 15 and 40, with uncertain etiology. It is mostly presented with hyperandrogenism and insulin resistance along with a variety of comorbidities that significantly reduce a patient's quality of life. Many disturbed metabolic pathways are correlated with PCOS. Moreover, it is evident that there is a strong genetic factor for PCOS. Indeed, several altered gene expressions have been found in PCOS subjects, but the exact genetic origins are still unclear. The major treatment options such as pharmacological treatments are to improve the symptoms. In addition, surgical procedures (Bariatric surgery and assisted reproductive technologies) can be used to treat some of the patient's complications and reduce their severity. Generally, using pharmacological agents for a long period of time can increase the risk of adverse effects. Moreover, surgical options may have high-risk consequences. Herein, there is an undeniable need for a different multidisciplinary approach to PCOS. Regenerative medicine with the help of stem cells can develop a worthy alternative approach for the treatment of PCOS. Furthermore, animal models can provide valuable knowledge of genetic alterations and metabolic pathway disturbances in PCOS. They can also be used for testing novel treatments in pre-clinical stages. Therein, the current knowledge of PCOS and investigation about the potential role of regenerative medicine in developing new and more efficient treatments for PCOS are summarized here.
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Affiliation(s)
- Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Setareh Alaei
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Foroughi Heravani
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Alavi-Moghadam
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Payab
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbube Ebrahimpour
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Aghayan
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Goodarzi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Park YJ, Shin H, Jeon S, Cho I, Park HJ. Development and Effects of College-Based Lifestyle Modification Program for Menstrual Health of Young Adult Women with Irregular Menses: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E233. [PMID: 33396852 PMCID: PMC7795728 DOI: 10.3390/ijerph18010233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 12/24/2022]
Abstract
Purpose: This study was conducted to develop the 'College-based Lifestyle Modification Program' (College-based LMP) for young adult women with irregular menstruation and examine its effects after intervention. Methods: The College-based LMP consisted of small group education, individual physical exercise counseling/training, individual diet counseling, and feedback and support. Participants were comprised of 38 females who reported less than 10 irregular menstruations in a year and were randomly assigned to the experimental and control groups. The primary outcome variables consisted of menstrual cycle index (MCI), sex hormone binding globulin (SHBG), and androgenic profile (testosterone-T, free androgen index-FAI), while the outcome variables included premenstrual symptoms (PMS), menstrual volume, body composition parameters, glycemic parameters (fasting blood sugar-FBS, insulin, HOMA-IR), sleep duration, perceived stress, and nutrient intake.. Results: There were no significant differences in primary outcome variables (MCI, SHBG, T, and FAI). In the variables, there were no significant differences except for the partial domain of PMS (symptoms of depression and anxiety) and sleep duration. Conclusions: The study was significant in that it demonstrated the importance of lifestyle, which could provide ordinary young adult women with healthy menstruation. The College-based LMP needs to be elaborated with further studies.
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Affiliation(s)
| | | | | | - Inhae Cho
- College of Nursing, Korea University, Seoul 02841, Korea; (Y.-J.P.); (H.S.); (S.J.); (H.J.P.)
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Moran LJ, Tassone EC, Boyle J, Brennan L, Harrison CL, Hirschberg AL, Lim S, Marsh K, Misso ML, Redman L, Thondan M, Wijeyaratne C, Garad R, Stepto NK, Teede HJ. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: Lifestyle management. Obes Rev 2020; 21:e13046. [PMID: 32452622 DOI: 10.1111/obr.13046] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
Lifestyle is fundamental in chronic disease prevention and management, and it has been recommended as a first-line treatment in the Australian polycystic ovary syndrome (PCOS) guideline 2011. The first international evidence-based guideline on PCOS was developed in 2018, which expanded the scope and evidence in the Australian guideline. This paper summarizes the lifestyle recommendations and evidence summaries from the guideline. International multidisciplinary guideline development groups delivered the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. The process followed the Appraisal of Guidelines for Research and Evaluation II and The Grading of Recommendations, Assessment, Development and Evaluation framework. Extensive communication and meetings addressed six prioritized clinical questions through five reviews. Evidence-based recommendations were formulated before consensus voting within the panel. Evidence shows the benefits of multicomponent lifestyle intervention, efficacy of exercise and weight gain prevention with no specific diet recommended. Lifestyle management is the first-line management in the intervention hierarchy in PCOS. Multicomponent lifestyle intervention including diet, exercise and behavioural strategies is central to PCOS management with a focus on weight and healthy lifestyle behaviours. The translation programme optimizes reach and dissemination for health professionals and consumers.
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Affiliation(s)
- Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Department of Endocrinology and Diabetes, Monash Health, Clayton, Melbourne, Victoria, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Clayton, Melbourne, Victoria, Australia
| | - Leah Brennan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | | | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Kate Marsh
- Northside Nutrition & Dietetics, Chatswood, New South Wales, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Leanne Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Mala Thondan
- Harp Family Medical, Kew East, Victoria, Australia
| | - Chandrika Wijeyaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Nigel K Stepto
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,Medicine Western Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Department of Endocrinology and Diabetes, Monash Health, Clayton, Melbourne, Victoria, Australia
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Shang Y, Zhou H, Hu M, Feng H. Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2020; 105:5867491. [PMID: 32621748 DOI: 10.1210/clinem/dgaa425] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The effect of diet on insulin resistance (IR) in polycystic ovary syndrome (PCOS) is controversial. Thus, we conducted this systematic review and meta-analysis to evaluate whether diet could reduce IR in women with PCOS while providing optimal and precise nutrition advice for clinical practice. DESIGN The search was conducted in 8 databases through June 30, 2019. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A random-effects model was adopted to calculate the overall effects. RESULTS A total of 19 trials (1193 participants) were included. The analysis showed that diet was significantly related to improvements in IR and body composition (eg, homeostasis model assessment of insulin resistance, fasting insulin, fasting plasma glucose, body mass index [BMI], weight, and waist circumference) in PCOS patients. The Dietary Approaches to Stop Hypertension diet and calorie-restricted diets might be the optimal choices for reducing IR and improving body composition, respectively, in the PCOS population. Additionally, the effects were associated with the course of treatment. The longer the duration, the greater the improvement was. Compared with metformin, diet was also advantageous for weight loss (including BMI and weight) and had the same effects on insulin regulation. CONCLUSION Overall, our findings suggest that diet is an effective, acceptable and safe intervention for relieving IR, and professional dietary advice should be offered to all PCOS patients.
