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Stefanaki K, Karagiannakis DS, Peppa M, Vryonidou A, Kalantaridou S, Goulis DG, Psaltopoulou T, Paschou SA. Food Cravings and Obesity in Women with Polycystic Ovary Syndrome: Pathophysiological and Therapeutic Considerations. Nutrients 2024; 16:1049. [PMID: 38613082 PMCID: PMC11013286 DOI: 10.3390/nu16071049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, constitutes a metabolic disorder frequently associated with obesity and insulin resistance (IR). Furthermore, women with PCOS often suffer from excessive anxiety and depression, elicited by low self-esteem due to obesity, acne, and hirsutism. These mood disorders are commonly associated with food cravings and binge eating. Hypothalamic signaling regulates appetite and satiety, deteriorating excessive food consumption. However, the hypothalamic function is incapable of compensating for surplus food in women with PCOS, leading to the aggravation of obesity and a vicious circle. Hyperandrogenism, IR, the reduced secretion of cholecystokinin postprandially, and leptin resistance defined by leptin receptors' knockout in the hypothalamus have been implicated in the pathogenesis of hypothalamic dysfunction and appetite dysregulation. Diet modifications, exercise, and psychological and medical interventions have been applied to alleviate food disorders, interrupting the vicious circle. Cognitive-behavioral intervention seems to be the mainstay of treatment, while the role of medical agents, such as GLP-1 analogs and naltrexone/bupropion, has emerged.
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Affiliation(s)
- Katerina Stefanaki
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.S.); (T.P.); (S.A.P.)
| | - Dimitrios S. Karagiannakis
- Academic Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit and Diabetes Center, Second Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
- 3rd Department of Internal Medicine, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, 11526 Athens, Greece;
| | - Sophia Kalantaridou
- 3rd Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.S.); (T.P.); (S.A.P.)
| | - Stavroula A. Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.S.); (T.P.); (S.A.P.)
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Białka-Kosiec A, Orszulak D, Gawlik A, Drosdzol–Cop A. The relationship between the level of vitamin D, leptin and FGF23 in girls and young women with polycystic ovary syndrome. Front Endocrinol (Lausanne) 2022; 13:1000261. [PMID: 36246904 PMCID: PMC9561846 DOI: 10.3389/fendo.2022.1000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Polycystic ovary syndrome is an endocrinopathy that mainly affects adolescent girls and young women of childbearing age. In girls, the presence of clinical and biochemical symptoms of hyperandrogenism should be particularly considered. The role of vitamin D deficiency in insulin resistance, inflammation, dyslipidemia, and obesity, i.e. in diseases associated with PCOS, has been investigated, which may suggest its involvement in the pathophysiology of the syndrome. Leptin has been shown to stimulate the formation of FGF23 in bones. There is a relationship between the incidence of dyslipidemia, adipose tissue mass and the concentration of fibroblast growth factor 23. The main aim of the presented research project is to assess the concentration of vitamin D, calcium, and selected hormones as well as the concentration of adipokines (leptin) in girls diagnosed with polycystic ovary syndrome. MATERIALS AND METHODS The study included a population of 85 girls and young women aged 14 to 22 years. The study group included 37 girls who were diagnosed with polycystic ovary syndrome according to the modified Rotterdam's criteria. The control group consisted of 48 completely healthy girls. In the first stage of the study participants were required to answer background questions. Next, anthropometric measurements were performed. The laboratory tests assessed: leptin, FGF23, FSH, SHGB, total testosterone, DHEA-S, 25-OH-D3, PTH, calcium, androstadiene, AMH, glucose, insulin. RESULTS The vitamin D level in the group with polycystic ovary syndrome was lower than in the control group, but there was no statistically significant difference. The level of anti-Müllerian hormone was significantly higher in the group of girls diagnosed with PCOS compared to the control group. Statistically significant differences between both groups were also noted in the HOMA-IR value. The concentration of calcium, parathyroid hormone, FGF23 and leptin in the study and control groups showed no statistically significant difference. CONCLUSIONS In the studied group of girls with PCOS, no correlation between the level of vitamin D and selected parameters such as: AMH leptin, HOMA-IR and FGF23 was confirmed. On this basis, it can be assumed that additional vitamin D supplementation would not reduce the symptoms of polycystic ovary syndrome.
