Understanding the Effect of Obesity on Fertility Among Reproductive-Age Women

Love Matters: The Effect of Mating Motive on Female Food Choice

The prevalence of obesity has been increasing globally in recent decades. Behind the phenomenon, high-fat food consumption has been conceived as an important driver. In the current study, we explored whether mating motive caused an effect on female food choice as well as the psychological mechanism underlying it. In Study 1, we recruited 64 participants from a university and asked them to complete a mating prime, after which they would finish a food choice task in which food with different flavors were shown. In Study 2, we replicated Study 1 with a different mating priming method and examined the mediating role of body shaping desire on the relation between mating motive and female food choice. Results showed that: (1) The salience of mating motive decreased female's high-fat food choice but increased male's high-fat food choice; (2) the effect of mating motive in females was robust and more salient for sweet food rather than salty food; and (3) the body shaping desire partially mediated the effect of mating motive on female food choice.

Metabolic risk factors and fertility disorders: A narrative review of the female perspective

Metabolic risk factors such as obesity are considered major obstacles to female fertility. Chronic infertility imposes psychological and social burdens on women because infertility violates societal gender roles. Although the prevalence of obesity among women is expected to increase in the future, the relevance of metabolic status for fertility is still underestimated. However, the assessment of metabolic risk factors is highly relevant for understanding fertility disorders and improving infertility treatment. This narrative review discusses the associations of metabolic risk factors (e.g. obesity, female athlete triad, oxidative stress) with significant infertility. An electronic search was conducted for studies published between 2006 and 2020 in Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, PubMed, Scopus, Google Scholar and related databases. In total, this search identified 19,309 results for polycystic ovary syndrome, 28,969 results for endometriosis, and only 1611 results for idiopathic and/or unknown infertility. For the present narrative review, 50 relevant studies were included: 19 studies were on obesity, 24 studies investigated the female athlete triad, and seven studies addressed other risk factors, including reactive oxygen species. This narrative review confirms the direct impact of obesity on female infertility, while the effect of other risk factors needs to be confirmed by large-scale population studies.

Secondary infertility with a history of vaginal childbirth: Ready to have another one?

INTRODUCTION

Up to 30% of couples may face secondary infertility. The impact of ectopic pregnancy, spontaneous abortion, pregnancy termination or live birth with caesarean section may impair further fertility in different ways. However, secondary infertility after physiological vaginal life childbirth has been little studied. The aim of this study was to describe the population and the fertility issues and analyze the predictive factors of success in in vitro fertilization in women presenting secondary infertility after a physiological vaginal childbirth.

MATERIAL AND METHODS

This single-centre retrospective study included women aged 18-43 years consulting between 2013 and 2020 for secondary infertility in a couple having already had previous vaginal life childbirth. Couples' characteristics, management decision after the first consultation and IVF outcomes were analyzed.

RESULTS

Secondary infertility was found in 286 couples, out of whom 138 had a history of vaginal life childbirth. Population was characterized by an advanced female age and overweight. After the first consultation, IVF was performed in only 40% of couples. No predictive factor of live birth was found.

CONCLUSION

Our study shows that in couples with secondary infertility after prior physiological delivery cigarette smoking is frequent in male partners, and ovarian reserve markers are altered. However, no statistically significant predictive factor of live birth after IVF treatment has been identified. Further large prospective studies are necessary.

Minority and low-income patients are less likely to have a scale for self-weighing in their home: A survey in primary care

Daily self-weighing is a weight management behaviour that requires a scale; however, scale ownership may be cost-prohibitive for some patients. Our objective was to understand the proportion of primary care patients with a scale at home, and factors associated with home scale access, to potentially inform future interventions that facilitate scale access. Cross sectional survey of 216 adult patients from three primary care clinics: mixed-income urban/suburban (n = 68); mixed-income urban (n = 70); low-income urban (n = 74). The dependent variable was presence of a home scale; bivariate associations were conducted with variables including demographics, insurance type, clinic setting and self-reported height/weight. Mean age was 53 years; 71% women; 71% racial minority; mean body mass index 32 kg/m2 . Overall, 56% had a home scale. Most (79%) white patients owned a scale, compared to 46% of racial minority patients (P < .01); 33% of low-income patients owned scale, compared to over 66% of patients at the clinics serving mixed-income populations (P < .01). Most low-income urban clinic patients do not own a home scale. Because self-weighing is an effective weight-management behaviour, clinicians could consider assessing scale access, and future research should assess the health impact of providing scales to patients with overweight/obesity who desire weight loss or maintenance.