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Affiliation(s)
- Yujie Shang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Huifang Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghui Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Hua Feng
- Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Vocational College of Medicine, Yancheng, China
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Lie Fong S, Douma A, Verhaeghe J. Implementing the international evidence-based guideline of assessment and management of polycystic ovary syndrome (PCOS): how to achieve weight loss in overweight and obese women with PCOS? J Gynecol Obstet Hum Reprod 2020; 50:101894. [PMID: 32814159 DOI: 10.1016/j.jogoh.2020.101894] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/29/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Many of these women are overweight or obese. A minor weight loss of 5%-10% can significantly reduce reproductive, metabolic and psychological symptoms of PCOS and is recommended as a first step in the treatment of overweight or obese women with PCOS. Many weight loss programs have been proposed, but optimal methods on how to achieve the recommend weight loss are lacking. The aim of this systematic review was to generate practical tools for health professionals to guide women with PCOS towards a sustainable healthier lifestyle. PRISMA guidelines were used to conduct the systematic review. Eleven randomized controlled trials were found eligible for inclusion. Lifestyle modification strategies consisted of a diet, physical exercise, behavioural coaching or combined interventions. Mean weight loss ranged from +0.5 to -10.6 % of the initial body weight. However, the majority of the studies reported considerable drop-out rates varying between 12% and 47%. The heterogeneity of the described interventions and the high drop-out rates impede extrapolation of these results to daily clinical care. Hence, none of the described interventions seems superior to another in achieving substantial weight loss. In conclusion, the need for obtaining a healthier weight in overweight and obese women with PCOS is now well accepted. However, achieving this goal remains a challenge for both patients and healthcare providers. More research focusing on the multidisciplinary approach of lifestyle modification advice in daily practice is needed.
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Affiliation(s)
- Sharon Lie Fong
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium; Leuven University Fertility Centre, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium.
| | - Annewiets Douma
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium
| | - Johan Verhaeghe
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium
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Patten RK, Boyle RA, Moholdt T, Kiel I, Hopkins WG, Harrison CL, Stepto NK. Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Physiol 2020; 11:606. [PMID: 32733258 PMCID: PMC7358428 DOI: 10.3389/fphys.2020.00606] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive and metabolic manifestations. Exercise training has consistently been found to result in improved clinical outcomes in women with PCOS, but shortfalls with exercise prescription are evident. The aim of this systematic review and meta-analysis was to identify exercise intervention characteristics that provide favourable outcomes in women with PCOS. Methods: A systematic review of published literature was conducted using EBSCOhost and Ovid Medline up to May 2019. The review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines as per our PROSPERO protocol (CRD42018088367). Randomised controlled trials, non-randomised controlled trials, and uncontrolled trials that evaluated an exercise intervention of at least moderate intensity in women with PCOS were included. Meta-analyses were performed using general linear mixed modelling and Bayesian inferences about effect magnitudes. Results: Thirty-three articles were identified for systematic review of which 19 were meta-analysed. Intervention duration ranged from 6 to 26 weeks. A total number of 777 women were included in the meta-analysis. The meta-analysis found that improvements in health outcomes are more dependent on exercise intensity rather than dose. Fixed effects analysis reported a moderate increase in VO2peak (24.2%; 90% CL, 18.5–30.1), and small reductions in HOMA-IR (−36.2%; 90% CL, −55.3 to −9.0), and waist circumference (−4.2%; 90% CL −6.0 to −2.3) as a result of vigorous intensity exercise. These results are confirmed in the predicted analysis which reported the greatest improvements in VO2peak, BMI, and waist circumference after vigorous intensity exercise alone or when combined with diet, particularly for women with clinically adverse baseline values. Conclusions: Exercise training in the management of PCOS is becoming more common. Results from our analysis support the use of exercise and suggest that vigorous intensity exercise may have the greatest impact on cardiorespiratory fitness, body composition, and insulin resistance. Our results indicate that, a minimum of 120 min of vigorous intensity per week is needed to provide favourable health outcomes for women with PCOS with studies of longer duration required to evaluate outcomes with sustained exercise.
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Affiliation(s)
- Rhiannon K Patten
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Russell A Boyle
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ida Kiel
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - William G Hopkins
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nigel K Stepto
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, VIC, Australia
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Haudum C, Lindheim L, Ascani A, Trummer C, Horvath A, Münzker J, Obermayer-Pietsch B. Impact of Short-Term Isoflavone Intervention in Polycystic Ovary Syndrome (PCOS) Patients on Microbiota Composition and Metagenomics. Nutrients 2020; 12:E1622. [PMID: 32492805 PMCID: PMC7656308 DOI: 10.3390/nu12061622] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide and is associated with disorders of glucose metabolism. Hormone and metabolic signaling may be influenced by phytoestrogens, such as isoflavones. Their endocrine effects may modify symptom penetrance in PCOS. Equol is one of the most active isoflavone metabolites, produced by intestinal bacteria, and acts as a selective estrogen receptor modulator. METHOD In this interventional study of clinical and biochemical characterization, urine isoflavone levels were measured in PCOS and control women before and three days after a defined isoflavone intervention via soy milk. In this interventional study, bacterial equol production was evaluated using the log(equol: daidzein ratio) and microbiome, metabolic, and predicted metagenome analyses were performed. RESULTS After isoflavone intervention, predicted stool metagenomic pathways, microbial alpha diversity, and glucose homeostasis in PCOS improved resembling the profile of the control group at baseline. In the whole cohort, larger equol production was associated with lower androgen as well as fertility markers. CONCLUSION The dynamics in our metabolic, microbiome, and predicted metagenomic profiles underline the importance of external phytohormones on PCOS characteristics and a potential therapeutic approach or prebiotic in the future.
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Affiliation(s)
- Christoph Haudum
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, 8010 Graz, Austria; (L.L.); (A.A.); (C.T.); (J.M.); (B.O.-P.)
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Lisa Lindheim
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, 8010 Graz, Austria; (L.L.); (A.A.); (C.T.); (J.M.); (B.O.-P.)
| | - Angelo Ascani
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, 8010 Graz, Austria; (L.L.); (A.A.); (C.T.); (J.M.); (B.O.-P.)
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, 8010 Graz, Austria; (L.L.); (A.A.); (C.T.); (J.M.); (B.O.-P.)
| | - Angela Horvath
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, 8010 Graz, Austria;
| | - Julia Münzker
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, 8010 Graz, Austria; (L.L.); (A.A.); (C.T.); (J.M.); (B.O.-P.)
- Department of Medicine, Integrated Research and Treatment Centre for Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, 8010 Graz, Austria; (L.L.); (A.A.); (C.T.); (J.M.); (B.O.-P.)
