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van der Ham K, Moolhuijsen LME, Brewer K, Sisk R, Dunaif A, Laven JSE, Louwers YV, Visser JA. Clustering Identifies Subtypes With Different Phenotypic Characteristics in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2024:dgae298. [PMID: 38753423 DOI: 10.1210/clinem/dgae298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Indexed: 05/20/2024]
Abstract
CONTEXT Hierarchical clustering (HC) identifies subtypes of polycystic ovary syndrome (PCOS). OBJECTIVE This work aimed to identify clinically significant subtypes in a PCOS cohort diagnosed with the Rotterdam criteria and to further characterize the distinct subtypes. METHODS Clustering was performed using the variables body mass index (BMI), luteinizing hormone (LH), follicle-stimulating hormone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), testosterone, insulin, and glucose. Subtype characterization was performed by analyzing the variables estradiol, androstenedione, dehydroepiandrosterone, cortisol, anti-Müllerian hormone (AMH), total follicle count (TFC), lipid profile, and blood pressure. Study participants were girls and women who attended our university hospital for reproductive endocrinology screening between February 1993 and February 2021. In total, 2502 female participants of European ancestry, aged 13 to 45 years with PCOS (according to the Rotterdam criteria), were included. A subset of these (n = 1067) fulfilled the National Institutes of Health criteria (ovulatory dysfunction and hyperandrogenism). Main outcome measures included the identification of distinct PCOS subtypes using cluster analysis. Additional clinical variables associated with these subtypes were assessed. RESULTS Metabolic, reproductive, and background PCOS subtypes were identified. In addition to high LH and SHBG levels, the reproductive subtype had the highest TFC and levels of AMH (all P < .001). In addition to high BMI and insulin levels, the metabolic subtype had higher low-density lipoprotein levels and higher systolic and diastolic blood pressure (all P < .001). The background subtype had lower androstenedione levels and features of the other 2 subtypes. CONCLUSION Reproductive and metabolic traits not used for subtyping differed significantly in the subtypes. These findings suggest that the subtypes capture distinct PCOS causal pathways.
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Affiliation(s)
- Kim van der Ham
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Loes M E Moolhuijsen
- Department of Internal Medicine, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Kelly Brewer
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ryan Sisk
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Andrea Dunaif
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Jenny A Visser
- Department of Internal Medicine, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
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Juber NF, Abdulle A, Ahmad A, AlAnouti F, Loney T, Idaghdour Y, Valles Y, Ali R. Associations between Polycystic Ovary Syndrome (PCOS) and Antibiotic Use: Results from the UAEHFS. Antibiotics (Basel) 2024; 13:397. [PMID: 38786126 PMCID: PMC11117232 DOI: 10.3390/antibiotics13050397] [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: 03/30/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Women with polycystic ovary syndrome (PCOS) have a higher susceptibility to infections compared to those without PCOS. Studies evaluating antibiotic use based on PCOS status are scarce. Therefore, we aimed to (i) assess the associations between self-reported PCOS and antibiotic use, and (ii) whether PCOS treatment and the age at PCOS diagnosis modified the associations above. This cross-sectional analysis used the United Arab Emirates Healthy Future Study (UAEHFS) conducted from February 2016 to March 2023 involving 2063 Emirati women aged 18-62 years. We performed ordinal logistic regressions under unadjusted and demographic-health-characteristic-adjusted models to obtain the odds ratios (ORs) and 95% confidence intervals (CIs) to analyze PCOS and antibiotic use. Subgroup analyses were performed by treatment status and age at diagnosis. We found that women with PCOS were 55% more likely to frequently take a course of antibiotics in the past year (aOR 1.55; 95% CI 1.26-1.90). Similar likelihoods were also found among those being treated for PCOS and those without treatment but with a PCOS diagnosis at ≤25 years. Our study suggests that PCOS was associated with an increased use of antibiotics among Emirati women. Understanding the frequent antibiotic use susceptibility among those with PCOS may improve antibiotic use surveillance and promote antibiotic stewardship in these at-risk individuals.
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Affiliation(s)
- Nirmin F. Juber
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (A.A.); (A.A.); (Y.I.); (Y.V.); (R.A.)
| | - Abdishakur Abdulle
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (A.A.); (A.A.); (Y.I.); (Y.V.); (R.A.)
| | - Amar Ahmad
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (A.A.); (A.A.); (Y.I.); (Y.V.); (R.A.)
| | - Fatme AlAnouti
- College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 19282, United Arab Emirates;
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai P.O. Box 505055, United Arab Emirates;
| | - Youssef Idaghdour
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (A.A.); (A.A.); (Y.I.); (Y.V.); (R.A.)
| | - Yvonne Valles
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (A.A.); (A.A.); (Y.I.); (Y.V.); (R.A.)
| | - Raghib Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (A.A.); (A.A.); (Y.I.); (Y.V.); (R.A.)
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK
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Eralp B, Ibanoglu MC, Engin-Ustun Y. Evaluation of pregnancy and neonatal outcomes according to the phenotypic types of polycystic ovary syndrome: A prospective study. Int J Gynaecol Obstet 2023; 163:894-903. [PMID: 37278384 DOI: 10.1002/ijgo.14882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We aimed to compare pregnancy and neonatal outcomes in the phenotypic subtypes of patients with polycystic ovary syndrome (PCOS). METHODS This prospective cohort included the patients with PCOS (n = 121) diagnosed according to the presence of androgen excess, ovulatory dysfunction, and/or polycystic ovary morphology and healthy controls (n = 125). We stratified PCOS as phenotype A (n = 45), phenotype B (n = 8), phenotype C (n = 32) and phenotype D (n = 35) and followed throughout pregnancy, comparing their outcomes. RESULTS The study population had a mean age of 28.7 ± 4.9 years and a mean BMI of 31.6 kg/m2 with no difference between the groups. Primary cesarean deliveries were significantly more common in PCOS patients (23.3%) than in the control group (17.6%, P = 0.021). The phenotype A group had significantly higher rates of gestational diabetes mellitus (GDM) (42.2%, P < 0.001) and fetal macrosomia (14.6%, P = 0.002) compared with the control group (4.8% and 0.8%m respectively). We detected a significantly lower rate of normal risk score on the double screening test in the PCOS group (59.0%) than in the control group (75.4%) and in the other groups (P = 0.001). CONCLUSION The rates of GDM, fetal macrosomia, and cesarean section were higher in the PCOS group, depending on the phenotype. We observed changes in risk calculation according to phenotypic types at aneuploidy screening.
