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Livadas S, Yildiz BO, Mastorakos G, Gambineri A, Pignatelli D, Giorgino F, Andersen MS, Obermayer-Pietsch B, Macut D. European survey of diagnosis and management of the polycystic ovary syndrome: full report on the ESE PCOS Special Interest Group's 2023 Questionnaire. Eur J Endocrinol 2024; 191:134-143. [PMID: 39099229 DOI: 10.1093/ejendo/lvae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/15/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Although polycystic ovary syndrome (PCOS) is a very common endocrinopathy, there are several issues related to this disorder which perplex clinicians in their everyday practice. OBJECTIVE To determine the current state of knowledge among European endocrinologists concerning the full spectrum of PCOS. METHODS An online survey comprising 41 items covering various aspects of PCOS diagnosis and management was distributed to members of the European Society of Endocrinology. RESULTS A total of 505 European endocrinologists (64% females), with a mean age of 47 ± 11.6 years, participated in the survey. The Rotterdam criteria were the primary diagnostic tool for 85% of respondents. Most referrals (87.1%) occurred between ages 20 and 40 years. Twenty-five percent of physicians have access to mass spectrometry for the evaluation of androgen levels. While an extended metabolic profile was commonly employed as part of the workup, there was uncertainty regarding chronic anovulation diagnosis. Diabetes, including gestational or type 2, was recognized as a significant risk factor with universal screening irrespective of BMI status. Lifestyle modification and metformin were considered as standard interventions by all participants alongside oral contraceptives, though there was significant discrepancy in treatment duration. CONCLUSIONS The Rotterdam diagnostic criteria are widely adopted for PCOS diagnosis among European endocrinologists. The current updated survey shows an emphasis on steroid profiling as an important part of diagnostic workup and a strong position held for recognition of PCOS as a metabolic condition with potentially serious implications. Current therapy thus shifted to the demand for prioritizing lifestyle interventions and metabolic therapies, either as monotherapy or in combination with standard hormone compounds.
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Affiliation(s)
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Alessandra Gambineri
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy
| | - Duarte Pignatelli
- Department of Endocrinology, Centro Hospitalar Universitário S. João and Faculty of Medicine of the University of Porto, 4200 - 319 Porto, Portugal
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | | | - Barbara Obermayer-Pietsch
- Universitätsklinik für Innere Medizin, Klinische Abteilung Endokrinologie und Diabetologie und Universitätsklinik für Frauenheilkunde & Geburtshilfe Medizinische Universität Graz, 8036 Graz, Austria
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Zhao T, Xiao X, Li L, Zhu J, He W, Zhang Q, Wu J, Wu X, Yuan T. Changes in the serum metabolomics of polycystic ovary syndrome before and after compound oral contraceptive treatment. Front Endocrinol (Lausanne) 2024; 15:1354214. [PMID: 38948525 PMCID: PMC11211979 DOI: 10.3389/fendo.2024.1354214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/17/2024] [Indexed: 07/02/2024] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is both a common endocrine syndrome and a metabolic disorder that results in harm to the reproductive system and whole-body metabolism. This study aimed to investigate differences in the serum metabolic profiles of patients with PCOS compared with healthy controls, in addition to investigating the effects of compound oral contraceptive (COC) treatment in patients with PCOS. Materials and methods 50 patients with PCOS and 50 sex-matched healthy controls were recruited. Patients with PCOS received three cycles of self-administered COC treatment. Clinical characteristics were recorded, and the laboratory biochemical data were detected. We utilized ultra-performance liquid chromatography-high-resolution mass spectrometry to study the serum metabolic changes between patients with PCOS, patients with PCOS following COC treatment, and healthy controls. Result Patients with PCOS who received COC treatment showed significant improvements in serum sex hormone levels, a reduction in luteinising hormone levels, and a significant reduction in the levels of biologically active free testosterone in the blood. Differential metabolite correlation analysis revealed differences between PCOS and healthy control groups in N-tetradecanamide, hexadecanamide, 10E,12Z-octadecadienoic acid, and 13-HOTrE(r); after 3 months of COC treatment, there were significant differences in benzoic acid, organic acid, and phenolamides. Using gas chromatography-mass spectrometry to analyse blood serum in each group, the characteristic changes in PCOS were metabolic disorders of amino acids, carbohydrates, and purines, with significant changes in the levels of total cholesterol, uric acid, phenylalanine, aspartic acid, and glutamate. Conclusion Following COC treatment, improvements in sex hormone levels, endocrine factor levels, and metabolic levels were better than in the group of PCOS patients receiving no COC treatment, indicating that COC treatment for PCOS could effectively regulate the levels of sex hormones, endocrine factors, and serum metabolic profiles.
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Affiliation(s)
- Ting Zhao
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xiao Xiao
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lingchuan Li
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jing Zhu
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Wenli He
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Qiong Zhang
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jiaqi Wu
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xiaomei Wu
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Tao Yuan
- Department of Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Aksun S, Sonu NC, Aygun S, Karakulak UN, Mumusoglu S, Yildiz BO. Alterations of cardiometabolic risk profile in polycystic ovary syndrome: 13 years follow-up in an unselected population. J Endocrinol Invest 2024; 47:1129-1137. [PMID: 37930586 DOI: 10.1007/s40618-023-02230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Cardiometabolic risk factors are common in women with polycystic ovary syndrome (PCOS) during reproductive years. The aim of this study was to determine the impact of aging on cardiometabolic risk of the syndrome by examining women who had previously been diagnosed to have PCOS or to be healthy in an unselected population in 2009. PARTICIPANTS Forty-one women with PCOS who were diagnosed and phenotyped according to the Rotterdam criteria and 43 age- and body mass index (BMI)-matched healthy women from the same unselected cohort. METHODS All participants were evaluated by structured interview, physical examination, anthropometric, hormonal and biochemical measurements. Additionally, body composition analyses and echocardiographic assessments of 30 women with PCOS and 30 control women were conducted at 13 years of follow-up. RESULTS There was no difference between the patient and the control groups in terms of anthropometric and body composition measures and metabolic parameters. Echocardiographic assessment showed similar systolic functions, strain measurements and epicardial fat measurements between the groups. PCOS patients still had higher levels of total testosterone, free androgen index (FAI) and dehydroepiandrosterone sulfate (DHEAS) levels compared to controls. Epicardial fat thickness showed positive correlations with BMI, total and truncal body fat, homeostatic model assessment for insulin resistance (HOMA-IR) and free androgen index (FAI). CONCLUSIONS Aging women with PCOS in the population have higher androgen levels and similar cardiometabolic risk profile compared to age- and BMI-matched healthy women. Epicardial fat thickness, a marker of cardiometabolic risk, appear to be associated with hyperandrogenism. Further research is needed on larger community-based cohorts where older patients are assessed with a longer follow-up.