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
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Kazemi A, Speakman JR, Soltani S, Djafarian K. Effect of calorie restriction or protein intake on circulating levels of insulin like growth factor I in humans: A systematic review and meta-analysis. Clin Nutr 2020; 39:1705-1716. [DOI: 10.1016/j.clnu.2019.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
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Porchia LM, Hernandez-Garcia SC, Gonzalez-Mejia ME, López-Bayghen E. Diets with lower carbohydrate concentrations improve insulin sensitivity in women with polycystic ovary syndrome: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 248:110-117. [PMID: 32200247 DOI: 10.1016/j.ejogrb.2020.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Women with polycystic ovary syndrome (PCOS) are associated with increased levels of insulin resistance (IR). Other than treatment with insulin-sensitizing drugs, specialized diets have also been implemented to reduce the patient's IR. However, the capacity of certain diets, concerning with the severity of the patient's IR, to improve insulin sensitivity has not fully been explored. Therefore, we conducted a meta-analysis to determine in PCOS subjects from low to severe IR, if hypocaloric diets improve insulin sensitivity. STUDY DESIGN PubMed, SCOPUS, EBSCO, and LILACS databases and retrieved studies' bibliographies were searched for prospective studies that investigated the association between diets and IR in PCOS women until October 2018. Diet was defined as a modification of the patients' nutrition intake according to caloric restriction, change in protein intake, or by using a specialized diet. IR measures (HOMA1-IR), pre- and post-intervention were extracted. Using Comprehensive Meta-Analysis software, depending on the level heterogeneity, determined by the ψ2-based Q-test and the I2-test, fixed-effects or random-effects models were used to calculate the pooled standard paired differences (SPD) and 95 %CI. RESULTS 20 publications (25 studies) fulfilled the inclusion criteria. Due to the heterogeneity of the diets, the random-effects model was used. In 48 % of the studies, the diets led to a decrease of IR, where 44 % had no effect. In 2 studies, the diets increased IR. Overall, the diets decreased IR (SPD=-0.58; 95 %CI: -0.81 to -0.36). Subjects with severe IR (HOMA1-IR>4.2) had a marked improvement (SPD=-1.22; 95 %CI: -1.61 to -0.84). Moreover, diets low in carbohydrate (<50 %) was also determined to improve IR (SPD=-0.86; 95 %CI: -1.23 to -0.50). CONCLUSIONS Here, we demonstrate that diets are more likely to improve IR in PCOS women with severe IR. Therefore, it is crucial to determine a subject's IR status before considering any intervention containing a diet.
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Affiliation(s)
- Leonardo M Porchia
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México City, Mexico
| | - Samantha Celeste Hernandez-Garcia
- Departamento de Genética, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2901 Col. Volcanes, C.P. 72000, Puebla, Pue, Mexico
| | - M Elba Gonzalez-Mejia
- Departamento de Genética, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2901 Col. Volcanes, C.P. 72000, Puebla, Pue, Mexico
| | - Esther López-Bayghen
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México City, Mexico.
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Paulson M, Norstedt G, Sahlin L, Hirschberg AL. Association between prolactin receptor expression and proliferation in the endometrium of obese women with polycystic ovary syndrome. Gynecol Endocrinol 2020; 36:226-232. [PMID: 31389293 DOI: 10.1080/09513590.2019.1650343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is associated with increased risk of endometrial cancer. There is growing evidence that prolactin and its receptor (PRLR) are involved in the development of cancer. We assessed endometrial expression of PRLR mRNA, and immunostaining of PRLR and the proliferation marker Ki67 on different cycle days in obese (OB-PCOS) and normal-weight women with PCOS and body mass index-matched controls. The OB-PCOS group underwent a 3 months lifestyle intervention. Prior to intervention, obese women with PCOS and controls had lower endometrial levels of PRLR mRNA in proliferative endometrium than the normal-weight groups (p < .05). After intervention, six OB-PCOS women had confirmed ovulation, while 12 remained anovulatory. Both these subgroups displayed higher immunostaining of PRLR in endometrial stroma, and in the anovulatory subgroup also increased Ki67, on cycle days 21-23 compared with controls (p < .05). In obese controls, the PRLR mRNA expression was decreased in secretory endometrium compared with proliferative endometrium (p = .004). A corresponding change within the cycle was not found in OB-PCOS women. Immunostaining of PRLR in the secretory phase correlated positively with Ki67 (p < .05) in the endometrium. These observations suggest that short-term lifestyle intervention can restore ovulation but not normalize PRLR expression in the endometrium of obese women with PCOS. Trial registration: ISRCTN, ISRCTN18400086, https://doi.org/10.1186/ISRCTN18400086.
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Affiliation(s)
- Mariana Paulson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Pediatric Endocrinology Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Norstedt
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Pediatric Endocrinology Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Lena Sahlin
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Nordfertil Research Lab Stockholm, Childhood Cancer Research Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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Kiel IA, Lionett S, Parr EB, Jones H, Røset MAH, Salvesen Ø, Vanky E, Moholdt T. Improving reproductive function in women with polycystic ovary syndrome with high-intensity interval training (IMPROV-IT): study protocol for a two-centre, three-armed randomised controlled trial. BMJ Open 2020; 10:e034733. [PMID: 32086359 PMCID: PMC7044845 DOI: 10.1136/bmjopen-2019-034733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/15/2020] [Accepted: 02/04/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age and the leading cause of anovulatory infertility. Women with PCOS have a 15-fold higher prevalence of infertility, compared with women without PCOS, independent of body mass index (BMI). A healthy lifestyle is recommended to improve overall health and fertility in PCOS but there is limited evidence on the isolated effects of exercise, especially for reproductive outcomes. Previous findings indicate superior metabolic health benefits after vigorous compared with moderate-intensity exercise. Our primary aim is to determine the effect of high-intensity interval training (HIT) on menstrual frequency, as a proxy of reproductive function, in women with PCOS. METHODS AND ANALYSIS The study is a two-centre, randomised, controlled trial with three parallel groups. Women (n=64) from Trondheim (Norway) and Melbourne (Australia) with PCOS according to the Rotterdam criteria will be randomly allocated (1:1:1) to high-volume HIT, low-volume HIT or a control group with no exercise after stratifying for BMI < or ≥ 27 kg/m2 and study centre. Measurements for study end points will be undertaken at baseline, after a 16 week exercise intervention and at 12 months following baseline assessments. The primary outcome measure is menstruation frequency, measured as the number of self-reported menstrual bleedings divided by the number of expected menstrual bleedings during a 12-month period. Secondary outcome measurements include markers of cardiovascular, metabolic and reproductive health, as well as quality of life and adherence to and enjoyment of exercise. ETHICS AND DISSEMINATION The Regional Committee Medical Research Ethics, Norway, and The Australian Catholic University Human Research Ethics Committee, Australia, have approved the trial protocol. This trial will provide new insight regarding the impact of exercise on fertility in PCOS. We expect this trial to contribute to new therapeutic exercise strategies as part of clinical care for women with PCOS. TRIAL REGISTRATION NUMBER Clinical trial gov NCT02419482.