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Affiliation(s)
- Berat Eralp
- Department of Gynecology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Mujde Can Ibanoglu
- Department of Gynecology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Gynecology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Naous E, Zouein G, Asmar S, Saad E, Achkar A, Hajj G. Phenotype Prevalence and Health-Related Quality of Life of Lebanese Women With Polycystic Ovary Syndrome. Endocr Pract 2023; 29:127-134. [PMID: 36494019 DOI: 10.1016/j.eprac.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders. Our study aimed to assess, for the first time, the phenotype prevalence and the health-related quality of life of Lebanese women with PCOS. METHODS This was a cross-sectional study conducted on 322 Lebanese women with PCOS, using a questionnaire containing sociodemographic data, comorbidities, disease-related clinical questions, and the validated PCOS questionnaire (PCOSQ). The quality of life mean scores and phenotypes were compared and correlated among the different sociodemographic data, comorbidities, and disease-related questions. RESULTS Phenotype A (67%) was the most common phenotype. High waist circumference and higher Body Mass Index (BMI) were reported mostly in classic phenotypes in comparison with nonclassic (P < .05). The mean total score of all PCOSQ domains was 3.61 ± 1.60. The mean score for each domain (from the greatest to the least serious concern) was menstrual problems (3.31 ± 1.26), emotion (3.33 ± 1.22), weight (3.41 ± 2.12), body hair (3.86 ± 1.79), and infertility (4.15 ± 1.61). Age was negatively correlated only to weight domain score (r = -0.17, P = .002). BMI was associated only with emotion and weight domain scores (P = .017 and P < .001, respectively). A bigger impairment in nearly all subscales of the PCOSQ in patients presenting with abdominal obesity, glucose intolerance, and increased blood pressure was noted (P < .05). CONCLUSION Most Lebanese women with PCOS present phenotype A and have a serious impairment in their health-related quality of life, particularly in the menstrual and emotional domains. This highlights the need for community and individual support.
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Affiliation(s)
- Elie Naous
- Department of Internal Medicine, St. Elizabeth's Medical Center, Tufts Medical Center and Boston Medical Center, Brighton, Massachusetts.
| | - Georges Zouein
- Department of Internal Medicine, Endocrinology Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Serena Asmar
- Department of Internal Medicine, Endocrinology Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Eddy Saad
- Department of Internal Medicine, Endocrinology Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Angela Achkar
- Department of Internal Medicine, Endocrinology Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Hajj
- Department of Internal Medicine, Endocrinology Division, Bellevue Medical Center, Beirut, Lebanon
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Wang W, Zeng W, Chen X, Tu L, Xu J, Yin X. Parameter study on characteristic pulse diagram of polycystic ovary syndrome based on logistic regression analysis. J OBSTET GYNAECOL 2022; 42:3712-3719. [PMID: 36562187 DOI: 10.1080/01443615.2022.2158317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to explore the parameters of the independent predictive characteristic pulse diagram of polycystic ovary syndrome (PCOS) by analysing the pulse characteristics between healthy women and the PCOS group. A total of 278 women were recruited for this study. Pulse wave parameters were collected by the pulse spectrum analyser. The single-factor analysis of the pulse diagram parameters was used to identify significant indicators, and the logistic regression analysis was carried out on the above indicators with statistical differences to obtain independent predictors. According to the single-factor and multi-factor analyses, h1, h5, h3/h1, t, t1 and t5 were independent predictors of PCOS diagnosis. The results showed that PCOS patients had a faster heart rate, decreased left ventricular systolic function and decreased aortic compliance compared to healthy individuals. These findings suggested that the characteristic pulse parameters screened out are valuable for the diagnosis of PCOS.IMPACT STATEMENTWhat is already known on this subject? Polycystic ovary syndrome (PCOS) is a common gynecological reproductive endocrine and metabolic disease, which is significant for screening and early intervention in the disease. However, due to the lack of pulse's diagnostic evidence of PCOS, there is still an unknown area in the research on the correlation between PCOS and pulse diagram parameters.What do the results of this study add? This study fills the gap between the research on PCOS and pulse wave. The study also shows that the pulse characteristic parameters h1, h5, h3/h1, t, t1, and t5 are independent predictors of PCOS, suggesting that the patients have a higher heart rate, lower ventricular systolic function, and aortic compliance than healthy individuals.What are the implications of these findings for clinical practice and/or further research? Prominent risk factors for pulse parameters associated with the occurrence of PCOS facilitate early screening and diagnosis of the disease. The objectification of pulse diagnosis helps to establish a health management model, which can be used for the accurate assessment and treatment of PCOS by traditional Chinese medicine (TCM). It provides a clinical reference for the study of pulse diagnosis objectification.
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Affiliation(s)
- Weiying Wang
- Department of Gynecology and Obstetrics, Shuguang Hospital Affiliated to the Shanghai University of Chinese Medicine, Shanghai, PR China
| | - Weiwei Zeng
- Department of Gynecology and Obstetrics, Shuguang Hospital Affiliated to the Shanghai University of Chinese Medicine, Shanghai, PR China
| | - Xinmin Chen
- Department of Gynecology and Obstetrics, Shuguang Hospital Affiliated to the Shanghai University of Chinese Medicine, Shanghai, PR China
| | - Liping Tu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Jiatuo Xu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Xiuqi Yin
- Department of Gynecology and Obstetrics, Shuguang Hospital Affiliated to the Shanghai University of Chinese Medicine, Shanghai, PR China
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Han SJ, Kim H, Hong YS, Kim SW, Ku SY, Suh CS. Prediction model of persistent ovulatory dysfunction in Korean women with polycystic ovary syndrome. J Obstet Gynaecol Res 2022; 48:1795-1805. [PMID: 35603765 DOI: 10.1111/jog.15288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/06/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
AIM There is no validated tool to predict persistent ovulatory dysfunction after medication with oral contraceptives in women with polycystic ovary syndrome (PCOS), which is the most severe subtype of PCOS. We aimed to build a model to predict persistent ovulatory dysfunction after medication of oral contraceptives in women with PCOS. METHODS A total of 286 patients with PCOS were treated with and without oral contraceptives at a tertiary academic medical center. Data were obtained from the electronic medical record system between January 2016 and March 2019. A risk prediction model was developed using multivariable logistic regression. Model 1 was based on age and chief complaints and Model 2 further included predictors evaluated during a clinic visit. Model 3 additionally included laboratory findings. RESULTS Of the study population, ovulatory dysfunction was persistent in 117 patients (40.9%). Compared with the simple model (Models 1 and 2), the full prediction model (Model 3) had better Akaike's information criterion (286, 244 vs. 225) and the area under the curve (AUC) increased from 0.74 and 0.79 to 0.84. The full model included 7 covariates measured during the evaluation of PCOS, and two covariates were significant predictors of persistent ovulatory dysfunction in PCOS: age (OR 0.91; 95% CI 0.84-0.97), and anti-Müllerian hormone (OR 1.17; 95% CI 1.09-1.26). This model demonstrated good discrimination (AUC, 0.84) and calibration (Hosmer-Lemeshow goodness of fit test, p = 0.74). CONCLUSIONS This prediction model was shown to be a useful method for predicting persistent ovulatory dysfunction after oral contraceptive medication in patients with PCOS.