Understanding Primary Care Patients' Self-weighing Habits: Cohort Analysis from the PaTH Clinical Data Research Network

BACKGROUND

Greater than 60% of adults have overweight or obesity. Self-weighing is an effective weight loss and weight maintenance tool. However, little is known about self-weighing habits among the primary care patient population. Our objective was to examine the frequency of patient-reported self-weighing, and to evaluate the associations of self-weighing with demographic characteristics and self-monitoring behaviors.

METHODS

We conducted an analysis of survey data collected as part of the PaTH Clinical Data Research Network, which recruited a cohort of 1,021 primary care patients at 4 academic medical centers. Patients of all body mass index (BMI) categories were included.

RESULTS

Response rate of 6-month survey was 727 (71%). The mean age was 56 years, and most were female (68%), White (78%), college graduates (66%), and employed/retired (85%). The mean BMI was 30.2 kg/m², 80% of participants had a BMI ≧ 25 kg/m². Of patients with BMI ≧ 25 kg/m², 35% of participants self-weighed weekly and 23% daily. Participants who reported self-weighing at least weekly were more likely to be older (59 vs 54 years, p < 0.01), married (p = 0.01), college graduates (p = 0.03), White (p < 0.01), and employed vs disabled/unemployed (p < 0.01). Patients who self-weighed daily had a lower BMI (29 kg/m² vs 31 kg/m², p = 0.04). Patients who tracked exercise or food intake were more likely to self-weigh daily (p < 0.01), as were patients wanting to lose or maintain weight (p < 0.01).

CONCLUSIONS

Despite its potential for primary and secondary obesity prevention, only 35% of primary care patients with overweight or obesity engage in self-weighing weekly and less than a quarter (23%) self-weigh daily. Socioeconomic status appears to be a factor influencing regular self-weighing in this population, potentially contributing to greater health disparities in obesity rates. Patients who self-weighed daily had a lower BMI, suggesting that it may play a role in primary prevention of obesity. More work is needed to explore self-weighing among patients.

Palmitic acid causes insulin resistance in granulosa cells via activation of JNK

Obesity is a worldwide health problem with rising incidence and results in reproductive difficulties. Elevated saturated free fatty acids (FFAs) in obesity can cause insulin resistance (IR) in peripheral tissues. The high intra-follicular saturated FFAs may also account for IR in ovarian granulosa cells (GCs). In the present study, we investigated the relationship between saturated FFAs and IR in GCs by the use of palmitic acid (PA). We demonstrated that the glucose uptake in cultured GCs and lactate accumulation in the culture medium were stimulated by insulin, but the effects of insulin were attenuated by PA treatment. Besides, insulin-induced phosphorylation of Akt was reduced by PA in a dose- and time-dependent manner. Furthermore, PA increased phosphorylation of JNK and JNK blockage rescued the phosphorylation of Akt which was downregulated by PA. These findings highlighted the negative effect of PA on GCs metabolism and may partially account for the obesity-related reproductive disorders.

Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control

CONTEXT

The National Academy of Medicine recommends childhood obesity prevention efforts making healthier options the passive choice. This review evaluated the effectiveness of population-level policies and programs from natural experiments for childhood obesity prevention.

EVIDENCE ACQUISTION

The search included PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 for policies evaluated by natural experiments reporting childhood BMI outcomes. The studies were analyzed in 2017-2018. Interventions were classified by environmental focus (food/beverage, physical activity, or both) and stratified by setting (school, community, both). Risk of bias was evaluated for each study.

EVIDENCE SYNTHESIS

Of 33 natural experiments, most (73%) took place in the school setting only. The most common environmental focus in any setting was food/beverage (48%). All four studies that focused on both food/beverage and physical activity in schools demonstrated decreased prevalence of overweight/obesity or BMI z-score by 0.04-0.17. BMI decreased in all four studies in both school and community settings. The largest effect size was a decrease in BMI z-score of 0.5, but most were <0.25. The risk of bias was high for most (76%) studies. Most (63%) of the eight studies with low/medium risk of bias took place in the school setting focused on the food/beverage environment; effects on BMI were mixed.

CONCLUSIONS

Natural experiments evaluating school-based policies focusing on both the food/beverage and physical activity environments (versus targeting only one) consistently showed improvement in BMI. However, most studies had high risk of bias, highlighting the need for improved methods for evaluation of natural experiments for childhood obesity prevention.

Obesity reversibly depletes the basal cell population and enhances mammary epithelial cell estrogen receptor alpha expression and progenitor activity

Background

Obesity is correlated with an increased risk for developing postmenopausal breast cancer. Since obesity rates continue to rise worldwide, it is important to understand how the obese microenvironment influences normal mammary tissue to increase breast cancer risk. We hypothesized that obesity increases the proportion of luminal progenitor cells, which are thought to be the cells of origin for the most common types of breast cancer, potentially leading to an increased risk for breast cancer.