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Affiliation(s)
- Ida Almenning Kiel
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sofie Lionett
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Exercise and Nutrition Research Programme, Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Evelyn Bridget Parr
- Exercise and Nutrition Research Programme, Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Helen Jones
- Research Institute for Sport and Exercise Science (RISES), Liverpool John Moores University, Liverpool, UK
| | - Maria Aurora Hernandez Røset
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Unit of Applied Clinical Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eszter Vanky
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Alotaibi M, Shaman AA. Enhancing polycystic ovarian syndrome awareness using private social network. Mhealth 2020; 6:33. [PMID: 33209914 PMCID: PMC7656104 DOI: 10.21037/mhealth.2019.12.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of the study is to evaluate the effectiveness of mobile health technology such as private social network (PCOS system) in creating awareness about the disease management among the women diagnosed with the polycystic ovarian syndrome. METHODS A pilot study was conducted in Tabuk, Saudi Arabia. The study was carried out for a period of three months using a private social network as an intervention. The private social network is used as an interface to educate and create awareness among the participants in the study. Fifty women diagnosed with PCOS were randomly selected and were distributed in to control group (doesn't use PCOS system) and intervention group (use the private social network). The level of the polycystic ovarian syndrome awareness was measured using a structured questionnaire at the beginning and end of the follow-up period. RESULTS More than 80 posts and 10 pictures contain data about PCOS were conveyed by medical staff. Also, about 120 private SMS messages between medical staff and the patients were refined. The after effects of this investigation demonstrated that the intervention had better awareness about polycystic ovary syndrome management compared to the control group (F =18.25; P<0.0001). CONCLUSIONS This study of the private social network among the PCOS patients demonstrated that mobile health technology such as the private social network can substantially enhance the PCOS disease awareness levels among Saudi women. The PCOS System can also help in reducing the costs as most of the disease management process is handled over the application through the messages and feedbacks is provided through the application, and in saving time by avoiding hospital visits. This study is first-of-its kind conducted in Saudi Arabia.
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Affiliation(s)
- Mohammed Alotaibi
- Faculty of Computers and Information Technology, University of Tabuk, Tabuk, Saudi Arabia
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Inositols' Importance in the Improvement of the Endocrine-Metabolic Profile in PCOS. Int J Mol Sci 2019; 20:ijms20225787. [PMID: 31752081 PMCID: PMC6888190 DOI: 10.3390/ijms20225787] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility and metabolic problems among women of reproductive age. The mechanism of PCOS is associated with concurrent alterations at the hormonal level. The diagnosis assumes the occurrence of three interrelated symptoms of varying severity, namely ovulation disorders, androgen excess, or polycystic ovarian morphology (PCOM), which all require a proper therapeutic approach. The main symptom seems to be an increased androgen concentration, which in turn may contribute to different metabolic disorders. A number of papers have demonstrated the significant role of inositol therapy in PCOS. However, there is a lack of detailed discussion about the importance of myo-inositol (MI) and d-chiro-inositol (DCI) in reference to particular symptoms. Thus, the aim of this review is to present the effectiveness of MI and DCI treatment for PCOS symptoms. Moreover, the review is focused on analyzing the use of inositols, taking into account their physiological properties, together with the mechanism of individual PCOS symptom formation.
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Ali AT, Guidozzi F. Midlife women's health consequences associated with polycystic ovary syndrome. Climacteric 2019; 23:116-122. [PMID: 31657237 DOI: 10.1080/13697137.2019.1679111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common female endocrinopathies. Its symptoms may appear as early as adolescence and may include irregular menstrual periods, amenorrhea, hirsutism and obesity. Regardless of their phenotypic appearance, women with PCOS are metabolically obese. PCOS is associated with metabolic syndrome, type 2 diabetes, depression, cardiovascular disease and gynecological cancers. The metabolic disorders in obese women with PCOS are invariably due to insulin resistance, while inflammation, oxidative stress and possible interaction with environmental factors are among the features linking women with PCOS alone to metabolic disorders. The current review aims to highlight the relationship between PCOS and midlife women's health complications.
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Affiliation(s)
- A T Ali
- Department of Chemical Pathology, NHLS, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F Guidozzi
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Samadi Z, Bambaeichi E, Valiani M, Shahshahan Z. Evaluation of Changes in Levels of Hyperandrogenism, Hirsutism and Menstrual Regulation After a Period of Aquatic High Intensity Interval Training in Women with Polycystic Ovary Syndrome. Int J Prev Med 2019; 10:187. [PMID: 31807257 PMCID: PMC6852193 DOI: 10.4103/ijpvm.ijpvm_360_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 06/30/2019] [Indexed: 01/03/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder in women of reproductive ages which will lead to infertility. This study is aimed to determine changes in levels of hyperandrogenism, hirsutism and menstrual regulation after a period of aquatic high intensity interval training (AHIIT) in women with PCOS. Methods Thirty patients with PCOS having age between 20 and 35 and body mass index (BMI) ≥30 kg/m2 in obstetrics and gynaecology clinics in Isfahan were selected based on Rotterdam Diagnostic Criteria. They were randomly divided into experimental (AHIIT + metformin, N = 15) and control groups (metformin, N = 15). The exercises were done for 12 weeks, three sessions of 20 minutes. Metformin (1500 mg) was taken daily for 3 consecutive days for 12 weeks. Kolmogorov-Smirnov test, t-test, Covariance and Wilcoxon were applied (P value < 0.05). Results After 12 weeks, no significant difference was observed in waist-to-hip ratio (WHR), but in AHIIT, the BMI and fat mass significantly decreased and levels of follicle-stimulating hormone (FSH), free testosterone (FT) and sex hormone binding globulin (SHBG) increased compared to control group (P < 0.05). While levels of improvement of total testosterone (TT), dehydroepiandrosterone sulphate (DHEAS), FT, luteinising hormone (LH) and free androgen index (FAI) were not significant between the two groups (P > 0.05). Furthermore, there was a significant decrease in homeostatic assessment of insulin resistance (HOMA-IR) and hirsutism severity in experimental group (P < 0.05). In both groups, the order of menstrual cycles improved significantly (P < 0.05). Conclusions Doing AHIIT besides drug therapy can be effective for PCOS patients.