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Affiliation(s)
- Soo Jin Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Yun Soo Hong
- Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sung Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
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İncesu Çintesun FN, Can Ü, Çintesun E, Altunkeser A, Kaya A, Günenç O. Serum sclerostin level and its relation to subclinical atherosclerosis in the polycystic ovary syndrome phenotypes: A prospective controlled study. Turk J Obstet Gynecol 2021; 18:167-174. [PMID: 34580388 PMCID: PMC8480218 DOI: 10.4274/tjod.galenos.2021.51436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective We aim to study the relationship between atherosclerosis and serum sclerostin levels in different phenotypes of polycystic ovary syndrome (PCOS). Materials and Methods A total of 134 women with PCOS and 33 age-matched controls participated in this study. Women with PCOS were further divided into subgroups based on their PCOS phenotypes: phenotype A (n=35), phenotype B (n=33), phenotype C (n=31), and phenotype D (n=35). Metabolic parameters, hormonal parameters, carotid intima-media thickness (CIMT), and sclerostin levels were compared among the PCOS phenotypes. Results Statistically significant differences occurred among groups regarding follicle-stimulating hormone, luteinizing hormone, estradiol, total cholesterol, low-density lipoprotein, Ferriman-Gallwey score, total testosterone, and free androgen index. The mean CIMT was statistically higher in all PCOS phenotypes than in controls. In subgroup comparison, phenotypes A and B had a higher body mass index (BMI) adjusted CIMT than other phenotypes, respectively (p=0.005). Serum sclerostin levels were higher in PCOS patients than in controls. A concentration of ≥6.297 ng/mL showed a sensitivity of 56% and a specificity of 69.7% to predict PCOS. The BMI-adjusted sclerostin level was significantly higher in phenotype C (20.3±0.7 ng/mL) than in other phenotypes. Conclusion Patients with phenotypes A and B seem to have an increased risk for atherosclerosis. Although sclerostin was higher in PCOS patients, we could not demonstrate the relation between sclerostin and atherosclerosis in different PCOS phenotypes.
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Affiliation(s)
- Feyza Nur İncesu Çintesun
- University of Health Sciences Turkey, Konya City Hospital, Clinic of Obstetrics and Gynecology, Konya, Turkey
| | - Ümmügülsüm Can
- University of Health Sciences Turkey, Konya City Hospital, Clinic of Biochemistry, Konya, Turkey
| | - Ersin Çintesun
- Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Ayşegül Altunkeser
- University of Health Sciences Turkey, Konya City Hospital, Clinic of Radiology, Konya, Turkey
| | - Aybike Kaya
- Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Oğuzhan Günenç
- University of Health Sciences Turkey, Konya City Hospital, Clinic of Obstetrics and Gynecology, Konya, Turkey
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Kim JJ. Update on polycystic ovary syndrome. Clin Exp Reprod Med 2021; 48:194-197. [PMID: 34488284 PMCID: PMC8421664 DOI: 10.5653/cerm.2020.04329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/12/2021] [Indexed: 12/11/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common disorder in reproductive-age women. In 2018, an international evidence-based guideline announced recommendations spanning a wide range of issues on the assessment and management of PCOS. From the 166 recommendations, the present study reviews those that are of particular clinical relevance for daily practice and introduces other relevant studies that have been published since the global guideline. The 2018 guideline increased the antral follicle count cutoff for the diagnosis of PCOS from 12 to 20 when using a high-frequency probe. Hirsutism was defined as having a score of ≥4–6 based on a lower percentile of 85%–90% or cluster analysis, which was lower than the traditionally used 95th percentile-based cutoff. The diagnosis of PCOS in adolescents is challenging, and irregular menstruation was defined carefully according to years from menarche. The use of ultrasonography for the diagnosis of PCOS was restricted to those 8 years after menarche. As medication for non-fertility indications, combined oral contraceptives are the first-line drug. Metformin, in addition to lifestyle modifications, should be considered for adult patients with a body mass index ≥25 kg/m2 for the management of weight and metabolic outcomes. An aromatase inhibitor is the recommended first-line medication for ovulation induction, a subsequent individual patient data meta-analysis also reported the same conclusion. Whether the new global guideline will be fully adopted by many specialists and change clinical practice is open to question. Further studies are needed to better understand and manage PCOS patients well.
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Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital and the Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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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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10
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Choi YM, Hwang KR, Oh SH, Lee D, Chae SJ, Yoon SH, Kim JJ. Progression to prediabetes or diabetes in young Korean women with polycystic ovary syndrome: A longitudinal observational study. Clin Endocrinol (Oxf) 2021; 94:837-844. [PMID: 33440048 DOI: 10.1111/cen.14416] [Citation(s) in RCA: 4] [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] [Received: 10/05/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate changes in glycaemic status in women with polycystic ovary syndrome (PCOS). DESIGN Longitudinal observational study. PATIENTS Women with PCOS who underwent baseline and follow-up screening tests for diabetes (n = 262). Four patients with type 2 diabetes (T2DM) at baseline and 6 patients who were taking drugs at the final follow-up were excluded. MEASUREMENTS Changes in glycaemic classification based on fasting glucose, haemoglobin A1c and oral glucose tolerance test. RESULTS The median length of follow-up was 2.9 years. The mean age and body mass index in the normoglycaemia group (n = 202) were 23.0 years and 21.6 kg/m2 , while it was 23.6 years and 22.9 kg/m2 in the prediabetes group (n = 50). In the normoglycaemia group, 38 (18.8%) and 2 (1.0%) developed prediabetes and T2DM, respectively. In the prediabetes group, 22 (44.0%) remained in the same category, 6 (12.0%) developed T2DM, while 22 (44.0%) achieved normoglycaemia. The incidence rate of T2DM was 9.3 per 1,000 person-years, which was significantly higher than that of the female population of similar age, and the incidence was higher in women with fasting glucose ≥ 5.6 mmol/L at baseline than in women with < 5.6 mmol/L. CONCLUSIONS About 20% of normoglycaemic women had developed prediabetes or T2DM after a median time of 2.9 years. Meanwhile, nearly half of prediabetes women achieved normoglycaemia. Higher baseline fasting glucose levels were associated with an increased incidence of T2DM. Our results are the first to evaluate glycaemic status changes using all three parameters in patients with PCOS.