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Affiliation(s)
- S Aksun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - N C Sonu
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Aygun
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - U N Karakulak
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Mumusoglu
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - B O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey.
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey.
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Lan H, Dong Z, Zhang M, Li W, Chong C, Wu Y, Wang Z, Liu J, Liu Z, Qin X, Jiang T, Song J. Sinapic acid modulates oxidative stress and metabolic disturbances to attenuate ovarian fibrosis in letrozole-induced polycystic ovary syndrome SD rats. Food Sci Nutr 2024; 12:2917-2931. [PMID: 38628198 PMCID: PMC11016395 DOI: 10.1002/fsn3.3973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 04/19/2024] Open
Abstract
Sinapic acid (SA) is renowned for its many pharmacological activities as a polyphenolic compound. The cause of polycystic ovary syndrome (PCOS), a commonly encountered array of metabolic and hormonal abnormalities in females, has yet to be determined. The present experiment was performed to evaluate the antifibrotic properties of SA in rats with letrozole-induced PCOS-related ovarian fibrosis. SA treatment successfully mitigated the changes induced by letrozole in body weight (BW) (p < .01) and relative ovary weight (p < .05). Histological observation revealed that SA reduced the number of atretic and cystic follicles (AFs) and (CFs) (p < .01), as well as ovarian fibrosis, in PCOS rats. Additionally, SA treatment impacted the serum levels of sex hormones in PCOS rats. Luteinizing hormone (LH) and testosterone (T) levels were decreased (p < .01, p < .05), and follicle-stimulating hormone (FSH) levels were increased (p < .05). SA administration also decreased triglyceride (TG) (p < .01) and total cholesterol (TC) levels (p < .05) and increased high-density lipoprotein cholesterol (HDL-C) levels (p < .01), thereby alleviating letrozole-induced metabolic dysfunction in PCOS rats. Furthermore, SA treatment targeted insulin resistance (IR) and increased the messenger RNA (mRNA) levels of antioxidant enzymes in the ovaries of PCOS rats. Finally, SA treatment enhanced the activity of peroxisome proliferator-activated receptor-γ (PPAR-γ), reduced the activation of transforming growth factor-β1 (TGF-β1)/Smads, and decreased collagen I, α-smooth muscle actin (α-SMA), and connective tissue growth factor (CTGF) levels in the ovaries of PCOS rats. These observations suggest that SA significantly ameliorates metabolic dysfunction and oxidative stress and ultimately reduces ovarian fibrosis in rats with letrozole-induced PCOS.
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Affiliation(s)
- Huan Lan
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
- College of Chinese Material MedicaGuangzhou University of Chinese MedicineGuangzhouGuangzhouChina
| | - Zhe‐Wen Dong
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
- College of PharmacyShenyang Pharmaceutical UniversityShenyangLiaoningChina
| | - Ming‐Yu Zhang
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Wan‐Ying Li
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Chao‐Jie Chong
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Ya‐Qi Wu
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Zi‐Xian Wang
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Jun‐Yang Liu
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Zhi‐Qiang Liu
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Xiao‐Hui Qin
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
| | - Tie‐Min Jiang
- South Asia Branch of National Engineering Center of Dairy for Maternal and Child HealthGuilin University of TechnologyGuilinGuangxiChina
| | - Jia‐Le Song
- Guangxi Key Laboratory of Environmental Exposureomics and Entire Lifecycle HealthGuilin Medical UniversityGuilinGuangxiChina
- South Asia Branch of National Engineering Center of Dairy for Maternal and Child HealthGuilin University of TechnologyGuilinGuangxiChina
- Department of Obstetrics and Clinical NutritionThe Second Affiliated Hospital of Guilin Medical UniversityGuilinGuangxiChina
- Guangxi Key Laboratory of Health Care Food Science and TechnologyHezhou UniversityHezhouGuangxiChina
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de Oliveira NM, Machado J, Lopes L, Criado MB. A Review on Acupuncture Efficiency in Human Polycystic Ovary/Ovarian Syndrome. J Pharmacopuncture 2023; 26:105-123. [PMID: 37405111 PMCID: PMC10315877 DOI: 10.3831/kpi.2023.26.2.105] [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] [Received: 04/20/2021] [Revised: 03/14/2022] [Accepted: 02/28/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives Human Polycystic Ovary/Ovarian Syndrome (PCOS), a frequent endocrine pathophysiology among women of fertile age, is associated with woman's lifespan endocrine, metabolic and psychological implications. Long-term usage side effects of allopathic strategies and their low efficacy made complementary medicine treatments a relevant subject for these patients. The main aim of this work is to review the efficiency of the acupuncture treatment reported in the latest studies on literature regarding PCOS patients. Methods A comprehensive literature search, in English language, about the use of acupuncture on the management of PCOS, was conducted in October 2020 using EBSCO, Cochrane, PubMed, Medline, Embase, databases for randomised and non-randomised controlled trials between 2015 and 2020 (09/2015-10/2020), following the PRISMA protocol. Results This research led us to an analysis, according to PICOS, of six final papers selected among 178 in total. The articles addressed distinct aspects of the PCOS condition, diverse acupuncture techniques and different main and secondary outcomes in agreement to the respective main objective. According to this review, acupuncture seems to be useful for the treatment of this debilitating and chronic health condition which affects millions of women worldwide, many of them part of the workforce in their community. Conclusion Despite of the display of these positive results addressing acupuncture treatments to manage PCOS major symptoms - whether they are reproductive, metabolic, or mental health features - more research is urgent. Randomized, double blinded controlled trials with improved quality design and following STRICTA and/or CONSORT recommendations are necessary to engage acupuncture as a standardized and scientific validated technique in PCOS condition.