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Affiliation(s)
- Zeinab Samadi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Effat Bambaeichi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Mahboubeh Valiani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan, Iran
| | - Zahra Shahshahan
- Department of Gynecology, AL Zahra Hospital, Sofhe Street, Isfahan University of Medical Sciences, Isfahan, Iran
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Stepto NK, Patten RK, Tassone EC, Misso ML, Brennan L, Boyle J, Boyle RA, Harrison CL, Hirschberg AL, Marsh K, Moreno-Asso A, Redman L, Thondan M, Wijeyaratne C, Teede HJ, Moran LJ. Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough? Sports Med 2019; 49:1143-1157. [PMID: 31166000 PMCID: PMC6905185 DOI: 10.1007/s40279-019-01133-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.
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Affiliation(s)
- Nigel K Stepto
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia.
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia.
- Department Medicine Western Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, VIC, Australia.
| | - Rhiannon K Patten
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Leah Brennan
- School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia
- Centre for Eating, Weight and Body Image, Melbourne, VIC, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Russell A Boyle
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Department of Gynecology and Reproductive Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kate Marsh
- Private Practice, Sydney, NSW, Australia
| | - Alba Moreno-Asso
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
- Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia
| | - Leanne Redman
- Reproductive Endocrinology and Women's Health Laboratory, Clinical Sciences Division Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Mala Thondan
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
- Harp Family Medical Centre, Kew East, VIC, Australia
| | - Chandrika Wijeyaratne
- Faculty of Medicine, University of Colombo and De Soyza Hospital for Women Colombo, Colombo, Sri Lanka
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
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Fruzzetti F, Capozzi A, Canu A, Lello S. Treatment with d-chiro-inositol and alpha lipoic acid in the management of polycystic ovary syndrome. Gynecol Endocrinol 2019; 35:506-510. [PMID: 30612488 DOI: 10.1080/09513590.2018.1540573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To evaluate the effects of the combination of d-chiro inositol and alpha lipoic acid on menstrual cycles and insulin sensitivity in women with polycystic ovary syndrome (PCOS). Forty-one women with PCOS and 31 controls have been enrolled in the study. The menstrual cycle, BMI, homeostasis model assessment index (HOMA-I), and insulin secretion in response to an OGTT were evaluated before and after 6 months of treatment. During the observation period, the patients have been asked to not modify their diet and physical activity. The menstrual cycle length improved in 76.7% of the women. Ovulation was restored in 40%. During treatment, BMI significantly decreased (p<.002). The HOMA-I and insulin secretion were unchanged by treatment. However, when women were divided according to the presence of insulin resistance (IR; HOMA-I > 2.5), in those with IR the HOMA-I and the insulin secretion significantly decreased (p<.05 and p<.006). The association of d-chiro-inositol and alpha lipoic acid improves menstrual cycle length, restoring ovulation in the majority of women. Insulin sensitivity improved in women with IR only, confirming that in presence of IR the d-chiro-inositol has a role in restoring the insulin action overcoming the inactivity of epimerase in transforming myo-inositol to d-chiro inositol.
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Affiliation(s)
- Franca Fruzzetti
- a Department of Obstetrics and Gynecology , Santa Chiara Hospital , Pisa , Italy
| | - Anna Capozzi
- b Department of Woman and Child Health , Policlinico Gemelli Foundation IRCCS , Rome , Italy
| | - Alessandro Canu
- a Department of Obstetrics and Gynecology , Santa Chiara Hospital , Pisa , Italy
| | - Stefano Lello
- b Department of Woman and Child Health , Policlinico Gemelli Foundation IRCCS , Rome , Italy
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Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 3:CD007506. [PMID: 30921477 PMCID: PMC6438659 DOI: 10.1002/14651858.cd007506.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects 8% to 13% of reproductive-aged women and is associated with reproductive and metabolic dysfunction. Obesity worsens the presentation of PCOS and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions. OBJECTIVES To assess the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in PCOS. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL and AMED (date of last search March 2018). We also searched controlled trials registries, conference abstracts, relevant journals, reference lists of relevant papers and reviews, and grey literature databases, with no language restrictions applied. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing lifestyle treatment (diet, exercise, behavioural or combined treatments) to minimal or no treatment in women with PCOS. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed evidence quality and risk of bias, and extracted data. Our primary outcomes were live birth, miscarriage and pregnancy. We used inverse variance and fixed-effect models in the meta-analyses. We reported dichotomous outcomes as an odds ratio and continuous outcomes as a mean difference (MD) or standardised mean difference (SMD). MAIN RESULTS We included 15 studies with 498 participants. Ten studies compared physical activity to minimal dietary and behavioural intervention or no intervention. Five studies compared combined dietary, exercise and behavioural intervention to minimal intervention. One study compared behavioural intervention to minimal intervention. Risk of bias varied: eight studies had adequate sequence generation, seven had adequate clinician or outcome assessor blinding, seven had adequate allocation concealment, six had complete outcome data and six were free of selective reporting. No studies assessed the fertility primary outcomes of live birth or miscarriage. No studies reported the secondary reproductive outcome of menstrual regularity, as defined in this review.Lifestyle intervention may improve a secondary (endocrine) reproductive outcome, the free androgen index (FAI) (MD -1.11, 95% confidence interval (CI) -1.96 to -0.26, 6 RCTs, N = 204, I2 = 71%, low-quality evidence). Lifestyle intervention may reduce weight (kg) (MD -1.68 kg, 95% CI -2.66 to -0.70, 9 RCTs, N = 353, I2 = 47%, low-quality evidence). Lifestyle intervention may reduce body mass index (BMI) (kg/m2) (-0.34 kg/m2, 95% CI -0.68 to -0.01, 12 RCTs, N = 434, I2= 0%, low-quality evidence). We are uncertain of the effect of lifestyle intervention on glucose tolerance (glucose outcomes in oral glucose tolerance test) (mmol/L/minute) (SMD -0.02, 95% CI -0.38 to 0.33, 3 RCTs, N = 121, I2 = 0%, low-quality evidence). AUTHORS' CONCLUSIONS Lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS. We are uncertain of the effect of lifestyle intervention on glucose tolerance. There were no studies that looked at the effect of lifestyle intervention on live birth, miscarriage or menstrual regularity. Most studies in this review were of low quality mainly due to high or unclear risk of bias across most domains and high heterogeneity for the FAI outcome.