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Affiliation(s)
- Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - So Hee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Dayong Lee
- Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soo Jin Chae
- Department of Obstetrics and Gynecology, IORA Fertility Clinic, Suwon, Korea
| | - Sang Ho Yoon
- Department of Obstetrics and Gynecology, School of Medicine, Dongguk University, Seoul, Korea
| | - Jin Ju Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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11
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Kim JJ, Hwang KR, Chae SJ, Yoon SH, Choi YM. Impact of the newly recommended antral follicle count cutoff for polycystic ovary in adult women with polycystic ovary syndrome. Hum Reprod 2021; 35:652-659. [PMID: 32211797 DOI: 10.1093/humrep/deaa012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/17/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the impact of the newly recommended antral follicle count (AFC) cutoff for polycystic ovary (PCO) on the diagnostic status of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Among patients with phenotypes requiring the presence of PCO for diagnosis, approximately half (48.2%) were excluded from having PCOS based on the new AFC cutoff, although these excluded women had worse metabolic and hormonal profiles than the controls and were indistinguishable from the remaining patients with regard to major hormonal and metabolic parameters. WHAT IS KNOWN ALREADY In the Rotterdam criteria, PCO is defined as either 12 or more follicles measuring 2-9 mm in diameter or an increased ovarian volume >10 cm3. Recently, an international PCOS guideline development group recommended an AFC threshold for PCO of ≥20 in adult women when using transducers with a high-resolution frequency, including 8 MHz. STUDY DESIGN, SIZE, DURATION The current study used a case control design. PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was diagnosed according to the Rotterdam criteria. Ultrasonography examinations were conducted with wide band frequency (5-9 MHz) transvaginal transducers and the centre frequency was 8 MHz. In patients who show both irregular menstruation and hyperandrogenism (HA), a diagnosis of PCOS can be made irrespective of the ovarian criteria change. Patients who were diagnosed according to HA and PCO (n = 86) or irregular menstruation and PCO (n = 443) were initially included among a total of 1390 adult women with PCOS (aged 20-40 years). Regardless of the AFC, if the ovarian volume is ≥10 cm3, a diagnosis of PCO can still be made. Thus, only patients who had an ovarian volume of <10 cm3 were analysed. Subjects who had an AFC of 12-19 and an ovarian volume <10 cm3 were designated as the 'low AFC group' (n = 255) and were the main focus of the study because they were excluded from having PCOS based on the new cutoff. Subjects with an AFC ≥20 and an ovarian volume <10 cm3 were designated as the 'high AFC group' (n = 101). A total of 562 premenopausal women without PCOS were enrolled as controls. MAIN RESULTS AND THE ROLE OF CHANCE Among patients with irregular menstruation and PCO or HA and PCO phenotypes, approximately half (48.2%, 255/529) were excluded from having PCOS, which corresponded to one-fifth (18.3%, 255/1390) of the total adult patients. However, compared to the control group, these excluded women had worse metabolic profiles and were more androgenised. Notably, they were indistinguishable from the 'high AFC group' with regard to major hormonal and metabolic parameters (BMI and diabetic classification status, and the prevalence of insulin resistance, metabolic syndrome and HA). LIMITATIONS, REASONS FOR CAUTION We cannot exclude the possibility of inter- and intraobserver variation in the evaluation of AFC. WIDER IMPLICATIONS OF THE FINDINGS With the newly recommended follicle count cutoff, a substantial proportion of women with PCOS might be classified as not having PCOS despite visiting a hospital due to irregular menstruation or hyperandrogenic symptoms. A practical approach to them would involve controlling the menstrual or hyperandrogenic symptoms in hand and regularly evaluating them regarding newly developed or worsening PCOS-related symptoms or metabolic abnormalities. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a grant from the Seoul National University Hospital Research Fund (No. 2520140090), Republic of Korea. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, 07061, Korea
| | - Soo Jin Chae
- Department of Obstetrics and Gynecology, Maria Fertility Hospital, Seoul, 02586, Korea
| | - Sang Ho Yoon
- Department of Obstetrics and Gynecology, School of Medicine, Dongguk University, Seoul, 04620, Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Korea
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12
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Zhou Y, Lan H, Dong Z, Cao W, Zeng Z, Song JL. Dietary proanthocyanidins alleviated ovarian fibrosis in letrozole-induced polycystic ovary syndrome in rats. J Food Biochem 2021; 45:e13723. [PMID: 33818798 DOI: 10.1111/jfbc.13723] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
This study investigated the effects of proanthocyanidins (PCs) on ovarian fibrosis in letrozole-induced polycystic ovary syndrome (PCOS) in rats. The administration of PCs effectively reduced the body weight (BW) and relative ovarian weight in PCOS rats. ELISA results revealed that PCs significantly reduced the level of serum T, LH, LH/FSH in the PCOS group. In addition, qRT-PCR results revealed that treatment with PCs significantly increased the main antioxidant enzymes (Cat, Sod2, Gpx3, Mgst1, Gsta4, Sod1 and Prdx3) in PCOS rats. Also, the expression analysis of proteins by Western blotting revealed that PCs significantly decreased the level of TGF-βR1, p-Smad3, p-Smad2 and Smad4 and reversed the downregulation of Smad7 in PCOS rats. The study suggested that PCs improved ovarian fibrosis in PCOS rats by regulating the serum hormone level, inhibiting oxidative stress and suppressing the activation of the TGF-β1/Smads signaling pathway. PRACTICAL APPLICATIONS: Currently, plant extracts are being widely used to treat female reproductive and metabolic disorders. Particularly, proanthocyanidins (PCs), the well-known natural polyphenolic compounds, which are a significant source of antioxidants present in many colored fruits, are consumed as fruits as well as a dietary supplement to prevent many disorders. Recent pharmacological studies have reported that PCs have many health beneficial properties, such as antioxidant activity, improving cholesterol homeostasis, blood lipid regulatory properties, microcirculation improvement effect, antitumor activity and anti-aging activity. Despite these properties of PCs, the antifibrosis effect of PCs has not been studied to date. The main purpose of this study was to research the role and the mechanisms of PCs in ovarian fibrosis in PCOS rats.
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Affiliation(s)
- Yanyuan Zhou
- Department of Analytical Chemistry & Drug Analysis, School of Pharmacy, Guilin Medical University, Guilin, China
| | - Huan Lan
- Department of Analytical Chemistry & Drug Analysis, School of Pharmacy, Guilin Medical University, Guilin, China
| | - Zhewen Dong
- Department of Analytical Chemistry & Drug Analysis, School of Pharmacy, Guilin Medical University, Guilin, China
| | - Wenjing Cao
- Department of Nutrition and Food Hygiene, School of Public Health, Guilin Medical University, Guilin, China
| | - Zhen Zeng
- Department of Nutrition and Food Hygiene, School of Public Health, Guilin Medical University, Guilin, China.,Department of Maternal and Child Health, XiangYa School of Public Health, Central South University, Changsha, China
| | - Jia-Le Song
- Department of Nutrition and Food Hygiene, School of Public Health, Guilin Medical University, Guilin, China.,Department of Clinical Nutrition, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
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13
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Dadachanji R, Patil A, Joshi B, Mukherjee S. Elucidating the impact of obesity on hormonal and metabolic perturbations in polycystic ovary syndrome phenotypes in Indian women. PLoS One 2021; 16:e0246862. [PMID: 33635862 PMCID: PMC7909663 DOI: 10.1371/journal.pone.0246862] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
Polycystic ovary syndrome is a complex endocrinopathy with heterogeneous presentation and multifactorial etiology. We have undertaken this case-control study to compare metabolic and endocrine characteristics in different phenotypic subgroups of women with PCOS and the impact of obesity on them. Women with PCOS (n = 489) were classified into 4 phenotypes according to Rotterdam criteria. Comparisons of clinical, biochemical and hormonal parameters were performed across all phenotypic groups of PCOS and with controls (n = 270) by Welch’s ANOVA with subsequent Games-Howell post-hoc test. We found maximum prevalence of normoandrogenic phenotype D, which is milder form of PCOS in terms of insulin resistance, gonadotropin levels and dyslipidemia, followed by phenotype A, in our total study population. After classification of the study group into lean and obese groups, only few insulin and lipid-related traits showed marked differences between phenotypes. Further, we noted that obese women showed adverse metabolic but not androgenic traits compared to lean counterparts in the same phenotype. Metabolic syndrome frequency is increased in hyperandrogenic phenotypes with HDL-C and waist circumference being most predominant contributing factors in total, lean and obese groups. We demonstrate that in our study population there is greater occurrence of phenotype D of PCOS. Our study highlights the importance of clinicians concurrently employing Rotterdam criteria along with obesity status for ascertaining accurate PCOS status and formulating suitable therapeutic intervention.