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Affiliation(s)
- Natália M. de Oliveira
- ICBAS - Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto-UP, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - Jorge Machado
- ICBAS - Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto-UP, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
- LABIOMEP – Porto Biomechanics Laboratory, University of Porto-UP, Porto, Portugal
| | - Lara Lopes
- ICBAS - Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto-UP, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - Maria Begoña Criado
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
- TOXRUN – Toxicology Research Unit, University Institute of Health Sciences, CESPU, Gandra, Portugal
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Forslund M, Landin-Wilhelmsen K, Brännström M, Dahlgren E. No difference in morbidity between perimenopausal women with PCOS with and without previous wedge resection. Eur J Obstet Gynecol Reprod Biol 2023; 285:74-78. [PMID: 37080084 DOI: 10.1016/j.ejogrb.2023.04.008] [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: 02/19/2023] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS), affecting more than every 10th woman of reproductive age, is associated with increased risk factors for cardiovascular disease (CVD). Most knowledge regarding longtime consequences concerning morbidity is based on women where ovarian wedge resection (WR) was used as a surgical treatment, a method not used today. The aim of this study was to compare women with PCOS who had and had not undergone WR, regarding risk factors for CVD. The hypothesis was that women who had undergone WR had a more severe PCOS phenotype, and that this cohort thus had more associated CVD risk factors compared with women diagnosed through non-invasive methods. STUDY DESIGN A cross-sectional study was performed. A PCOS cohort who underwent WR in the 1950-60 s (n = 27) were compared with a PCOS cohort diagnosed by NIH-criterions in the 1990s without WR (n = 32). Both cohorts were examined at perimenopausal age. RESULTS No differences were seen in prevalence of hypertension, obesity or type 2 diabetes mellitus (T2DM) between the women with PCOS with or without WR, respectively. The results were persistent irrespective of the lower mean BMI in the WR group, 26.4 vs. 30.7 kg/m2, p = 0.01. In the stratified group of overweight and obese, there was no difference in T2DM 27% vs 25% or hypertension 27% vs 25%, in WR and non-WR women with PCOS, respectively. The cohort diagnosed through WR had higher free androgen index (6.3 vs. 2.1, p < 0.01) and total testosterone (2.20 vs. 0.99 nmol/L, p < 0.01). CONCLUSION No differences in CVD risk factors were found in perimenopausal women with PCOS with or without a previous WR, and irrespective of body weight. The results indicate that CVD morbidity and mortality from studies in women with PCOS who have undergone WR are generalizable to women with PCOS who have not undergone WR.
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Affiliation(s)
- Maria Forslund
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Kerstin Landin-Wilhelmsen
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Section for Endocrinology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - Mats Brännström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva Dahlgren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Akram W, Nori W, Abdul Ghani Zghair M. Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome. World J Clin Cases 2023; 11:1318-1329. [PMID: 36926136 PMCID: PMC10013102 DOI: 10.12998/wjcc.v11.i6.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) was reported in most polycystic ovarian syndrome (PCOS) cases. Metformin, a biguanide drug, successfully reduced IR. Homeostatic Model Assessment for IR (HOMA-IR) and Doppler parameters assessed metformin's effectiveness.
AIM To verify whether the area under the curve of the internal carotid artery (AUC-ICA) Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.
METHODS An observational, cross-sectional study recruited 54 eligible PCOS women; the anthropometrics were as follows: age, body mass index (BMI), menstrual cycle days, biochemical serum cholesterol, low and high-density lipoprotein, sex hormone-binding globulin, fasting blood glucose, and HOMA-IR, hormonal testosterone, luteinizing hormone over follicle-stimulating hormone ratio, and ultrasonic pulsatility index (PI) and resistance index (RI), carotid artery intima-media thickness (CIMT) and (AUC-ICA) parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg; three times/day for 6 mo. In addition, AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.
RESULTS Metformin caused a progressive reduction in BMI, menstrual cycle days, biochemical hormonal, and Doppler parameters (CIMT, PI, RI, and AUC-ICA). AUC-ICA correlated strongly to all PCOS parameters. AUC-ICA correlated inversely with treatment time (r = -0.98, P < 0.001) and positively with HOMA-IR (r = 0.98, P < 0.0001). Via the best subset regression model, the AUC-ICA had the highest predictive value for HOMA-IR.
CONCLUSION AUC-ICA preceded PI, RI, and CIMT with a strong, meaningful correlation to all PCOS parameters, making it a reliable marker for the assessment of IR, especially during metformin therapy. Further studies are recommended to promote the application in practice.
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Affiliation(s)
- Wisam Akram
- Department of Obstetrics and Gynecology, Mustansiriyah, Al Saydihya 10052, Baghdad, Iraq
| | - Wassan Nori
- Department of Obstetrics and Gynecology, Mustansiriyah, Al Saydihya 10052, Baghdad, Iraq
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Zhao T, Xiao X, Li L, Tao X, He W, Zhang Q, Wu X, Yuan T. Role of kisspeptin in polycystic ovarian syndrome: A metabolomics study. Clin Endocrinol (Oxf) 2023. [PMID: 36843187 DOI: 10.1111/cen.14899] [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: 12/12/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a pathophysiological disease affecting reproductive and metabolic indicators. Research has shown that kisspeptin might be involved in the regulation of pituitary hormone secretion and energy metabolism. The aim of this study was to investigate the relationship between serum kisspeptin levels and abnormal metabolism in PCOS. METHODS Fifty patients with PCOS and 50 control patients were recruited for this study. Serum kisspeptin levels were measured via ELISA. High-performance liquid chromatography-tandem mass spectrometry metabolomics was used to study the changes in serum metabolism between the PCOS and control groups. RESULTS Serum kisspeptin levels were significantly elevated in individuals with PCOS compared with those in healthy controls (p = 0.011) and positively correlated with LH, T, FFA, BA, and LEP levels (p < 0.05). Significantly dysregulated expression of several metabolites was observed in the intergroup comparisons of the high-kisspeptin PCOS, low-kisspeptin PCOS, and healthy control groups. These primarily consisted of lipid, amino acid, and carbohydrate metabolites, among which palmitic acid and N-formylkynurenine levels were lower in the high-kisspeptin group than in controls. Metabolite set enrichment analysis was also performed based on metabolites in the KEGG database. The results showed that owing to the differences in kisspeptin concentrations in individuals with PCOS, there was a significant difference in amino acid and pyruvate metabolism. CONCLUSIONS Kisspeptin could be a potential biomarker for the diagnosis of PCOS and plays an important role in metabolic regulation in individuals with PCOS. In addition, metabolomics provides a promising method for the study of metabolic abnormalities in individuals with PCOS, which might contribute to our understanding of its mechanisms.
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Affiliation(s)
- Ting Zhao
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xiao Xiao
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lingchuan Li
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xinghua Tao
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Wenli He
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Qiong Zhang
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xiaomei Wu
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Tao Yuan
- Department of Gynacologist, The First People's Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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9
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de Oliveira NM, Machado J, Huang Z, Criado MB. Acupuncture in Women with Human Polycystic Ovary/Ovarian Syndrome: Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2022; 10:1999. [PMID: 36292446 PMCID: PMC9602079 DOI: 10.3390/healthcare10101999] [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] [Received: 08/05/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: Human polycystic ovary/ovarian syndrome (PCOS) is linked to endocrine, metabolic, and psychological complications. We propose a randomized controlled pilot study for an acupuncture protocol regarding the management of PCOS symptoms based on TCM diagnosis; (2) Methods: We will randomly allocate 120 women diagnosed with PCOS into two groups. The study group will be treated with acupuncture for points known to act upon the autonomous regulation of the hormonal, metabolic and emotional components. (3) Results and Conclusions: We expect to provide evidence of high methodological quality related to the effects and safety of an acupuncture protocol based on the perspective of a TCM diagnostic.