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Affiliation(s)
- Siew S Lim
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Samantha K Hutchison
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
- Monash HealthDiabetes Unit and Endocrinology Unit246 Clayton RoadClaytonVictoriaAustralia3168
| | - Emer Van Ryswyk
- College of Medicine and Public Health, Flinders UniversityAdelaide Institute for Sleep Health: A Flinders Centre for Research ExcellenceSturt RoadAdelaideSouth AustraliaAustralia5042
| | - Robert J Norman
- University of AdelaideObstetrics & Gynaecology, Robinson InstituteAdelaideSouth AustraliaAustralia5005
- Fertility SAAdelaideAustralia
| | - Helena J Teede
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Lisa J Moran
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
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Oberg E, Gidlöf S, Jakson I, Mitsell M, Tollet Egnell P, Hirschberg AL. Improved menstrual function in obese women with polycystic ovary syndrome after behavioural modification intervention-A randomized controlled trial. Clin Endocrinol (Oxf) 2019; 90:468-478. [PMID: 30565716 DOI: 10.1111/cen.13919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Lifestyle intervention is the recommended first-line treatment for overweight women with polycystic ovary syndrome (PCOS). However, the efficacy of lifestyle change in improving reproductive function is still unclear. DESIGN A randomized controlled trial (RCT) with allocation to a behavioural modification programme (intervention) or minimal intervention (control) for 4 months with a follow-up at 12 months. PATIENTS Sixty-eight women, aged 18-40 years, body mass index (BMI) ≥ 27 kg/m2 , fulfilling all Rotterdam PCOS criteria were randomized to treatment. MEASUREMENTS The primary outcome was improved menstrual regularity. Secondary outcomes were ovulation and pregnancy rates. RESULTS At 4 months, the weight loss was significant in the intervention group (-2.1%, P = 0.002) and nonsignificant in the control group (-1.0%). A higher proportion of patients in the intervention group improved menstrual regularity compared to the control group, mean difference 35% (95% CI: 16-60), P = 0.003. There was no difference in ovulation rate between groups. Logistic regression analysis showed that intervention was the only predictor of improved menstrual function, OR 3.9 (95% CI: 1.3-11.9). At 12 months, a total of 54% of the women improved menstrual regularity compared to baseline (P = 0.000) and 43% (P = 0.000) had confirmed ovulation. 38% of the women wishing to become pregnant succeeded within 1 year of study completion. CONCLUSIONS This is the first RCT in overweight women with PCOS showing efficacy in improving reproductive function following behavioural modification intervention in comparison with minimal intervention. Although extensive weight loss is difficult to achieve in these women, behavioural modification intervention can help improve reproductive function.
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Affiliation(s)
- Emma Oberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Gidlöf
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivika Jakson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Children's and Women's Health Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marja Mitsell
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Petra Tollet Egnell
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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Kite C, Lahart IM, Afzal I, Broom DR, Randeva H, Kyrou I, Brown JE. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev 2019; 8:51. [PMID: 30755271 PMCID: PMC6371542 DOI: 10.1186/s13643-019-0962-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Typically, management of PCOS focuses on lifestyle changes (exercise and diet), aiming to alleviate symptoms, and lower the associated risk of type 2 diabetes and cardiovascular disease. Our objective was to analyse evidence on the effectiveness of exercise in the management of PCOS, when compared to (i) usual care, (ii) diet alone, and (iii) exercise combined with diet, and also exercise combined with diet, compared to (i) control or usual care and (ii) diet alone. METHODS Relevant databases were searched (June 2017) with no time limit for trial inclusion. Eligible trials employed a randomised or quasi-randomised design to measure the chronic effects of exercise, or exercise and diet in women with PCOS. RESULTS Searches returned 2390 articles; of those, 27 papers from 18 trials were included. Results are presented as mean difference (MD) and 95% confidence intervals (95% CI). Compared with control, exercise had a statistical effect on change from baseline fasting insulin (MD - 2.44 μIU/mL, 95% CIs - 4.24 to - 0.64; very low-quality evidence), HOMA-IR (- 0.57, - 0.99 to - 0.14; very low-quality evidence), total cholesterol (- 5.88 mg/dL, - 9.92 to - 1.83; low-quality evidence), LDL cholesterol (- 7.39 mg/dL, - 9.83 to - 4.95; low-quality evidence), and triglycerides (- 4.78 mg/dL, - 7.52 to - 2.05; low-quality evidence). Exercise also improved VO2 max (3.84 ml/kg/min, 2.87 to 4.81), waist circumference (- 2.62 cm, - 4.13 to - 1.11), and body fat percentage (- 1.39%, - 2.61 to - 0.18) when compared with usual care. No effect was found for change value systolic/diastolic blood pressure, fasting glucose, HDL cholesterol (all low-quality evidence), or waist-to-hip ratio. Many favourable change score findings were supported by post-intervention value analyses: fasting insulin (- 2.11 μIU/mL, - 3.49 to - 0.73), total cholesterol (- 6.66 mg/dL, - 11.14 to - 2.17), LDL cholesterol (- 6.91 mg/dL, - 12.02 to - 1.80), and VO2 max (5.01 ml/kg/min, 3.48 to 6.54). Statistically lower BMI (- 1.02 kg/m2, - 1.81 to - 0.23) and resting heart rate (- 3.26 beats/min - 4.93 to - 1.59) were also revealed in post-intervention analysis. Subgroup analyses revealed the greatest improvements in overweight/obese participants, and more outcomes improved when interventions were supervised, aerobic in nature, or of a shorter duration. Based on limited data, we found no differences for any outcome between the effects of exercise and diet combined, and diet alone. It was not possible to compare exercise vs diet or exercise and diet combined vs diet. CONCLUSION Statistically beneficial effects of exercise were found for a range of metabolic, anthropometric, and cardiorespiratory fitness-related outcomes. However, caution should be adopted when interpreting these findings since many outcomes present modest effects and wide CIs, and statistical effects in many analyses are sensitive to the addition/removal of individual trials. Future work should focus on rigorously designed, well-reported trials that make comparisons involving both exercise and diet. SYSTEMATIC REVIEW REGISTRATION This systematic review was prospectively registered on the Prospero International Prospective Register of Systematic Reviews ( CRD42017062576 ).