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Affiliation(s)
- Roshan Dadachanji
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Srabani Mukherjee
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
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14
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Oxidative Stress and Low-Grade Inflammation in Polycystic Ovary Syndrome: Controversies and New Insights. Int J Mol Sci 2021; 22:ijms22041667. [PMID: 33562271 PMCID: PMC7915804 DOI: 10.3390/ijms22041667] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
The pathophysiology of Polycystic Ovary Syndrome (PCOS) is quite complex and different mechanisms could contribute to hyperandrogenism and anovulation, which are the main features of the syndrome. Obesity and insulin-resistance are claimed as the principal factors contributing to the clinical presentation; in normal weight PCOS either, increased visceral adipose tissue has been described. However, their role is still debated, as debated are the biochemical markers linked to obesity per se. Oxidative stress (OS) and low-grade inflammation (LGI) have recently been a matter of researcher attention; they can influence each other in a reciprocal vicious cycle. In this review, we summarize the main mechanism of radical generation and the link with LGI. Furthermore, we discuss papers in favor or against the role of obesity as the first pathogenetic factor, and show how OS itself, on the contrary, can induce obesity and insulin resistance; in particular, the role of GH-IGF-1 axis is highlighted. Finally, the possible consequences on vitamin D synthesis and activation on the immune system are briefly discussed. This review intends to underline the key role of oxidative stress and low-grade inflammation in the physiopathology of PCOS, they can cause or worsen obesity, insulin-resistance, vitamin D deficiency, and immune dyscrasia, suggesting an inverse interaction to what is usually considered.
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15
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Kim JJ, Hwang KR, Lee D, Choi YM. Reply: Impact of the newly recommended antral follicle count cut-off for polycystic ovary in adult women with polycystic ovary syndrome. Hum Reprod 2020; 35:2167-2169. [PMID: 32756986 DOI: 10.1093/humrep/deaa170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Dayong Lee
- Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea
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16
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Circulating levels of Meteorin-like protein in polycystic ovary syndrome: A case-control study. PLoS One 2020; 15:e0231943. [PMID: 32330176 PMCID: PMC7182262 DOI: 10.1371/journal.pone.0231943] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
Patients diagnosed with polycystic ovary syndrome (PCOS) are at high risk of developing a myriad of endocrinologic and metabolic derailments. Moreover, PCOS is a leading cause of habitual abortion, also known as recurrent pregnancy loss (RPL). Meteorin-like protein (Metrnl) is a newly discovered adipokine with the potential to counteract the metaflammation. This study aimed at determining the associations of serum Metrnl levels with homocysteine, hs-CRP, and some components of metabolic syndrome in PCOS-RPL and infertile PCOS patients.This case-control study was conducted in 120 PCOS patients (60 PCOS-RPL and 60 infertile) and 60 control. Serum hs-CRP and homocysteine were assessed using commercial kits, while adiponectin, Metrnl, FSH, LH, free testosterone and insulin levels were analyzed using ELISA technique. Serum Metrnl levels were found to be lower in PCOS patients when compared to controls (67.98 ± 26.66 vs. 96.47 ± 28.72 pg/mL, P <0.001)). Furthermore, serum adiponectin levels were lower, while free testosterone, fasting insulin, HOMA-IR, homocysteine, and hs-CRP were significantly higher in PCOS group compared to controls. Moreover, serum Metrnl correlated with BMI, adiponectin, and homocysteine in controls, and inversely correlated with FBG, fasting insulin, and HOMA-IR in PCOS group and subgroups. Besides, it inversely correlated with hs-CRP in control, and PCOS group and subgroups. These findings revealed a possible role of Metrnl in the pathogenesis of PCOS and RPL. Nevertheless, there is a necessity for future studies to prove this concept.
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17
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Jabbour R, Ott J, Eppel W, Frigo P. Carotid intima-media thickness in polycystic ovary syndrome and its association with hormone and lipid profiles. PLoS One 2020; 15:e0232299. [PMID: 32330202 PMCID: PMC7182264 DOI: 10.1371/journal.pone.0232299] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/11/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Polycystic ovary syndrome (PCOS) has been associated with an increased risk of metabolic disturbances and cardiovascular disease. Intima-media thickness of the common carotid artery (CIMT) represents a valid surrogate marker of early systemic atherosclerosis. This study aimed to investigate if CIMT is increased in PCOS patients compared to healthy controls and if there is an association with hormone and metabolic profiles. Methods In this prospective cross-sectional study, past medical history, anthropometrical measurements and hormonal, lipidemic and glycemic parameters were obtained in 41 PCOS patients and 43 age-matched healthy controls of similar body mass index (BMI) and frequency of smokers. B-mode ultrasound enabled CIMT measurement at the far wall of the left and right common carotid artery. Results Patients with PCOS showed significantly increased CIMT values compared to healthy controls (0.49±0.04mm vs. 0.37±0.04mm respectively, P<0.001). They featured a generally increased cardiovascular risk profile. Correlation analysis showed a positive association between CIMT and the adverse metabolic risk profile. The diagnosis of PCOS was the strongest predictor of CIMT, even after multiple adjustments for BMI, age and smoking status (β = 0.797, P<0.001, R2 = 0.73). A model among oligomenorrhoic patients revealed a relationship between CIMT and the suspected duration of disease (β = 0.373, P = 0.021, R2 = 0.14). Conclusions PCOS patients are likely to feature signs of premature systemic atherosclerosis at a young age. Early exposure to adverse cardiovascular risk factors may possibly have long-term consequences on the vascular system. An early vessel screening might thus already be beneficial in these patients at a younger age.
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Affiliation(s)
- Rhea Jabbour
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Eppel
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Peter Frigo
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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18
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Belenkaia LV, Lazareva LM, Walker W, Lizneva DV, Suturina LV. Criteria, phenotypes and prevalence of polycystic ovary syndrome. ACTA ACUST UNITED AC 2020; 71:211-223. [PMID: 31089072 DOI: 10.23736/s0026-4784.19.04404-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Polycystic ovarian syndrome (PCOS) is known as one of the most frequent endocrine diseases in women worldwide. However, this term does not completely capture the diversity of clinical signs associated with this syndrome e.g., menstrual irregularity and clinical features of androgen excess, which are though commonplace in women with PCOS, they are not included under the definition of PCOS, limited to polycystic ovarian morphology (PCOM). Utilizing the most globally accepted criterion used today in the diagnosis of PCOS, the authors of this article review and discuss the historical and current context of evidence as well as their limitations. This review addresses the phenotypic approach and age-dependent aspects of PCOS in adolescents, adult and peri/postmenopausal women, as presented in the NIH (1990, 2012), Rotterdam (2003), AE-PCOS Society (2006) consensuses and in the latest evidence-based international guideline (2018). Global data on the epidemiology of PCOS, including prevalence and distribution of polycystic ovarian syndrome phenotypes, is also analyzed in the article. Lastly, the authors discuss the importance and current need to perform more epidemiological studies focused on PCOS.