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Affiliation(s)
- Natália M de Oliveira
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, 4099-002 Porto, Portugal
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
| | - Jorge Machado
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, 4099-002 Porto, Portugal
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
- LABIOMEP-Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal
| | - Zaiwei Huang
- IEC-International Education College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Maria Begoña Criado
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
- TOXRUN-CESPU Toxicology Research Unit, University Institute of Health Sciences, CESPU, 4585-116 Gandra, Portugal
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10
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Kujanpää L, Arffman RK, Pesonen P, Korhonen E, Karjula S, Järvelin M, Franks S, Tapanainen JS, Morin‐Papunen L, Piltonen TT. Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: A population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:728-736. [PMID: 35673942 PMCID: PMC9564432 DOI: 10.1111/aogs.14382] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This population-based follow-up study investigated the comorbidities, medication use, and healthcare services among women with polycystic ovary syndrome (PCOS) at age 46 years. MATERIAL AND METHODS The study population derived from the Northern Finland Birth Cohort 1966 and consisted of women reporting oligo/amenorrhea and hirsutism at age 31 years and/or a PCOS diagnosis by age 46 years (n = 246) and controls without PCOS symptoms or diagnosis (n = 1573), referred to as non-PCOS women. The main outcome measures were self-reported data on symptoms, diagnosed diseases, and medication and healthcare service use at the age of 46 years. RESULTS Overall morbidity risk was increased by 35% (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.16-1.57) and medication use by 27% [RR 1.27, 95% CI 1.08-1.50) compared with non-PCOS women, and the risk remained after adjusting for body mass index. Diagnoses with increased prevalence in women with PCOS were migraine, hypertension, tendinitis, osteoarthritis, fractures, and endometriosis. PCOS was also associated with autoimmune diseases and recurrent upper respiratory tract infections and symptoms. Interestingly, healthcare service use did not differ between the study groups after adjusting for body mass index. CONCLUSIONS Women with PCOS are burdened with multimorbidity and higher medication use, independent of body mass index.
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Affiliation(s)
- Linda Kujanpää
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
| | - Riikka K. Arffman
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
| | - Paula Pesonen
- Infrastructure for Population Studies, Faculty of MedicineUniversity of OuluOuluFinland
| | - Elisa Korhonen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
| | - Salla Karjula
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
| | - Marjo‐Riitta Järvelin
- Department of Epidemiology and Biostatistics, MRC‐PHE Center for Environment and HealthSchool of Public Health, Imperial College LondonLondonUK
- Center for Life Course Health Research, Faculty of MedicineUniversity of OuluOuluFinland
- Unit of Primary Health CareOulu University HospitalOuluFinland
- Department of Life Sciences, College of Health and Life SciencesBrunel University LondonLondonUK
| | - Stephen Franks
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUK
| | - Juha S. Tapanainen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
- Department of Obstetrics and GynecologyUniversity of Helsinki, Helsinki University HospitalHelsinkiFinland
| | - Laure Morin‐Papunen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
| | - Terhi T. Piltonen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology)University of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland
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11
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McIlvenna LC, Altıntaş A, Patten RK, McAinch AJ, Rodgers RJ, Stepto NK, Barrès R, Moreno-Asso A. Transforming growth factor β1 impairs the transcriptomic response to contraction in myotubes from women with polycystic ovary syndrome. J Physiol 2022; 600:3313-3330. [PMID: 35760527 PMCID: PMC9544746 DOI: 10.1113/jp282954] [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] [Received: 02/08/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Abstract Polycystic ovary syndrome (PCOS) is characterised by a hormonal imbalance affecting the reproductive and metabolic health of reproductive‐aged women. Exercise is recommended as a first‐line therapy for women with PCOS to improve their overall health; however, women with PCOS are resistant to the metabolic benefits of exercise training. Here, we aimed to gain insight into the mechanisms responsible for such resistance to exercise in PCOS. We employed an in vitro approach with electrical pulse stimulation (EPS) of cultured skeletal muscle cells to explore whether myotubes from women with PCOS have an altered gene expression signature in response to contraction. Following EPS, 4719 genes were differentially expressed (false discovery rate <0.05) in myotubes from women with PCOS compared to 173 in healthy women. Both groups included genes involved in skeletal muscle contraction. We also determined the effect of two transforming growth factor β (TGFβ) ligands that are elevated in plasma of women with PCOS, TGFβ1 and anti‐Müllerian hormone (AMH), alone and on the EPS‐induced response. While AMH (30 ng/ml) had no effect, TGFβ1 (5 ng/ml) induced the expression of extracellular matrix genes and impaired the exercise‐like transcriptional signature in myotubes from women with and without PCOS in response to EPS by interfering with key processes related to muscle contraction, calcium transport and actin filament. Our findings suggest that while the fundamental gene expression responses of skeletal muscle to contraction is intact in PCOS, circulating factors like TGFβ1 may be responsible for the impaired adaptation to exercise in women with PCOS.
![]() Key points Gene expression responses to in vitro contraction (electrical pulse stimulation, EPS) are altered in myotubes from women with polycystic ovary syndrome (PCOS) compared to healthy controls, with an increased expression of genes related to pro‐inflammatory pathways. Transforming growth factor β1 (TGFβ1) upregulates genes related to extracellular matrix remodelling and reduces the expression of contractile genes in myotubes, regardless of the donor's health status. TGFβ1 alters the gene expression response to EPS, providing a possible mechanism for the impaired exercise adaptations in women with PCOS.