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Affiliation(s)
- Chris Kite
- School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.,Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury, SY3 8HQ, UK
| | - Ian M Lahart
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Islam Afzal
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK
| | - David R Broom
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Harpal Randeva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.,Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - Ioannis Kyrou
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.,Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - James E Brown
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK. .,School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
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44
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Brower MA, Hai Y, Jones MR, Guo X, Chen YDI, Rotter JI, Krauss RM, Legro RS, Azziz R, Goodarzi MO. Bidirectional Mendelian randomization to explore the causal relationships between body mass index and polycystic ovary syndrome. Hum Reprod 2019; 34:127-136. [PMID: 30496407 PMCID: PMC6295958 DOI: 10.1093/humrep/dey343] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 10/17/2018] [Accepted: 11/01/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the causal relationships between polycystic ovary syndrome (PCOS) and body mass index (BMI)? SUMMARY ANSWER Bidirectional Mendelian randomization analyses suggest that increased BMI is causal for PCOS while the reverse is not the case. WHAT IS KNOWN ALREADY The contribution of obesity to the pathogenesis of PCOS is controversial. To date, published genetic studies addressing this question have generated conflicting results and have not utilized the full extent of known single nucleotide polymorphisms associated with body mass index (BMI). STUDY DESIGN, SIZE, DURATION This cross-sectional Mendelian randomization (MR) and genetic association study was conducted in 750 individuals of European origin and with PCOS and 1567 BMI-matched controls. PARTICIPANTS/MATERIALS, SETTING, METHODS Cases and controls were matched for BMI as well as for distribution of weight categories (normal weight, overweight, obese). Two-sample MR using inverse variance weighting (IVW) was conducted using a 92-SNP instrument variable for BMI with PCOS as the outcome, followed by two-sample MR with a 16-SNP instrument variable for PCOS with BMI as the outcome. Sensitivity analyses included MR-Egger and maximum likelihood methods. Secondary analyses assessed associations of genetic risk scores and individual SNPs with PCOS, BMI and quantitative androgen-related and glucose homeostasis-related traits. MAIN RESULTS AND THE ROLE OF CHANCE Each standard deviation genetically higher BMI was associated with a 4.89 (95% CI 1.46-16.32) higher odds of PCOS. Conversely, genetic risk of PCOS did not influence BMI. Sensitivity analyses yielded directionally consistent results. The genetic risk score of 92 BMI SNPs was associated with the diagnosis of PCOS (OR 1.043, 95% CI 1.009-1.078, P = 0.012). Of the 92 BMI risk variants evaluated, none were associated individually with PCOS after considering multiple testing. The association of FTO SNP rs1421085 with BMI was stronger in women with PCOS (β = 0.071, P = 0.0006) than in controls (β = 0.046, P = 0.065). LIMITATIONS, REASONS FOR CAUTION The current sample size, while providing good power for MR and genetic risk score analyses, had limited power to demonstrate association of individual SNPs with PCOS. Cases and controls were not matched for age; however, this was mitigated by adjusting analyses for age. Dietary and lifestyle data, which could have been used to explore the greater association of the FTO SNP with BMI in women with PCOS, was not available. WIDER IMPLICATIONS OF THE FINDINGS Increasing BMI appears to be causal for PCOS but having PCOS does not appear to affect BMI. This study used the most comprehensive set of SNPs for BMI currently available. Prior studies using fewer SNPs had yielded conflicting results and may have been confounded because cases and controls were not matched for weight categories. The current results highlight the potential utility of weight management in the prevention and treatment of PCOS. STUDY FUNDING/COMPETING INTEREST(S) National Institutes of Health Grants R01-HD29364 and K24-HD01346 (to R.A.), Grant R01-DK79888 (to M.O.G.), Grant U54-HD034449 (to R.S.L.), Grant U19-HL069757 (to R.M.K.). The funders had no influence on the data collection, analyses or conclusions of the study. No conflict of interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M A Brower
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Y Hai
- Department of Statistics, University of Auckland, Auckland, New Zealand
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - M R Jones
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - X Guo
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Y -D I Chen
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - J I Rotter
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - R M Krauss
- Children’s Hospital of Oakland Research Institute, Oakland, CA, USA
| | - R S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - R Azziz
- Departments of Obstetrics and Gynecology and Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - M O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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45
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Rofey DL, El Nokali NE, Jackson Foster LJ, Seiler E, McCauley HL, Miller E. Weight Loss Trajectories and Adverse Childhood Experience among Obese Adolescents with Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2018. [PMID: 29526815 DOI: 10.1016/j.jpag.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To examine the effect of childhood trauma and family history of psychiatric illness on weight loss trajectories of obese, female adolescents with polycystic ovary syndrome (PCOS). DESIGN Prospective study. SETTING PCOS and adolescent medicine outpatient clinics. PARTICIPANTS Participants were, on average, 15.8 years of age, 80% Caucasian (39/49 participants), and had a body mass index of 36.8 ± 8.8. INTERVENTIONS Healthy Bodies, Healthy Minds is an evidence-based one-on-one intervention consisting of 4 weekly sessions, 4 biweekly sessions, and 3 monthly booster sessions. Each session was 45-60 minutes long with 15-30 minutes of physical activity with a lifestyle coach. MAIN OUTCOME MEASURES Paired sample t tests were used to assess group differences in pre- and post-treatment weight between participants reporting childhood trauma and body mass index-matched controls not endorsing trauma. One-way analysis of variance was performed to assess the influence of childhood trauma on weight loss between the 2 groups. RESULTS Adolescents without a family history of psychiatric illness lost more weight (mean, -1.28 kg; SD, 6.89) than those who had a family history of psychiatric illness (mean, -0.64 kg; SD, 4.7) from baseline to booster session completion (6 months). However, results of independent t tests did not reveal statistically significant group differences in weight loss from baseline to booster session completion (t21 = 0.51; P = .6). CONCLUSION Obese adolescents with PCOS who have experienced childhood trauma can lose weight and acquire its health benefits when enrolled in an intervention addressing weight, mood, and sleep. Family history of psychiatric illness emerged as a potential predictor of lesser weight loss.