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Affiliation(s)
- Liliia V Belenkaia
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russia
| | - Lyudmila M Lazareva
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russia
| | - Walidah Walker
- Research Administration Office, Augusta University, Augusta, GA, USA
| | - Daria V Lizneva
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Larisa V Suturina
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russia -
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19
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Kim JJ, Choi YM. Phenotype and genotype of polycystic ovary syndrome in Asia: Ethnic differences. J Obstet Gynaecol Res 2019; 45:2330-2337. [PMID: 31588677 DOI: 10.1111/jog.14132] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/07/2019] [Indexed: 12/20/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, and ethnic diversity has been reported in its manifestation. This review addressed phenotype and genetic studies in Asian women with PCOS. Generally, East Asians are less hirsute, and the hirsutism score cutoff is lower than the Caucasian counterpart. It is not clear whether there are any significant differences in the prevalence or severity of irregular menstruation (IM) or characteristics of polycystic ovary (PCO) across ethnicities. Interestingly, the IM/PCO subgroup is a relatively common phenotype in East Asian patients but not in Caucasian patients. The prevalence of insulin resistance in PCOS patients varies depending on the index used and the cutoff, but women with PCOS showed a higher degree of insulin resistance than those of controls across ethnicities. Lower body mass index (BMI) and lower prevalence of metabolic syndrome were reported in East Asian patients, but despite lower BMI, a comparative study reported that Asian women with PCOS were more likely to have diabetes compared with Caucasian patients, suggesting they also have metabolic complications. Unlike East Asian patients, South Asian patients showed an increased degree of hirsutism, early onset of symptoms, and severe insulin resistance and metabolic risks compared with Caucasians. Genetic components play important roles in the pathogenesis of PCOS, and genome-wide association studies of PCOS suggest that similar genetic risk factors exist between Asian and Caucasian patients. Continuous comparative studies are needed to standardize the diagnosis and management of PCOS across different ethnicities.
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Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
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20
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Tavares A, Rêgo Barros RC. The Prevalence of Metabolic Syndrome in the Different Phenotypes of Polycystic Ovarian Syndrome. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2019; 41:37-43. [PMID: 30716785 PMCID: PMC10418812 DOI: 10.1055/s-0038-1676568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of metabolic syndrome (MetS) in the phenotypes of polycystic ovarian syndrome (PCOS). METHODS This was a cross-sectional study involving 111 women aged between 18 and 39 years old diagnosed with PCOS, according to the Rotterdam Criteria, and grouped into four phenotypes: A: ovulatory dysfunction + hyperandrogenism + polycystic ovaries; B: ovulatory dysfunction + hyperandrogenism; C: hyperandrogenism + polycystic ovaries; D: ovulatory dysfunction + polycystic ovaries. To evaluate the presence of MetS, we measured serum triglyceride levels, HDL cholesterol, fasting blood glucose, blood pressure, and waist circumference. RESULTS The prevalence of MetS found in this sample was 33.6%, and there was no statistically significant difference (p < 0.05) among the 4 phenotypes. However, phenotype D presented a significantly higher mean glucose level after fasting (93.6 mg/dL) and 2 hours after ingesting a solution with 75 g of anhydrous glucose (120 mg/dL), as well as the lowest mean level of high-density lipoprotein (HDL) cholesterol (44.7 mg/dL). The women in this group demonstrated a high prevalence of abdominal circumference ≥ 80 cm (68.2%), as well as the highest mean abdominal circumference (90.1 cm). Amongst the women with an abdominal circumference ≥ 80 cm, phenotype A increased approximately six-fold the chance of developing metabolic syndrome in relation to phenotype C. CONCLUSION The four phenotypes of PCOS demonstrated similar prevalence rates of metabolic syndrome; abdominal obesity presented a relevant role in the development of metabolic alterations, regardless of the phenotype.
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21
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Anastasiou OE, Canbay A, Fuhrer D, Reger-Tan S. Metabolic and androgen profile in underweight women with polycystic ovary syndrome. Arch Gynecol Obstet 2017; 296:363-371. [PMID: 28608050 DOI: 10.1007/s00404-017-4422-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/02/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a disorder associated with insulin resistance and obesity. Aim of our study is to clarify the prevalence of underweight in PCOS patients and whether metabolic and androgen profiles of PCOS differ depending on normal or low body weight. METHODS Out of 1269 consecutive patients with PCOS recruited from the Department of Endocrinology and Metabolism at the University of Duisburg-Essen, 19 patients (1.5%) were underweight and were compared to 375 lean PCOS subjects (29.6%). Clinical and endocrine parameters were evaluated. Insulin resistance was assessed by 3-h oral glucose tolerance test (OGTT). RESULTS Prevalence of type 2 diabetes and free androgen index did not differ between the two groups. Total cholesterol and low density lipoprotein levels were significantly lower in the group of underweight patients. While no significant difference was found for the Homeostasis model assessment (HOMA) index at fasting state, the HOMA-M120, calculated 2 h after glucose intake in OGTT, was significantly higher in underweight patients. Underweight patients also showed significantly higher postprandial insulin secretion after glucose intake in OGTT. Six underweight PCOS patients received metformin treatment for oligomenorrhea. An improvement of the menstrual cycle was observed in three cases, while two patients were lost to follow up and one discontinued therapy due to side effects. CONCLUSIONS The prevalence of underweight in patients with PCOS is very low. Underweight in PCOS is associated with higher postprandial insulin levels. Several of our underweight patients were able to achieve regular menstrual cycle under metformin therapy.
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Affiliation(s)
- Olympia E Anastasiou
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology, University Hospital, University of Magdeburg, Essen, Germany
| | - Dagmar Fuhrer
- Department of Endocrinology and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Susanne Reger-Tan
- Department of Endocrinology and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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22
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Kim JJ, Kim D, Yim JY, Kang JH, Han KH, Kim SM, Hwang KR, Ku SY, Suh CS, Kim SH, Choi YM. Polycystic ovary syndrome with hyperandrogenism as a risk factor for non-obese non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2017; 45:1403-1412. [PMID: 28370150 DOI: 10.1111/apt.14058] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/13/2016] [Accepted: 03/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is known to be associated with polycystic ovary syndrome (PCOS). However, most studies investigated the prevalence of NAFLD in obese PCOS patients. AIM To compare the prevalence of non-obese NAFLD in women with or without PCOS, and to assess an independent association between PCOS and NAFLD in a non-obese Asian cohort. METHODS This was a case-control study using a prospective PCOS cohort. After subjects with other potential causes of chronic liver disease were excluded, 275 non-obese women with PCOS and 892 non-obese controls were enrolled. NAFLD was determined by hepatic ultrasonography. Main outcomes were the prevalence of NAFLD on hepatic ultrasonography between non-obese women with or without PCOS, and an independent association between non-obese NAFLD and PCOS. RESULTS Non-obese women with PCOS had a significantly higher prevalence of NAFLD than those without PCOS (5.5% vs. 2.8%, P = 0.027). PCOS was associated with non-obese NAFLD (odds ratio: 2.62, 95% confidence intervals: 1.25-5.48) after adjustment for age and body mass index (BMI). In women with PCOS, the level of androgenicity represented by free testosterone or free androgen index was associated with NAFLD after adjustment for age, BMI, lipid profile, insulin resistance or glycaemic status. CONCLUSIONS Non-obese NAFLD is more prevalent in women with polycystic ovary syndrome than in those without. In non-obese patients with polycystic ovary syndrome, hyperandrogenemia may be an independent risk factor for non-obese NAFLD.