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Affiliation(s)
| | - Dominika Orszulak
- Department of Gynaecology, Obstetrics and Oncological Gynaecology, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Drosdzol–Cop
- Department of Gynaecology, Obstetrics and Oncological Gynaecology, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Seth MK, Gulati S, Gulati S, Kumar A, Rawat D, Kumari A, Sehgal R, Zangmo R, Dixit V, Premlata, Gulati A. "Association of Leptin with Polycystic Ovary Syndrome: a Systematic Review and Meta-Analysis ". J Obstet Gynaecol India 2021; 71:567-576. [PMID: 34898893 DOI: 10.1007/s13224-021-01510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background Serum leptin has been considered as an important measurable diagnostic and prognostic biomarker for polycystic ovarian syndrome (PCOS), although its evidence for use in clinical practice is limited. We aim to synthesize the available evidence on the clinical use of serum leptin values in PCOS by doing a systematic review and meta-analysis of studies. Objective To conduct a meta-analysis to determine the pooled effect size of the association of leptin levels in patients with PCOS. Methods We searched electronic databases, i.e., PubMed, Google Scholar, Web of Science, ClinicalTrials.gov, and Medline from inception to September 2020, keeping filters for human studies and published in the English language. We used the random-effects model if heterogeneity between the studies was > 50%; otherwise, a fixed-effect model was applied to determine the standardized mean difference with 95% CI for comparison of leptin level between cases and controls. All the statistical analyses were completed using software STATA version 13. Results The meta-analysis included a total of 35 studies involving 2015 cases and 1767 controls that suggested statistically significantly higher leptin levels in the women with PCOS as compared to controls (SMD, 1.76, 95% CI 1.28 to 2.23, P < 0.001). In the stratified analysis when only high methodological quality studies were included, we did not observe a statistically significant difference in the leptin level between PCOS and controls (SMD 0.68, 95% CI -0.09 to 1.46). Analysis restricted to low methodological quality studies observed statistically significant high leptin levels in PCOS women as compared to controls (SMD 2.24, 95% CI 1.65 to 2.83). Conclusion The available evidence suggests that elevated leptin levels may be associated with risk of PCOS as compared to controls; however, failure to observe the similar association in high methodological quality studies demands further well-designed adequately powered studies to validate the findings.
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Affiliation(s)
- Mahesh Kumar Seth
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.,Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India
| | - Sarthak Gulati
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.,Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India
| | - Shreya Gulati
- Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India.,Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Amit Kumar
- Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India.,Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Dimple Rawat
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.,Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India
| | - Aradhana Kumari
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.,Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India
| | - Rohini Sehgal
- Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India.,Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rinchen Zangmo
- Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India.,Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Dixit
- Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India.,Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Premlata
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.,Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India
| | - Arti Gulati
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.,Department of Orthopedics, J.J.M Medical College, Davanagere, Karnataka India
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Benjamin JJ, Kuppusamy M, Koshy T, Kalburgi Narayana M, Ramaswamy P. Cortisol and polycystic ovarian syndrome - a systematic search and meta-analysis of case-control studies. Gynecol Endocrinol 2021; 37:961-967. [PMID: 33818258 DOI: 10.1080/09513590.2021.1908254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) has become an emerging disorder affecting women of reproductive age group. Its intricate presentation of signs and symptoms makes it a disease of interest to research. While there are varied hypotheses related to its cause and pathogenesis, role of stress in this disease is yet to be grounded. There is emerging body of evidence on cortisol and PCOS, although it is currently equivocal. METHODS Medline, Embase, Pubmed, Science Direct, Google Scholar, and Scopus were searched from March 1985 to March 2020 using MeSH terms. After dual quality assessments and data abstraction, the final articles were included for meta-analysis. RESULTS Forty-one studies qualified for the analysis. Pooled meta-analysis showed that the level of cortisol was significantly higher in PCOS when compared to healthy controls (standard mean difference [SMD] = 0.83, 95% confidence interval [CI] = 0.42-1.23) with highly significant heterogeneity (I2 = 94%). Subgroup analysis done based on type of sample stated high effect size for blood cortisol levels (SMD = 0.9, 95%CI = 0.32; 1.51) compared to overall effect. CONCLUSIONS This systematic review and meta-analysis on cortisol and PCOS have helped in generating evidence regarding the role of cortisol in the pathogenesis of PCOS and the use of cortisol estimation as a potential stress marker in PCOS.