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Affiliation(s)
- Dana L Rofey
- Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.
| | - Nermeen E El Nokali
- Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lovie J Jackson Foster
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Seiler
- University of Pittsburgh School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather L McCauley
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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46
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Benham JL, Yamamoto JM, Friedenreich CM, Rabi DM, Sigal RJ. Role of exercise training in polycystic ovary syndrome: a systematic review and meta-analysis. Clin Obes 2018; 8:275-284. [PMID: 29896935 DOI: 10.1111/cob.12258] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 01/20/2023]
Abstract
Preliminary evidence suggests exercise in polycystic ovary syndrome (PCOS) may improve reproductive and cardiometabolic parameters. Our primary aim was to determine the impact of exercise training on reproductive health in women with PCOS. Our secondary aim was to determine the effect of exercise training on cardiometabolic indices. A systematic review of published literature was conducted using MEDLINE and EMBASE based on a pre-published protocol (PROSPERO CRD42017065324). The search was not limited by year. Randomized controlled trials, non-randomized controlled trials and uncontrolled trials that evaluated an exercise intervention in women with PCOS and reported reproductive outcomes were included. Reproductive outcomes were analysed semi-quantitatively and a meta-analysis was conducted for reported cardiometabolic outcomes. Of 517 screened abstracts, 14 studies involving 617 women with PCOS were included: seven randomized controlled trials, one non-randomized controlled trial and six uncontrolled trials. There were insufficient published data to describe the effect of exercise interventions on ovulation quantitatively, but semi-quantitative analysis suggested that exercise interventions may improve menstrual regularity, pregnancy and ovulation rates. Our meta-analysis found that exercise improved lipid profiles and decreased waist circumference, systolic blood pressure and fasting insulin. The impact of exercise interventions on reproductive function remains unclear. However, our meta-analysis suggests that exercise interventions may improve cardiometabolic profiles in women with PCOS.
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Affiliation(s)
- J L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - C M Friedenreich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R J Sigal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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47
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Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, Moholdt T. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ Open Sport Exerc Med 2018; 4:e000387. [PMID: 30057778 PMCID: PMC6059324 DOI: 10.1136/bmjsem-2018-000387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Overweight and obese women often seek assisted fertilisation. In the obese population, pregnancy rates are 30%-75% below that of normal weight women who undergo assisted fertilisation. We hypothesised that high-intensity interval training (HIT) would improve fertility by improving insulin sensitivity and thus affect the hypothalamic-pituitary-ovarian axis and ovarian androgen production. Our aim was to assess whether HIT prior to assisted fertilisation would increase pregnancy rate. METHODS Eighteen overweight and obese women (body mass index>25.0 kg/m2) were randomised to HIT (n=8) or usual care (control, n=10) before assisted fertilisation. HIT was undertaken three times weekly for 10 weeks; two sessions of 4×4 min HIT and one session of 10×1 min HIT. Primary outcome was ongoing pregnancy. Secondary outcomes included insulin sensitivity, reproductive hormones, oxygen uptake and body composition. RESULTS Four women got pregnant in both the HIT group (50%) and in the control group (44%), no between-group difference (p=0.6). Insulin sensitivity (glucose infusion rate) improved significantly after HIT, from 264.1 mg/m2/min (95% CI 193.9 to 334.4) at baseline to 324.7 mg/m2/min (95% CI 247.2 to 402.2) after 10 weeks (between-group difference, p=0.04). Fasting glucose, visceral fat, waist circumference and VO2peak were significantly improved in the group that undertook HIT. CONCLUSIONS HIT significantly improved insulin sensitivity, VO2peak and abdominal fat. Low statistical power makes it difficult to conclude on whether HIT prior to assisted fertilisation could increase pregnancy rate. Larger trials are needed to determine if improvements in insulin sensitivity are clinically relevant for assisted fertilisation success rates in this population.
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Affiliation(s)
- Ida Almenning Kiel
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Magrethe Lundgren
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siv Mørkved
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrun Beate Kjøtrød
- Department of Public Health and General Practice, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
- Research Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Fertility, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Liv Bente Romundstad
- Department of Public Health and General Practice, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Smithson DS, Vause TD, Cheung AP. No. 362-Ovulation Induction in Polycystic Ovary Syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:978-987. [DOI: 10.1016/j.jogc.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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49
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Smithson DS, Vause TD, Cheung AP. No 362 - Déclenchement de l'ovulation en présence d'un syndrome des ovaires polykystiques. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:988-998. [DOI: 10.1016/j.jogc.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Infertility has been described as a devastating life crisis for couples, and has a particularly severe effect on women, in terms of anxiety and depression. Anovulation accounts for around 30% of female infertility, and while lifestyle factors such as physical activity are known to be important, the relationship between exercise and ovulation is multi-factorial and complex, and to date there are no clear recommendations concerning exercise regimes. OBJECTIVES The objective of this review was to systematically assess the effect of physical activity on ovulation and to discuss the possible mechanisms by which exercise acts to modulate ovulation in reproductive-age women. This was done with a view to improve existing guidelines for women wishing to conceive, as well as women suffering from anovulatory infertility. SEARCH METHODS The published literature was searched up to April 2016 using the search terms ovulation, anovulatory, fertility, sport, physical activity and exercise. Both observational and interventional studies were considered, as well as studies that combined exercise with diet. Case studies and articles that did not report anovulation/ovulation or ovarian morphology as outcomes were excluded. Studies involving administered drugs in addition to exercise were excluded. RESULTS In total, ten interventions and four observational cohort studies were deemed relevant. Cohort studies showed that there is an increased risk of anovulation in extremely heavy exercisers (>60 min/day), but vigorous exercise of 30-60 min/day was associated with reduced risk of anovulatory infertility. Ten interventions were identified, and of these three have studied the effect of vigorous exercise on ovulation in healthy, ovulating women, but only one showed a significant disruption of ovulation as a result. Seven studies have investigated the effect of exercise on overweight/obese women suffering from polycystic ovary syndrome (PCOS) or anovulatory infertility, showing that exercise, with or without diet, can lead to resumption of ovulation. The mechanism by which exercise affects ovulation is most probably via modulation of the hypothalamic-pituitary-gonadal (HPG) axis due to increased activity of the hypothalamic-pituitary-adrenal (HPA) axis. In heavy exercisers and/or underweight women, an energy drain, low leptin and fluctuating opioids caused by excess exercise have been implicated in HPA dysfunction. In overweight and obese women (with or without PCOS), exercise contributed to lower insulin and free androgen levels, leading to the restoration of HPA regulation of ovulation. CONCLUSIONS Several clear gaps have been identified in the existing literature. Short-term studies of over-training have not always produced the disturbance to ovulation identified in the observational studies, bringing up the question of the roles of longer term training and chronic energy deficit. We believe this merits further investigation in specific cohorts, such as professional athletes. Another gap is the complete absence of exercise-based interventions in anovulatory women with a normal body mass index (BMI). The possibly unjustified focus on weight loss rather than the exercise programme means there is also a lack of studies comparing types of physical activity, intensity and settings. We believe that these gaps are delaying an efficient and effective use of exercise as a therapeutic modality to treat anovulatory infertility.
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Affiliation(s)
- Osnat Hakimi
- Laboratory of Protein Biochemistry, Federal University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiz-Claudio Cameron
- Laboratory of Protein Biochemistry, Federal University of State of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Biochemistry, Olympic Laboratory, Brazil Olympic Committee, Rio de Janeiro, Brazil
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