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Affiliation(s)
- Luke C McIlvenna
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ali Altıntaş
- The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rhiannon K Patten
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
| | - Andrew J McAinch
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Victoria University, Melbourne, Victoria, Australia
| | - Raymond J Rodgers
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia.,The Robinson Research Institute, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel K Stepto
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Victoria University, Melbourne, Victoria, Australia
| | - Romain Barrès
- The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Institut de Pharmacologie Moléculaire et Cellulaire, Université Côte d'Azur and Centre National pour la Recherche Scientifique (CNRS), Valbonne, France
| | - Alba Moreno-Asso
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Victoria University, Melbourne, Victoria, Australia
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12
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Yalameha B, Nejabati HR, Nouri M. Circulating microparticles as indicators of cardiometabolic risk in PCOS. Clin Chim Acta 2022; 533:63-70. [PMID: 35718107 DOI: 10.1016/j.cca.2022.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
Polycystic ovary syndrome (PCOS), the most prevalent endocrine disturbance of the female reproductive system, is associated with several pathologic conditions, such as metabolic syndrome, obesity, diabetes, dyslipidemia, and insulin resistance, all of which are tightly connected to its progression. These factors are associated with a type of extracellular vesicle, ie, microparticles (MPs), released by shedding due to cell activation and apoptosis. Circulating MPs (cMPs) are secreted by a variety of cells, such as platelets, endothelial, leukocytes, and erythrocytes, and contain cytoplasmic substances derived from parent cells that account for their biologic activity. Current evidence has clearly shown that increased cMPs contribute to endothelial dysfunction, diabetes, hypertriglyceridemia, metabolic syndrome, cardiovascular abnormalities as well as PCOS. It has also been reported that platelet and endothelial MPs are specifically increased in PCOS thus endangering vascular health and subsequent cardiovascular disease. Given the importance of cMPs in the pathophysiology of PCOS, we review the role of cMPs in PCOS with a special focus on cardiometabolic significance.
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Affiliation(s)
- Banafsheh Yalameha
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Reza Nejabati
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Nouri
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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13
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Forslund M, Schmidt J, Brännström M, Landin-Wilhelmsen K, Dahlgren E. Morbidity and mortality in PCOS: A prospective follow-up up to a mean age above 80 years. Eur J Obstet Gynecol Reprod Biol 2022; 271:195-203. [PMID: 35220175 DOI: 10.1016/j.ejogrb.2022.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Despite the clear evidence of increased cardiovascular disease (CVD) risk factors, the long-term effect on CVD and mortality is still uncertain in women with PCOS, especially in the elderly. Studies in elderly women with PCOS are lacking. The objective was to study morbidity/mortality in PCOS women compared with a reference group up to a mean age above 80 years. STUDY DESIGN A well-defined cohort of women with PCOS, examined in 1987 and 2008, was re-examined 32 years later in 2019 (age range 72-91 years), in parallel with an age-matched reference group. For deceased women register data was used, for women alive interviews were done, and medical records studied. Blood pressure and blood tests were analyzed. Morbidity and mortality data was available in 35/36 women with PCOS, and in 99/118 women in the reference group. RESULTS At mean age 81 years there was no difference in all-cause mortality (HR 1.1, ns), CVD-related mortality (HR 1.7, ns), all CVD (HR 1.2, ns), hypertension (HR 1.8, ns), type 2 diabetes (HR 1.7, ns), in levels of blood lipids, glucose, insulin or thyroid hormones. Comparing baseline data from the deceased and living women with PCOS, no differences were found regarding age, menopausal age, BMI, HOMA-IR, FAI, total testosterone or SHBG. However, deceased women with PCOS had a higher WHR (0.87 vs. 0.80; p-value < 0.01) at baseline. CONCLUSIONS No evidence of increased all-cause mortality or CVD was found in women with PCOS. The elevated testosterone levels and CVD risk profile in PCOS present during perimenopause do not seem to be associated with increased CVD morbidity/mortality risk later in life.
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Affiliation(s)
- Maria Forslund
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Johanna Schmidt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva Dahlgren
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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14
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Islam H, Masud J, Islam YN, Haque FKM. An update on polycystic ovary syndrome: A review of the current state of knowledge in diagnosis, genetic etiology, and emerging treatment options. WOMEN'S HEALTH 2022; 18:17455057221117966. [PMID: 35972046 PMCID: PMC9386861 DOI: 10.1177/17455057221117966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age, which is still incurable. However, the symptoms can be successfully managed with proper medication and lifestyle interventions. Despite its prevalence, little is known about its etiology. In this review article, the up-to-date diagnostic features and parameters recommended on the grounds of evidence-based data and different guidelines are explored. The ambiguity and insufficiency of data when diagnosing adolescent women have been put under special focus. We look at some of the most recent research done to establish relationships between different gene polymorphisms with polycystic ovary syndrome in various populations along with the underestimated impact of environmental factors like endocrine-disrupting chemicals on the reproductive health of these women. Furthermore, the article concludes with existing treatments options and the scopes for advancement in the near future. Various therapies have been considered as potential treatment through multiple randomized controlled studies, and clinical trials conducted over the years are described in this article. Standard therapies ranging from metformin to newly found alternatives based on vitamin D and gut microbiota could shine some light and guidance toward a permanent cure for this female reproductive health issue in the future.
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Affiliation(s)
- Hiya Islam
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Jaasia Masud
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Yushe Nazrul Islam
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Fahim Kabir Monjurul Haque
- Microbiology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
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15
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Richards CT, Meah VL, James PE, Rees DA, Lord RN. HIIT'ing or MISS'ing the Optimal Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of High- Versus Moderate-Intensity Exercise Prescription. Front Physiol 2021; 12:715881. [PMID: 34483969 PMCID: PMC8415631 DOI: 10.3389/fphys.2021.715881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction: Polycystic Ovary syndrome (PCOS) is a metabolic disorder associated with increased cardiovascular disease risk. Exercise is an effective treatment strategy to manage symptoms and reduce long-term health risk. High-intensity interval training (HIIT) has been suggested as a more efficient exercise mode in PCOS; however, it is not clear whether HIIT is superior to moderate intensity steady state exercise (MISS). Methods: We synthesized available data through a systematic review and meta-analysis to compare the effectiveness of isolated HIIT and MISS exercise interventions. Our primary outcome measures were cardiorespiratory fitness and insulin resistance, measured using V˙O2max and HOMA-IR respectively. Results: A total of 16 studies were included. Moderate-quality evidence from 16 studies identified significant improvements in V˙O2max following MISS (Δ = 1.081 ml/kg/min, p < 0.001, n = 194), but not HIIT (Δ = 0.641 ml/kg/min, p = 0.128, n = 28). Neither HIIT nor MISS improved HOMA-IR [(Δ = −0.257, p = 0.374, n = 60) and (Δ = −0.341, p = 0.078, n = 159), respectively]. Discussion: A significant improvement in V˙O2max was evident following MISS, but not HIIT exercise in women with PCOS. This contrasts with previous literature in healthy and clinical cohorts that report superior benefits of HIIT. Therefore, based on available moderate-quality evidence, HIIT exercise does not provide superior outcomes in V˙O2max compared with MISS, although larger high-quality interventions are needed to fully address this. Additional dietary/pharmacological interventions may be required in conjunction with exercise to improve insulin sensitivity.