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Affiliation(s)
- J J Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - D Kim
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - J Y Yim
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - J H Kang
- Department of Radiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - K H Han
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - S M Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - K R Hwang
- Department of Obstetrics and Gynecology, Seoul Municipal Boramae Hospital, Seoul, Korea
| | - S Y Ku
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - C S Suh
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - S H Kim
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Y M Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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23
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Afifi L, Saeed L, Pasch LA, Huddleston HG, Cedars MI, Zane LT, Shinkai K. Association of ethnicity, Fitzpatrick skin type, and hirsutism: A retrospective cross-sectional study of women with polycystic ovarian syndrome. Int J Womens Dermatol 2017; 3:37-43. [PMID: 28492053 PMCID: PMC5419030 DOI: 10.1016/j.ijwd.2017.01.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 11/13/2022] Open
Abstract
Background The complex interplay between ethnicity, Fitzpatrick skin type (FST), and hirsutism in patients with polycystic ovarian syndrome (PCOS) is poorly understood. Objective In this cross-sectional, retrospective analysis, we examined the prevalence, severity, and distribution of hirsutism with clinician-rated site-specific and total modified Ferriman-Gallwey (mFG) visual scoring in a diverse cohort of American patients with PCOS. Methods Independent analyses were conducted on the basis of patient-reported FST ratings and ethnicity. Results In this PCOS cohort, a correlation was found between hirsutism and ethnicity and the highest prevalence of hirsutism and total mFG scores was observed in Hispanic, Middle Eastern, African American, and South Asian patients. A positive correlation between hirsutism and FST was also observed with an increasing prevalence of hirsutism in the group of patients with higher FSTs. Significant trends in the anatomic distribution of hirsutism were observed between ethnic groups as well. A higher facial mFG score was found in African American patients but higher mFG scores in the truncal and extremity regions were observed in Middle Eastern patients. Truncal hirsutism was also associated with higher FSTs. Conclusions Ethnicity and FST may be important variables in both the quantitative and qualitative presentations of hirsutism in women with PCOS and should be considered in the diagnostic evaluation of any patient who is suspected of having the condition. Previously published studies that examined ethnicity, FST, and hirsutism in homogeneous cohorts limited comparison and generalizability but the strength of this study lies in its detailed analysis within a single large and diverse PCOS cohort. Validated studies are needed to determine whether clinical criteria for hirsutism should be adjusted for ethnicity and FST in the PCOS population and particularly within diverse cohorts and patients of mixed ancestry.
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Affiliation(s)
- L Afifi
- Department of Dermatology, University of California, San Francisco, CA
| | - L Saeed
- Department of Dermatology, University of California, San Francisco, CA
| | - L A Pasch
- Department of Psychiatry, University of California, San Francisco, CA
| | - H G Huddleston
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - M I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - L T Zane
- Anacor Pharmaceuticals, Palo Alto, CA
| | - K Shinkai
- Department of Dermatology, University of California, San Francisco, CA
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24
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Chitme HR, Al Azawi EAK, Al Abri AM, Al Busaidi BM, Salam ZKA, Al Taie MM, Al Harbo SK. Anthropometric and body composition analysis of infertile women with polycystic ovary syndrome. J Taibah Univ Med Sci 2017; 12:139-145. [PMID: 31435228 PMCID: PMC6694878 DOI: 10.1016/j.jtumed.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 01/30/2023] Open
Abstract
Objectives To evaluate the body composition and anthropometric profile of infertile women who have been diagnosed with polycystic ovary syndrome (PCOS) and to investigate the incidence of PCOS and to examine body fat composition as a risk factor for this disease. Methods This hospital-based case controlled study was conducted on a cohort of 132 patients with and without PCOS. Bioelectrical impedance analysis was used to record body composition parameters, such as total body fat, visceral fat, subcutaneous fat, skeletal muscle composition and their distribution in the trunk, legs and arms, as well as blood pressure. Anthropometric profile parameters, including body mass index (BMI), ideal body weight (IBW), waist circumference, hip circumference and waist-to-hip ratio, were also recorded. Results The mean age of incidence of PCOS was 29.74 ± 3.32 years (OR 1.417), and most of the cohort exhibited high to very high visceral fat with significant correlation (p < 0.001). Total body fat distribution and whole, trunk, arm and leg subcutaneous fat were significantly higher in patients with PCOS (p < 0.001). The mean BMI, waist and hip circumference of the PCOS group were 28.2 ± 6.08, 97.44 ± 15.11 cm and 109.22 ± 17.39 cm, respectively. The results also indicated significant increases in DP and MAP (OR 1.528) in patients with PCOS compared to the control group (p < 0.001). Conclusion This study exhibits higher levels of BMI, body fat distribution, waist and hip circumference, diastolic and mean blood pressure, visceral fat, and a disproportionate increase in the level of global fat and its distribution.
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Affiliation(s)
- Havagiray R Chitme
- Department of Pharmacy, Oman Medical College, Bowshar Campus, Muscat, Oman
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25
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Li H, Li L, Gu J, Li Y, Chen X, Yang D. Should All Women with Polycystic Ovary Syndrome Be Screened for Metabolic Parameters?: A Hospital-Based Observational Study. PLoS One 2016; 11:e0167036. [PMID: 27902723 PMCID: PMC5130242 DOI: 10.1371/journal.pone.0167036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/08/2016] [Indexed: 12/15/2022] Open
Abstract
This hospital-based observational study aims to estimate differences in metabolic abnormalities between different polycystic ovary syndrome (PCOS) phenotypes and their distribution characteristics. The prevalence of metabolic abnormalities among different PCOS phenotypes, including diabetes mellitus (DM), metabolic syndrome (MS), pre-diabetes mellitus (pre-DM), insulin resistance (IR) and dyslipidemia were compared. A total of 2436 women who were ≥18 years old and who were hospitalized in Sun Yat-Sen University affiliated hospital from 1998 to 2015 in GuangZhou, China, were included in this study. PCOS phenotypes were recorded according to the 2003 Rotterdam criteria, including the polycystic ovary morphology (PCO), hyperandrogenism (HA) and ovulation dysfunction (OD) phenotype (PCO+HA+OD); the ovulation phenotype (PCO+HA); the non-PCO phenotype (HA+OD); and the non-HA phenotype (PCO+OD). Notably, 56% of the patients had the classic phenotype (PCO+HA+OD). Importantly, there was no significant difference in the prevalence of metabolic abnormalities or the distribution characteristics of the metabolic abnormalities among these four PCOS phenotypes. Our study supports the notion that metabolic abnormalities and the distribution characteristics of metabolic abnormalities should not be used to distinguish among the various clinical PCOS phenotypes.