Methods

To study the obese microenvironment within the mammary gland, we used a high-fat diet mouse model of obesity and human breast tissue from reduction mammoplasty surgery. We identified changes in breast epithelial cell populations using flow cytometry for cell surface markers, in vitro functional assays and expression of markers on breast tissue sections.

Results

In both obese female mice and women, mammary epithelial cell populations demonstrated significant decreases in basal/myoepithelial cells, using either flow cytometry or cell-type-specific markers (SMA and p63). Estrogen receptor alpha (ERα) expression was significantly increased in luminal cells in obese mammary tissue, compared with control mice or breast tissue from lean women. Functional assays demonstrated significantly enhanced mammary epithelial progenitor activity in obese mammary epithelial cells and elevated numbers of ERα-positive epithelial cells that were co-labeled with markers of proliferation. Weight loss in a group of obese mice reversed increases in progenitor activity and ERα expression observed in obese mammary tissue.

Conclusions

Obesity enhances ERα-positive epithelial cells, reduces the number of basal/myoepithelial cells, and increases stem/progenitor activity within normal mammary tissue in both women and female mice. These changes in epithelial cell populations induced by obesity are reversible with weight loss. Our findings support further studies to examine how obesity-induced changes in stem/progenitor cells impact breast tumor incidence and histologic tumor types.

Electronic supplementary material

The online version of this article (doi:10.1186/s13058-017-0921-7) contains supplementary material, which is available to authorized users.

Treatment of Obesity in Patients With Diabetes

IN BRIEF More than 90% of patients with diabetes have overweight or obesity. Whereas weight gain and obesity worsen insulin resistance, weight loss slows the progression of diabetes complications. Given the elevated risk for diabetes complications in patients with obesity, clinicians must understand how to treat obesity in their patients with diabetes, including providing counseling and behavioral management, referral to weight loss programs, and medication management. This article summarizes guidelines for diagnosing and managing obesity in people with diabetes.

The sixth vital sign: what reproduction tells us about overall health. Proceedings from a NICHD/CDC workshop

STUDY QUESTION

Does the fertility status of an individual act as a biomarker for their future health?

SUMMARY ANSWER

Data support an association between reproductive health and overall health for men and women.

WHAT IS ALREADY KNOWN

Various chronic conditions, such as diabetes, obesity and cancer, can compromise fertility, but there are limited data for the converse situation, in which fertility status can influence or act as a marker for future health. Data reveal an association between infertility and incident cardiovascular disease and cancer in both men and women.

STUDY DESIGN SIZE AND DURATION

A National Institute of Child Health and Human Development-Centers for Disease Control and Prevention workshop in April 2016 was convened that brought together experts in both somatic diseases and conditions, and reproductive health. Goals of the workshop included obtaining information about the current state of the science linking fertility status and overall health, identifying potential gaps and barriers limiting progress in the field, and outlining the highest priorities to move the field forward.

PARTICIPANTS/MATERIALS SETTING AND METHODS

Approximately 40 experts participated in the workshop.

MAIN RESULTS AND THE ROLE OF CHANCE

While the etiology remains uncertain for infertility, there is evidence for an association between male and female infertility and later health. The current body of evidence suggests four main categories for considering biological explanations: genetic factors, hormonal factors, in utero factors, and lifestyle/health factors. These categories would be key to include in future studies to develop a comprehensive and possibly standardized look at fertility status and overall health. Several themes emerged from the group discussion including strategies for maximizing use of existing resources and databases, the need for additional epidemiologic studies and public health surveillance, development of strategies to frame research so results could ultimately influence clinical practice, and the identification of short and long-term goals and the best means to achieve them.

LIMITATIONS REASONS FOR CAUTION

Further research may not indicate an association between fertility status and overall health.

WIDER IMPLICATIONS OF THE FINDINGS

Currently medical care is compartmentalized. Reproductive medicine physicians treat patients for a short period of time before they transition to others for future care. Going forward, it is critical to take an interdisciplinary patient care approach that would involve experts in a broad range of medical specialties in order to more fully understand the complex interrelationships between fertility and overall health. If infertility is confirmed as an early marker of chronic disease then screening practices could be adjusted, as they are for patients with a family history of malignancy.

STUDY FUNDING/COMPETING INTERESTS

Funding for the workshop was provided by the Fertility and Infertility Branch, National Institute of Child Health and Human Development, National Institutes of Health and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control. There are no conflicts of interest to declare. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health.

TRIAL REGISTRATION NUMBER

Not applicable.