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Affiliation(s)
- Jiby Jolly Benjamin
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, India
| | - Maheshkumar Kuppusamy
- Biochemistry and Physiology, Government Yoga and Naturopathy Medical College and Hospital, Chennai, India
| | - Teena Koshy
- Department of Genetics, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, India
| | | | - Padmavathi Ramaswamy
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, India
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Ibrahim MK, Alobaidi AHA. Evaluation the Role of Ghrelin and Leptin as Biochemical Marker in Female with Polycystic Ovarian Syndrome. Antiinflamm Antiallergy Agents Med Chem 2021; 20:373-379. [PMID: 33888052 DOI: 10.2174/1871523020666210422132618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is a heterogeneous complex disorder of unwell defined aetiology. Some studies report its association to various endocrine, metabolic and immunological abnormalities. The hunger hormones ghrelin and leptin affect the pathogenesis of PCOS and might lead to the development of metabolic syndrome (MS) in obese women. AIM The study aims at evaluating the role of ghrelin and leptin level in female with poly cystic ovary syndrome as a biochemical marker for the diagnosis and monitoring progression. SUBJECTS AND METHODS The study including one hundred PCOS patients and fifty apparently healthy subjects with regular menstrual cycle, visiting gynecology outpatient clinic of Kalar General Hospital, from the beginning of February 2015 to the end of June 2015. Body mass index (BMI) along with serum ghrelin, leptin, Luteinizing hormone (LH), Follicle stimulating hormone (FSH) and testosterone levels were measured for both groups. Serum leptin was determined using sandwich ELISA, while serum ghrelin was determined using competitive ELISA. Differences between patient and control groups were tested by using t-test. Also one way Anova was used to test the relation among different groups. RESULTS There was a significant decrease in ghrelin level and increase in leptin levels in women with PCOS when compared with control group. Also there was a significant elevation in serum level of LH ,Testosterone , Prolactin and decrease in serum FSH in PCOS patients when compared to control group. Additionally, serum ghrelin decreased and serum leptin level increased significantly in women with PCOS compared to controls in all age and BMI groups. CONCLUSION The significant decrease in ghrelin and increased in leptin in PCOS patients than in controls indicated that they are at high risk for metabolic syndrome development.
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Circulating leptin concentration, LEP gene variants and haplotypes, and polycystic ovary syndrome in Bahraini and Tunisian Arab women. Gene 2019; 694:19-25. [DOI: 10.1016/j.gene.2019.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
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Daghestani MH, Daghestani M, Daghistani M, El-Mazny A, Bjørklund G, Chirumbolo S, Al Saggaf SH, Warsy A. A study of ghrelin and leptin levels and their relationship to metabolic profiles in obese and lean Saudi women with polycystic ovary syndrome (PCOS). Lipids Health Dis 2018; 17:195. [PMID: 30131073 PMCID: PMC6103980 DOI: 10.1186/s12944-018-0839-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is considered as one of the most frequently encountered hormonal pathologies in women during their reproductive years. Leptin and ghrelin, peptide hormones with adipostatic and orexigenic effect, respectively, seem to be involved in the metabolic changes that occur in PCOS. The aim of this study was to determine serum ghrelin and leptin levels in obese and lean Saudi women with PCOS and to investigate their relationship to the metabolic profiles in these women. METHODS This study was conducted as a prospective, observational, cross-sectional, case-control study, at the Department of Obstetrics and Gynecology, Al-Noor Hospital, Makkah, Kingdom of Saudi Arabia. The study population included 252 women [130 women with PCOS (diagnosed according to the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus, 2003) and 122 normo-ovulatory women as matched controls] attending the outpatient Gynecology Clinic. Demographic details were recorded, blood was extracted following overnight fast and serum was used for the determination of serum ghrelin and leptin levels and other hormonal and biochemical parameters including total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, and insulin. Insulin resistance and sensitivity were calculated as HOMA-IR and HOMA-S. RESULTS No significant differences in ghrelin (P = 0.1830) and leptin (P = 0.8329) levels were detected between the PCOS and control groups. However, ghrelin levels were significantly lower; and leptin levels were significantly higher in obese PCOS patients in comparison with lean patients (P = 0.0001 for both). In the PCOS group, there were significant correlations between ghrelin and leptin levels with Body Mass Index (BMI), waist-hip ratio, total cholesterol, triglycerides, HDL, LDL and insulin levels. Multiple regression analysis demonstrated that insulin was the main determinant for ghrelin (R2 = 0.316) and leptin (R2 = 0.352) levels (P = 0.0001 for both). CONCLUSIONS Although serum ghrelin and leptin levels were found to be normal in women with PCOS; yet, there is a relationship, possibly linked to obesity, hyperinsulinemia and insulin resistance between these levels and metabolic profile of Saudi PCOS.