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Affiliation(s)
- Cory T Richards
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Philip E James
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Rachel N Lord
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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16
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Yu Y, Tan P, Zhuang Z, Wang Z, Zhu L, Qiu R, Xu H. Untargeted metabolomic approach to study the serum metabolites in women with polycystic ovary syndrome. BMC Med Genomics 2021; 14:206. [PMID: 34416878 PMCID: PMC8379735 DOI: 10.1186/s12920-021-01058-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is not only a kind of common endocrine syndrome but also a metabolic disorder, which harms the reproductive system and the whole body metabolism of the PCOS patients worldwide. In this study, we aimed to investigate the differences in serum metabolic profiles of the patients with PCOS compared to the healthy controls. MATERIAL AND METHODS 31 PCOS patients and 31 matched healthy female controls were recruited in this study, the clinical characteristics data were recorded, the laboratory biochemical data were detected. Then, we utilized the metabolomics approach by UPLC-HRMS technology to study the serum metabolic changes between PCOS and controls. RESULTS The metabolomics analysis showed that there were 68 downregulated and 78 upregulated metabolites in PCOS patients serum compared to those in the controls. These metabolites mainly belong to triacylglycerols, glycerophosphocholines, acylcarnitines, diacylglycerols, peptides, amino acids, glycerophosphoethanolamines and fatty acid. Pathway analysis showed that these metabolites were enriched in pathways including glycerophospholipid metabolism, fatty acid degradation, fatty acid biosynthesis, ether lipid metabolism, etc. Diagnosis value assessed by ROC analysis showed that the changed metabolites, including Leu-Ala/Ile-Ala, 3-(4-Hydroxyphenyl) propionic acid, Ile-Val/Leu-Val, Gly-Val/Val-Gly, aspartic acid, DG(34:2)_DG(16:0/18:2), DG(34:1)_DG(16:0/18:1), Phe-Trp, DG(36:1)_DG(18:0/18:1), Leu-Leu/Leu-Ile, had higher AUC values, indicated a significant role in PCOS. CONCLUSION The present study characterized the difference of serum metabolites and related pathway profiles in PCOS patients, this finding hopes to provide potential metabolic markers for the prognosis and diagnosis of this disease.
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Affiliation(s)
- Ying Yu
- Institute of Laboratory Medicine, Jiangsu Key Laboratory of Laboratory Medicine, Jiangsu University, Zhenjiang, 210013, Jiangsu, People's Republic of China
- Department of Laboratory Medicine, Chinese Medicine Hospital of Zhejiang, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Panli Tan
- Department of Laboratory Medicine, Chinese Medicine Hospital of Zhejiang, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Zhenchao Zhuang
- Department of Laboratory Medicine, Chinese Medicine Hospital of Zhejiang, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Zhejiong Wang
- Department of Laboratory Medicine, Chinese Medicine Hospital of Zhejiang, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Linchao Zhu
- Department of Laboratory Medicine, Chinese Medicine Hospital of Zhejiang, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Ruyi Qiu
- Department of Laboratory Medicine, Chinese Medicine Hospital of Zhejiang, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Huaxi Xu
- Institute of Laboratory Medicine, Jiangsu Key Laboratory of Laboratory Medicine, Jiangsu University, Zhenjiang, 210013, Jiangsu, People's Republic of China.
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17
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Kazemi M, Pierson RA, Parry SA, Kaviani M, Chilibeck PD. Obesity, but not hyperandrogenism or insulin resistance, predicts skeletal muscle mass in reproductive-aged women with polycystic ovary syndrome: A systematic review and meta-analysis of 45 observational studies. Obes Rev 2021; 22:e13255. [PMID: 33855800 DOI: 10.1111/obr.13255] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/01/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) exhibit reduced muscle insulin-mediated glucose uptake, potentially attributed to altered muscle mass; however, this is inconclusive. Altered muscle mass may aggravate PCOS complications. Our systematic review and meta-analysis evaluated whether PCOS alters muscle mass and function. Databases (MEDLINE, Web of Science, Scopus) were searched through September 2, 2020, for studies documenting skeletal muscle mass (lean tissue mass) and function (strength) in PCOS and control groups. The primary outcome was total lean body mass (LBM) or fat-free mass (FFM). Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Forty-five studies (n = 3676 participants) were eligible. Women with PCOS had increased total (0.83 [0.08,1.58] kg; p = 0.03; I2 = 72.0%) yet comparable trunk (0.84 [-0.37,2.05] kg; p = 0.15; I2 = 73.0%) LBM or FFM versus controls. Results of meta-regression analyses showed no associations between mean differences between groups in total testosterone or homeostatic model assessment of insulin resistance and total or trunk LBM or FFM (All: p ≥ 0.75). Mean differences in body mass index (BMI) were associated with total (0.65 [0.23,1.06] kg; p < 0.01; I2 = 56.9%) and trunk (0.56 [0.11,1.01] kg; p = 0.02; I2 = 42.8%) LBM or FFM. The PCOS subgroup with BMI ≥ 25 kg/m2 had greater total LBM or FFM versus controls (1.58 [0.82,2.34] kg; p < 0.01; I2 = 64.0%) unlike the PCOS subgroup with BMI < 25 kg/m2 (-0.45 [-1.94,1.05] kg; p = 0.53; I2 = 69.5%). Appendicular lean mass and muscle strength data were contradictory and described narratively, as meta-analyses were impossible. Women with PCOS have higher total and trunk lean tissue mass attributed to overweight/obesity, unlike hyperandrogenism or insulin resistance.
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Affiliation(s)
- Maryam Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, New York, USA
| | - Roger A Pierson
- Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, New York, USA
| | - Mojtaba Kaviani
- School of Nutrition and Dietetics, Acadia University, Wolfville, Nova Scotia, Canada
| | - Philip D Chilibeck
- College of Kinesiology, Physical Activity Complex, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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18
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Butler AE, Dargham SR, Abouseif A, El Shewehy A, Atkin SL. Vitamin D deficiency effects on cardiovascular parameters in women with polycystic ovary syndrome: A retrospective, cross-sectional study. J Steroid Biochem Mol Biol 2021; 211:105892. [PMID: 33785436 DOI: 10.1016/j.jsbmb.2021.105892] [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: 11/21/2020] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is associated with vitamin D deficiency (25-hydroxyvitamin D (25(OH)D), and both are associated with increased cardiovascular risk; therefore, the combination of PCOS and moderate vitamin D deficiency may exacerbate the cardiovascular and metabolic characteristics in women with PCOS. This study sought to address this question. METHODS In this retrospective, cross-sectional study, demographic and metabolic data from women aged 18-40 years from the Qatar Biobank (QBB) (78 diagnosed with PCOS, 641 controls) was analyzed. RESULTS Moderate vitamin D deficiency was seen in both normal and PCOS cohorts irrespective of body mass index (BMI) stratification into normal, overweight and obese. Significant differences in free androgen index (FAI) and high density lipoproteins (HDL) (p < 0.05) were seen in PCOS irrespective of BMI, though insulin resistance and increased C-reactive protein (CRP) (p < 0.05) were seen only in obese PCOS subjects; however, there was no correlation (Pearson coefficient) of any these parameters with vitamin D for women with or without PCOS, nor when vitamin D deficiency was compared to vitamin D insufficiency (above and below 20 ng/mL, respectively) between the normal and PCOS groups. CONCLUSION Moderate vitamin D deficiency did not associate with nor exacerbate insulin resistance, androgen levels, inflammation or cardiovascular risk indices in women with PCOS, suggesting that a prospective study on vitamin D deficiency to confirm non-causality is required.