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Affiliation(s)
- Hui Li
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, GuangZhou, China
| | - Lin Li
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, GuangZhou, China
| | - Jian Gu
- Department of Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, GuangZhou, China
| | - Yu Li
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, GuangZhou, China
| | - Xiaoli Chen
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, GuangZhou, China
- * E-mail: (DY); (XC)
| | - Dongzi Yang
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, GuangZhou, China
- * E-mail: (DY); (XC)
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26
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Huang Z, Yong EL. Ethnic differences: Is there an Asian phenotype for polycystic ovarian syndrome? Best Pract Res Clin Obstet Gynaecol 2016; 37:46-55. [DOI: 10.1016/j.bpobgyn.2016.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
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27
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Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril 2016; 106:6-15. [PMID: 27233760 DOI: 10.1016/j.fertnstert.2016.05.003] [Citation(s) in RCA: 632] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/28/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a highly prevalent disorder effecting reproductive-aged women worldwide. This article addresses the evolution of the criteria used to diagnosis PCOS; reviews recent advances in the phenotypic approach, specifically in the context of the extended Rotterdam criteria; discusses limitations of the current criteria used to diagnosis, particularly when studying adolescents and women in the peri- and postmenopause; and describes significant strides made in understanding the epidemiology of PCOS. This review recognizes that although there is a high prevalence of PCOS, there is increased variability when using Rotterdam 2003 criteria, owing to limitations in population sampling and approaches used to define PCOS phenotypes. Last, we discuss the distribution of PCOS phenotypes, their morbidity, and the role that referral bias plays in the epidemiology of this syndrome.
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28
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Hunt PA, Sathyanarayana S, Fowler PA, Trasande L. Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union. J Clin Endocrinol Metab 2016; 101:1562-70. [PMID: 27003299 PMCID: PMC4880176 DOI: 10.1210/jc.2015-2873] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders. OBJECTIVE To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU). DESIGN An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources. SETTING, PATIENTS AND PARTICIPANTS AND INTERVENTION Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss. RESULTS The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20%–39%. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion. CONCLUSIONS EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.
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Affiliation(s)
- Patricia A Hunt
- School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003
| | - Sheela Sathyanarayana
- School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003
| | - Paul A Fowler
- School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003
| | - Leonardo Trasande
- School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003
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29
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Zhao Y, Ruan X, Mueck AO. Clinical and laboratory indicators of polycystic ovary syndrome in Chinese Han nationality with different Rotterdam criteria-based phenotypes. Gynecol Endocrinol 2016; 32:151-6. [PMID: 26553260 DOI: 10.3109/09513590.2015.1107895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to investigate the clinical, endocrinic and metabolic indicators in polycystic ovary syndrome (PCOS) with different Rotterdam criteria (RC)-based subtypes, thus to guide the treatments. Six hundred and forty-seven PCOS cases were divided into four groups, with 60 cases set as the control group, the clinical and endocrinic indicators of different subtypes were evaluated. Group A was the most common and the most serious (63.2%), while group B was the least (9%). The clinical signs, as well as the endocrinic and metabolic characteristics, of the two groups were similar, but group A exhibited higher androgen level and hirsutism score. The phenotypes of group C (15.6%) and group D (12.9%) were mild, but compared with the control group, luteinizing hormone (LH) and LH/follicle stimulating hormone (FSH) were significantly increased. Insulin resistance in these four subtypes were positively correlated with apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1), while only positively correlated with serum total testosterone, and negatively correlated with LH/FSH in group A. RC-PCOS typing could reflect the basic characteristics of the disease. Hyperandrogenism was the main basis for distinguishing PCOS, although the non-hyperandrogenism group could represent a relatively mild phenotype of PCOS, there might exist different pathogenic pathways.
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Affiliation(s)
- Yue Zhao
- a Department of Gynecological Endocrinology , Beijing Obstetrics & Gynecology Hospital, Capital Medical University , Beijing , China and
| | - Xiangyan Ruan
- a Department of Gynecological Endocrinology , Beijing Obstetrics & Gynecology Hospital, Capital Medical University , Beijing , China and
- b Department of Endocrinology , University Women's Hospital of Tuebingen , Tuebingen , Germany
| | - Alfred O Mueck
- a Department of Gynecological Endocrinology , Beijing Obstetrics & Gynecology Hospital, Capital Medical University , Beijing , China and
- b Department of Endocrinology , University Women's Hospital of Tuebingen , Tuebingen , Germany
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30
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Spritzer PM, Motta AB. Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment. Int J Clin Pract 2015; 69:1236-46. [PMID: 26289303 DOI: 10.1111/ijcp.12719] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/25/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Adolescence is a time characterised by changes in reproductive hormones and menstrual patterns, which makes it difficult to diagnose polycystic ovary syndrome (PCOS) in this population. The diagnosis of PCOS has a great physical and psychosocial impact on the young person. Despite the importance of a diagnosis of PCOS at adolescence, data available are limited. AIMS This review focuses on analysing markers of PCOS diagnosis and possible treatments in adolescence. RESULTS Although, during adolescence, diagnosis criteria of PCOS overlap with physiological changes including clinical manifestations of hyperandrogenism (acne and hirsutism), oligo/amenorrhoea, anovulation and ovarian microcysts, there is agreement that irregular menses and hyperandrogenaemia should be used to diagnose PCOS in this population. Moreover, considering that PCOS phenotype could change through the reproductive age and that adolescents display heterogeneous ovarian morphology, it has been proposed that diagnosis of PCOS should be confirmed after the age of 18. The first-line treatment for menstrual irregularity and hirsutism are oral contraceptive pills (OCPs) and for obesity and metabolic abnormalities are lifestyle changes. Insulin-sensitizer drugs, such as metformin, may be added to the treatment in the presence of metabolic alterations. Antiandrogen drugs may also be associated for treating moderate to severe hirsutism. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined. CONCLUSIONS During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined.
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Affiliation(s)
- P M Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre and Laboratory of Molecular Endocrinology, Department of Physiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A B Motta
- Laboratorio de Fisio-patología Ovárica, Facultad de Medicina, Universidad de Buenos Aires (UBA), Centro de Estudios Farmacológicos y Botánicos (CEFYBO)-Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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31
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Statistical Genomic Approach Identifies Association between FSHR Polymorphisms and Polycystic Ovary Morphology in Women with Polycystic Ovary Syndrome. BIOMED RESEARCH INTERNATIONAL 2015; 2015:483726. [PMID: 26273622 PMCID: PMC4529894 DOI: 10.1155/2015/483726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
Abstract
Background. Single-nucleotide polymorphisms (SNPs) in the follicle stimulating hormone receptor (FSHR) gene are associated with PCOS. However, their relationship to the polycystic ovary (PCO) morphology remains unknown. This study aimed to investigate whether PCOS related SNPs in the FSHR gene are associated with PCO in women with PCOS. Methods. Patients were grouped into PCO (n = 384) and non-PCO (n = 63) groups. Genomic genotypes were profiled using Affymetrix human genome SNP chip 6. Two polymorphisms (rs2268361 and rs2349415) of FSHR were analyzed using a statistical approach. Results. Significant differences were found in the allele distributions of the GG genotype of rs2268361 between the PCO and non-PCO groups (27.6% GG, 53.4% GA, and 19.0% AA versus 33.3% GG, 36.5% GA, and 30.2% AA), while no significant differences were found in the allele distributions of the GG genotype of rs2349415. When rs2268361 was considered, there were statistically significant differences of serum follicle stimulating hormone, estradiol, and sex hormone binding globulin between genotypes in the PCO group. In case of the rs2349415 SNP, only serum sex hormone binding globulin was statistically different between genotypes in the PCO group. Conclusions. Functional variants in FSHR gene may contribute to PCO susceptibility in women with PCOS.
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