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Affiliation(s)
| | - Mazin Daghestani
- Department of Obstetrics and Gynecology, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mamoon Daghistani
- Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Akmal El-Mazny
- Department of Obstetrics and Gynecology, College of Medicine, University of Cairo, Kasr Al-ainy, Cairo, Egypt
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
| | - Salvatore Chirumbolo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Samar H. Al Saggaf
- Department of Anatomy, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arjumand Warsy
- Central Laboratory, Female Center for Scientific and Medical Colleges, King Saud University, Riyadh, Saudi Arabia
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Li L, Feng Q, Ye M, He Y, Yao A, Shi K. Metabolic effect of obesity on polycystic ovary syndrome in adolescents: a meta-analysis. J OBSTET GYNAECOL 2017; 37:1036-1047. [DOI: 10.1080/01443615.2017.1318840] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Li Li
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiong Feng
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ming Ye
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yaojuan He
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Aling Yao
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Kun Shi
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Gynecologic and Obstetric Consequences of Obesity in Adolescent Girls. J Pediatr Adolesc Gynecol 2017; 30:156-168. [PMID: 26915924 DOI: 10.1016/j.jpag.2016.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/06/2016] [Accepted: 02/15/2016] [Indexed: 12/24/2022]
Abstract
In the past few decades, there has been an overwhelming increase in childhood and adolescent obesity worldwide. Besides the well recognized cardiometabolic complications and other physical conditions associated with obesity, during adolescence, it causes psychological and social distress in a period of life that is already sensitive for a girl. This in turn increases their risk of low self-esteem and depression. Furthermore, obesity diminishes health-related quality of life and years of life. Overweight and obese teenagers are more likely to have gynecologic and obstetric complications, during adolescence and also later in life. Consequences of obese and overweight childhood and adolescence include sexual maturation and reproductive dysfunction, alterations in menstruation, dysmenorrhea, risky sexual behavior, and inefficient use of contraception, polycystic ovary syndrome, bone density abnormalities, macromastia, and an increased risk of breast and endometrial cancer. Obese adolescents are at greater risk of pregnancy and perinatal complications, such as preeclampsia, gestational hypertension and preeclampsia, gestational diabetes mellitus, primary cesarean delivery, and induction of labor, to mention a few. Evidence shows that infants born to obese teenagers are also more likely to have complications including preterm or post-term delivery, small-for-gestational age newborns, macrosomia, meconium aspiration, respiratory distress, and even stillbirth, among others. This comprehensive review focuses on the gynecological and obstetric consequences of obesity in adolescent girls.
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Zheng SH, Du DF, Li XL. Leptin Levels in Women With Polycystic Ovary Syndrome: A Systematic Review and a Meta-Analysis. Reprod Sci 2016; 24:656-670. [PMID: 27798245 DOI: 10.1177/1933719116670265] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Conflicting results regarding leptin levels in women with polycystic ovary syndrome (PCOS) have been reported. We summarize all available evidence from human participant studies to evaluate leptin levels in PCOS. DATA SOURCES PubMed, ClinicalTrials.gov , and Web of Science databases were searched with English-language restriction for only human beings from the inception to December 31, 2015. Search terms included PCOS (polycystic ovary syndrome or PCOS) and leptin. METHODS OF STUDY SELECTION A total of 238 studies were reviewed, and a total of 19 studies, involving 991 women with PCOS and 898 controls, were eligible for our meta-analysis. Studies were eligible if provided leptin means and standard deviation in women with PCOS and healthy women controls. RESULTS Parameters, such as body mass index, insulin resistance (IR), and total testosterone, which may influence leptin levels were extracted. Data were collected and analyzed by RevMan 5.3 and Stata/SE14.0. The pooling analysis of all relevant studies revealed that leptin levels were significantly higher in patients with PCOS than in controls, with standardized mean difference of 1.62 (95% confidence interval: 1.01-2.23). However, the heterogeneity across studies was considerable and not eliminated in subgroup analyses. Meta-regression analysis further suggested that the heterogeneity might be relevant to variability in IR and study location. CONCLUSION Elevated leptin levels are detected in women with PCOS compared with non-PCOS controls. Higher leptin levels may be correlated with IR, metabolic disorder, infertility, and even cardiovascular disease risk in PCOS, which may contribute to the etiology and development of PCOS.