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Affiliation(s)
- Alexandra E Butler
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), PO Box 34110, Doha, Qatar.
| | - Soha R Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine, PO Box 24144, Doha, Qatar.
| | - Ahmed Abouseif
- Department of Obstetrics, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Abeer El Shewehy
- Research Faculty, Weill Cornell Medicine, PO Box 24144, Doha, Qatar.
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19
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Kazemi M, Kim JY, Parry SA, Azziz R, Lujan ME. Disparities in cardio metabolic risk between Black and White women with polycystic ovary syndrome: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224:428-444.e8. [PMID: 33316275 DOI: 10.1016/j.ajog.2020.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/26/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to summarize and quantitatively pool evidence on cardiometabolic health disparities between Black and White women with polycystic ovary syndrome in the United States in response to the call for further delineation of these disparities in the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. DATA SOURCES Databases of MEDLINE, Web of Science, and Scopus were searched initially through March 05, 2020, and confirmed on September 11, 2020. STUDY ELIGIBILITY CRITERIA Observational studies documenting cardiometabolic risk profile (glucoregulatory, lipid profile, anthropometric, and blood pressure status) in Black and White women with polycystic ovary syndrome were included. Studies on children (<17 years old) and pregnant or menopausal-aged women (>50 years) were excluded. The primary outcome was fasting glucose. Furthermore, data on major cardiovascular events (stroke, coronary heart disease, heart failure) and mortality rate (cardiovascular death, total mortality) were evaluated. METHODS Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Studies were weighted based on the inverse of the variance. Heterogeneity was evaluated by Cochran Q and I2 statistics. Study methodologic quality was assessed by the Newcastle-Ottawa scale. RESULTS A total of 11 studies (N=2851 [652 Black and 2199 White]) evaluated cardiometabolic risk profile and all had high quality (Newcastle-Ottawa scale score of ≥8). No studies reported on cardiovascular events and mortality rate. Black women had comparable fasting glucose (-0.61 [-1.69 to 2.92] mg/dL; I2=62.5%), yet exhibited increased fasting insulin (6.76 [4.97-8.56] μIU/mL; I2=59.0%); homeostatic model assessment of insulin resistance (1.47 [0.86-2.08]; I2=83.2%); systolic blood pressure (3.32 [0.34-6.30] mm Hg; I2=52.0%); and decreased triglyceride (-32.56 [-54.69 to -10.42] mg/dL; I2=68.0%) compared with White women (all, P≤.03). Groups exhibited comparable total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and diastolic blood pressure (all, P≥.06). CONCLUSIONS Black women with polycystic ovary syndrome have a greater tendency for an adverse cardiometabolic risk profile (increased insulin, homeostatic model assessment of insulin resistance, and systolic blood pressure) despite lower triglycerides than White women. Our observations support the consideration of these disparities for diagnostic, monitoring, and management practices in Black women and for future guideline recommendations. Given the heterogeneity among studies, future research should address the relative contributions of biologic, environmental, socioeconomic, and healthcare factors to the observed disparities. Furthermore, longitudinal research is required to address patient-pressing complications, including cardiovascular events and mortality rate in Black women with polycystic ovary syndrome as a high-risk yet understudied population.
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Affiliation(s)
- Maryam Kazemi
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY.
| | - Joy Y Kim
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY
| | - Ricardo Azziz
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, NY
| | - Marla E Lujan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY.
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Li J, Cui L, Jiang X, Zhao H, Zhao S, Shi Y, Wei D, You L, Ma J, Chen ZJ. Transmission of polycystic ovary syndrome susceptibility single-nucleotide polymorphisms and their association with phenotype changes in offspring. Hum Reprod 2021; 35:1711-1718. [PMID: 32619219 DOI: 10.1093/humrep/deaa125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION Does the inheritance of polycystic ovary syndrome (PCOS) susceptibility single-nucleotide polymorphism affect the phenotype of offspring? SUMMARY ANSWER Male offspring who inherit PCOS-related genetic variations from PCOS mothers were more susceptible to developing the metabolic abnormality in their later life. WHAT IS KNOWN ALREADY Genetic factors are considered the major etiology of PCOS. Previous studies have highlighted that offspring of women with PCOS had an increased risk of the same disease or PCOS-like symptoms. STUDY DESIGN, SIZE, DURATION The study involved 172 children born to women with PCOS and 529 children born to non-PCOS women. All offspring were conceived by assisted reproductive technologies. PARTICIPANTS/MATERIALS, SETTING, METHODS The offspring ranged from 1 to 8 years old. Metabolic phenotype analyses were performed in offspring aged from 2 to 8 (N = 619). Sanger sequencing, TaqMan and Sequenom MassARRAY were used to sequence the samples. MAIN RESULTS AND THE ROLE OF CHANCE In male offspring, the fasting insulin (FINS) (P = 0.037) homeostasis model assessment of insulin resistance (HOMA-IR) (P = 0.038) and the homeostasis model assessment of pancreatic beta-cell function (HOMA-β) (P = 0.038) levels were higher in offspring of PCOS mothers compared to controls. In female offspring, PCOS offspring had a significantly higher anti-Müllerian hormone levels (P = 0.001) compared to those from control mothers. In male offspring of PCOS mothers, subjects with a T allele at rs2349415 in the gene FSHR had higher FINS (P = 0.023), HOMA-IR (P = 0.030) and HOMA-β levels (P = 0.013) than those in the homozygous CC group. The same increased trend in FINS, HOMA-IR and HOMA-β levels could be found in the CC and TC group in rs2268361 located in gene FSHR compared to the TT group (P = 0.029, P = 0.030, P = 0.046, respectively). As for rs10818854 in the DENND1A gene, the AA and AG group had a higher FINS (P = 0.037) and HOMA-β (P = 0.008) levels than the homozygous CC group. LIMITATIONS, REASONS FOR CAUTION Firstly, the offspring may be too young to see any phenotype changes. Secondly, this study only analyzed the differences of genotype frequency using the dominant model instead of all three models due to the limited sample size of the homozygous model. The results, therefore, should be replicated and performed in a larger sample size population. Thirdly, environmental impacts cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS The findings presented in this thesis add to our understanding the changes in offspring born to PCOS women and remind us to consider early intervention to avoid more severe effects. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Key Research and Development Program of China 2017YFC1001000 (to Z.-J.C.), the National Natural Science Foundation of China 81430029 (to Z.-J.C.), 81622021 and 31571548 (to H.Z.), the National Natural Science Foundation of Shandong Province JQ201816 (to H.Z.) and Shandong Provincial Key Research and Development Program 2017G006036 (to L.-L.C.) and 2018YFJH0504 (to Z.-J.C.). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jingyu Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Linlin Cui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Xiao Jiang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Han Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Shigang Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Daimin Wei