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Affiliation(s)
- Sai-Hua Zheng
- 1 Department of Gynecology, OB/GYN Hospital, Fudan University, Shanghai, China
| | - Dan-Feng Du
- 1 Department of Gynecology, OB/GYN Hospital, Fudan University, Shanghai, China
| | - Xue-Lian Li
- 1 Department of Gynecology, OB/GYN Hospital, Fudan University, Shanghai, China.,2 Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Inal HA, Yilmaz N, Gorkem U, Oruc AS, Timur H. The impact of follicular fluid adiponectin and ghrelin levels based on BMI on IVF outcomes in PCOS. J Endocrinol Invest 2016; 39:431-7. [PMID: 26410834 DOI: 10.1007/s40618-015-0392-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/14/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed at evaluating the effects of polycystic ovary syndrome (PCOS) and body mass index (BMI) on follicular fluid (FF) adiponectin and ghrelin levels, and on in vitro fertilization outcomes in patients who underwent controlled ovarian hyperstimulation. METHODS This prospective cross-sectional study was performed with a total of 120 primary infertile women [group 1; non-PCOS = 60 (BMI <25 = 30, BMI ≥25 = 30) and group 2; PCOS = 60 (BMI <25 = 30, BMI ≥25 = 30)]. On the day of oocyte pickup, FF samples were collected. RESULTS The FF adiponectin levels were lower in the lean PCOS group than the lean non-PCOS group (p = 0.001), and these levels were lower in the overweight non-PCOS group compared to lean non-PCOS group (0.001). However, there was no difference in the FF ghrelin levels between the groups. Additionally, we could not find a relationship between clinical pregnancy and adiponectin and ghrelin levels. CONCLUSION The FF adiponectin and ghrelin levels have no effects on clinical pregnancy in PCOS. Therefore, further studies are needed to elucidate this issue.
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Affiliation(s)
- H A Inal
- Konya Education and Research Hospital, Konya, Turkey.
| | - N Yilmaz
- Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey
| | - U Gorkem
- Medical Faculty, Hitit University, Corum, Turkey
| | - A S Oruc
- Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey
| | - H Timur
- Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey
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Gao T, Wu L, Chang F, Cao G. Low circulating ghrelin levels in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocr J 2016; 63:93-100. [PMID: 26607017 PMCID: PMC4975374 DOI: 10.1507/endocrj.ej15-0318] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although numerous, human subject studies evaluating the relationship between circulating ghrelin levels and polycystic ovary syndrome (PCOS) risk have yielded inconsistent findings. We aimed to quantitatively assess the association by summarizing all available evidence from human subject studies. The PubMed and Web of Science databases were searched up to February 2015 for eligible studies. Studies were eligible if they reported circulating ghrelin levels in women with PCOS and healthy women controls. A fixed or random-effects model was used to pool risk estimations. Twenty studies including 894 PCOS patients and 574 controls were included in the meta-analysis. The studies had fair methodological quality. The pooling analysis of all available studies revealed that ghrelin levels were significantly lower in PCOS patients than in controls, with standardized mean difference of -0.40 (95% CI: -0.73, -0.08). The significant association persisted in many subgroup strata. However, the heterogeneity across studies was considerable and not eliminated in subgroup analyses. Meta-regression analysis further suggested that the heterogeneity might be relevant to variability in study location, PCOS relevant factors like HOMA-IR ratio, as well as other factors not assessed. In conclusion, our meta-analysis suggested that ghrelin levels were significantly lower in PCOS patients than in controls. Further studies with large sample sizes are warranted to replicate our findings.
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Affiliation(s)
- Tian Gao
- Department of Veterinary, Inner Mongolia Agricultural University, Hohhot, MO, 010018, People’s Republic of China
- Center for safty evaluation of drugs, Inner Mongolia Medical University, Hohhot, MO, 010110, People’s Republic of China
| | - Lang Wu
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Fuhou Chang
- Center for safty evaluation of drugs, Inner Mongolia Medical University, Hohhot, MO, 010110, People’s Republic of China
| | - Guifang Cao
- Department of Veterinary, Inner Mongolia Agricultural University, Hohhot, MO, 010018, People’s Republic of China
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Impact of Treatment with Metformin on Adipocytokines in Patients with Polycystic Ovary Syndrome: A Meta-Analysis. PLoS One 2015; 10:e0140565. [PMID: 26473366 PMCID: PMC4608563 DOI: 10.1371/journal.pone.0140565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background Metformin is effective for the treatment of polycystic ovary syndrome, but conflicting results regarding its effect on adipocytokine levels (adiponectin, resistin, visfatin, and leptin) in patients with polycystic ovary syndrome receiving metformin treatment have been reported. To provide high-quality evidence about the effect of metformin treatment on adipocytokines in patients with polycystic ovary syndrome, relevant studies that assessed the levels of adipocytokines (adiponectin, resistin, visfatin, and leptin) in patients with polycystic ovary syndrome receiving treatment with metformin administration were reviewed and analyzed. Methods A literature search was conducted in the SCI, PUBMED, EMBASE, and Elsevier databases, and personal contact was made with the authors. Standard mean differences and 95% confidence intervals were calculated and combined appropriately. To ensure synthesis of the best available evidence, sensitivity analyses were performed. Results A total of 34 data sets were included in 4 different outcomes, involving 744 women with polycystic ovary syndrome and adipocytokine levels measured both before and after metformin administration. Metformin treatment was associated with significantly elevated serum adiponectin concentrations (standard mean differences [95% confidence interval], −0.43 [−0.75 to −0.11]) and decreased serum leptin concentrations (0.65 [0.26 to 1.04]), whereas no significant difference in resistin level (−0.01 [−0.49 to 0.45]) or visfatin level (−0.04 [−1.55 to 1.46]) was found. Conclusions Metformin administration was associated with increased serum adiponectin concentrations and decreased serum leptin levels. Further study is needed to elucidate whether this apparent effect decreases the incidence of type 2 diabetes and other metabolic diseases in patients with polycystic ovary syndrome later in life.
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Abstract
Polycystic ovary syndrome is a frequent disorder in women of reproductive age that consists of a heterogeneous combination of hyperandrogenism, chronic anovulation, and polycystic ovaries. Hyperandrogenism and anovulation are clearly linked to insulin resistance and compensatory hyperinsulinism, with an ovarian androgenic hyperresponsiveness to circulating insulin. Evidence is increasing that suggests that lipotoxicity, which is a key mechanism in the development of insulin resistance and type 2 diabetes, could also explain the androgen overproduction. During adolescence, diagnosis of polycystic ovarian syndrome (PCOS) may be difficult but is of importance because PCOS increases future risk of type 2 diabetes and metabolic complications. Metabolic perturbations begin early in adolescence and also exist in adolescent relatives of women with PCOS, even before clinical signs of PCOS. Screening for impaired glucose tolerance or type 2 diabetes is also important in this population, and treatment should focus on PCOS clinical manifestations as well as long-term metabolic risk.
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Affiliation(s)
- Anne-Marie Carreau
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, 3001, 12th Ave North, Sherbrooke, Quebec, J1H 5 N4, Canada
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Agapova SE, Cameo T, Sopher AB, Oberfield SE. Diagnosis and challenges of polycystic ovary syndrome in adolescence. Semin Reprod Med 2014; 32:194-201. [PMID: 24715514 DOI: 10.1055/s-0034-1371091] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent over the years, determination of the minimum diagnostic features in adolescents is still an area of controversy. Of particular concern is that many of the features considered to be diagnostic for PCOS may evolve over time and change during the first few years after menarche. Nonetheless, attempts to define young women who may be at risk for development of PCOS is pertinent since associated morbidity such as obesity, insulin resistance, and dyslipidemia may benefit from early intervention. The relative utility of diagnostic tools such as persistence of anovulatory cycles, hyperandrogenemia, hyperandrogenism (hirsutism, acne, or alopecia), or ovarian findings on ultrasound is not established in adolescents. Some suggest that even using the strictest criteria, the diagnosis of PCOS may not valid in adolescents younger than 18 years. In addition, evidence does not necessarily support that lack of treatment of PCOS in younger adolescents will result in untoward outcomes since features consistent with PCOS often resolve with time. The presented data will help determine if it is possible to establish firm criteria which may be used to reliably diagnose PCOS in adolescents.
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Affiliation(s)
- Sophia E Agapova
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Aviva B Sopher
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
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Cırık DA, Dilbaz B. What do we know about metabolic syndrome in adolescents with PCOS? J Turk Ger Gynecol Assoc 2014; 15:49-55. [PMID: 24790517 DOI: 10.5152/jtgga.2014.95776] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/25/2013] [Indexed: 02/01/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women that manifests itself with a variety of features. For this reason, three different diagnostic criteria have been introduced. For adults, the National Institutes of Health Conference (NIH) criteria, which consists of hyperandrogenism and oligo-anovulation, is the most widely used. Symptoms of PCOS usually start with puberty and may overlap with normal pubertal development. Hormonal fluctuations during this period make the diagnosis of PCOS more difficult. Until now, there is no validated diagnostic criteria for PCOS in adolescents. Although menstrual disorders and cosmetic problems are the most common complaints of adolescents with PCOS, patients should also be evaluated for the potential risk for insulin resistance, obesity, subclinical atherosclerosis, diabetes, metabolic syndrome and cardiovascular disease. Obesity is the most prominent predictor of metabolic syndrome. As the incidence of obesity is increasing both in childhood and adolescence, governments will be faced with a social and economic burden in the future. Adolescents with PCOS are more obese than normal adolescents and have an increased risk of metabolic syndrome. It is suggested that abdominal adiposity increases the risk of metabolic syndrome by inducing various cytokine secretions. Although there is no consensus on metabolic syndrome criteria in the adolescent period, International Diabetes Federation (IDF) criteria may be used for children older than 10 years. Various clinical and metabolic markers are investigated for the prediction of metabolic syndrome in the literature. Waist circumference, serum triglycerides and androgens are the suspected predictors of metabolic syndrome. The prevention of abdominal adiposity and the early diagnosis of PCOS in adolescence should be the main target for the prevention of metabolic syndrome. Clinicians should investigate adolescents with PCOS for metabolic and cardiovascular risks and take preventive action. A Mediterranean diet, low in fat and high in fruits and vegetables, along with moderate-intensity exercise and smoking cessation are the recommended interventions for especially obese adolescents with PCOS. Metformin may be the treatment of choice when lifestyle modifications are ineffective.
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Affiliation(s)
- Derya Akdağ Cırık
- Department of Reproductive Endocrinology and Infertility, Ankara Etlik Zübeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Berna Dilbaz
- Department of Reproductive Endocrinology and Infertility, Ankara Etlik Zübeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
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Li S, Huang X, Zhong H, Peng Q, Chen S, Xie Y, Qin X, Qin A. Low circulating adiponectin levels in women with polycystic ovary syndrome: an updated meta-analysis. Tumour Biol 2014; 35:3961-73. [DOI: 10.1007/s13277-013-1595-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/23/2013] [Indexed: 12/17/2022] Open
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Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Hum Reprod Update 2013; 20:153-74. [PMID: 24173881 DOI: 10.1093/humupd/dmt033] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Reproductive function is tightly regulated by nutritional status. Indeed, it has been well described that undernutrition or obesity can lead to subfertility or infertility in humans. The common regulatory pathways which control energy homeostasis and reproductive function have, to date, been poorly understood due to limited studies or inconclusive data. However, gut hormones and adipose tissue hormones have recently emerged as potential regulators of both energy homeostasis and reproductive function. METHODS A PubMed search was performed using keywords related to gut and adipose hormones and associated with keywords related to reproduction. RESULTS Currently available evidence that gut (ghrelin, obestatin, insulin, peptide YY, glucagon-like peptide-1, glucose-dependent insulinotropic peptide, oxyntomodulin, cholecystokinin) and adipose hormones (leptin, adiponectin, resistin, omentin, chemerin) interact with the reproductive axis is presented. The extent, site and direction of their effects on the reproductive axis are variable and also vary depending on species, sex and pubertal stage. CONCLUSIONS Gut and adipose hormones interact with the reproductive axis as well as with each other. While leptin and insulin have stimulatory effects and ghrelin has inhibitory effects on hypothalamic GnRH secretion, there is increasing evidence for their roles in other sites of the reproductive axis as well as evidence for the roles of other gut and adipose hormones in the complex interplay between nutrition and reproduction. As our understanding improves, so will our ability to identify and design novel therapeutic options for reproductive disorders and accompanying metabolic disorders.
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Affiliation(s)
- Alexander N Comninos
- Department of Investigative Medicine, Imperial College London, 6th Floor Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
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