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Li You
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Jinlong Ma
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, Shandong 250012, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200000, China.,Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China
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Saenz C, Hooper S, Orange T, Knight A, Barragan M, Lynch T, Remenapp A, Coyle K, Winters C, Hausenblas H. Effect of a Free-Living Ketogenic Diet on Feasibility, Satiety, Body Composition, and Metabolic Health in Women: The Grading Level of Optimal Carbohydrate for Women (GLOW) Study. J Am Coll Nutr 2021; 40:295-306. [PMID: 33705257 DOI: 10.1080/07315724.2021.1875338] [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: 10/21/2022]
Abstract
OBJECTIVE The study's purpose was to examine a free-living, ketogenic diet (WFKD) on feasibility, satiety, body composition, and metabolic health in women. METHODS Twenty-two women (age (yr.) 42.2 ± 8.1, Ht. (cm) 164.2 ± 5.9, BMI 27.3 ± 6.0) participated in a 21-day, free-living dietary intervention. Daily ketone measurements and satiety/craving surveys, weekly diet records, and PRE and POST assessments of anthropometrics, body composition, blood pressure, and fasted capillary-blood glucose (BG) and cholesterol panels were collected. RESULTS Women maintained calories (PRE: 1938 kcal vs POST: 1836 kcal) and protein (PRE: 17% vs POST: 20%) but decreased carbohydrate (PRE: 36% vs POST: 13%) and increased fat (PRE: 45% vs POST: 65%) PRE to POST (p ≤ 0.05). Daily self-reports suggested no changes in satiety or food cravings between PRE, WK 1, WK 2, and WK 3. Ketones increased (PRE 0.3 ± 0.2 mmol vs POST 0.8 ± 0.6 mmol) PRE to POST with significant differences between PRE and all other time points (p ≤ 0.05). Bodyweight (PRE: 73.9 kg vs POST: 72.3 kg) and body fat (PRE: 28.9 ± 13.4 kg vs POST 27. 4 ± 13.5 kg) decreased but there were no differences in fat-free mass PRE to POST (p ≤ 0.05). Systolic blood pressure decreased (PRE: 119.2 ± 8.9 mmHg vs POST: 109.5 ± 10.9 mmHg), diastolic blood pressure increased (PRE: 74.1 ± 7.5 mmHg vs POST: 78.8 ± 7.4 mmHg), and BG improved (94.0 ± 8.3 mg/dL vs POST 89.9 ± 9.0 mg/dL) PRE to POST (p ≤ 0.05). No differences were observed in total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) but TC/HDL decreased and low-density lipoprotein increased PRE to POST (p ≤ 0.05). CONCLUSION Women were able to maintain calories, improve body composition, blood pressure, and BG, increase ketones, and improve some but not all cholesterol markers after 21 days on a free-living WFKD.
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Affiliation(s)
- Catherine Saenz
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Stephanie Hooper
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Terrance Orange
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Ashlyn Knight
- Clinical Mental Health Counseling, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Martin Barragan
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Tarah Lynch
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Abigail Remenapp
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Kevin Coyle
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Carena Winters
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
| | - Heather Hausenblas
- Department of Kinesiology, School of Applied Health Sciences, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Florida, USA
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22
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Harreiter J, Fadl H, Kautzky-Willer A, Simmons D. Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes? Curr Diab Rep 2020; 20:61. [PMID: 33033953 PMCID: PMC7544714 DOI: 10.1007/s11892-020-01348-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes. RECENT FINDINGS In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher "within-gender" RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities. The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.
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Affiliation(s)
- Jürgen Harreiter
- grid.22937.3d0000 0000 9259 8492Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Helena Fadl
- grid.15895.300000 0001 0738 8966Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
| | - Alexandra Kautzky-Willer
- grid.22937.3d0000 0000 9259 8492Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Gender Institute, Gars am Kamp, Austria
| | - David Simmons
- grid.15895.300000 0001 0738 8966Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
- grid.1029.a0000 0000 9939 5719Macarthur Clinical School, Western Sydney University, Sydney, New South Wales Australia
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Sharma M, Barai RS, Kundu I, Bhaye S, Pokar K, Idicula-Thomas S. PCOSKB R2: a database of genes, diseases, pathways, and networks associated with polycystic ovary syndrome. Sci Rep 2020; 10:14738. [PMID: 32895427 PMCID: PMC7477240 DOI: 10.1038/s41598-020-71418-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023] Open
Abstract
PolyCystic Ovary Syndrome KnowledgeBase (PCOSKBR2) is a manually curated database with information on 533 genes, 145 SNPs, 29 miRNAs, 1,150 pathways, and 1,237 diseases associated with PCOS. This data has been retrieved based on evidence gleaned by critically reviewing literature and related records available for PCOS in databases such as KEGG, DisGeNET, OMIM, GO, Reactome, STRING, and dbSNP. Since PCOS is associated with multiple genes and comorbidities, data mining algorithms for comorbidity prediction and identification of enriched pathways and hub genes are integrated in PCOSKBR2, making it an ideal research platform for PCOS. PCOSKBR2 is freely accessible at http://www.pcoskb.bicnirrh.res.in/ .
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Affiliation(s)
- Mridula Sharma
- Biomedical Informatics Center, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Ram Shankar Barai
- Biomedical Informatics Center, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Indra Kundu
- Biomedical Informatics Center, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Sameeksha Bhaye
- Biomedical Informatics Center, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Khushal Pokar
- Biomedical Informatics Center, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Susan Idicula-Thomas
- Biomedical Informatics Center, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, 400012, India.
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24
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Helvaci N, Yildiz BO. Polycystic ovary syndrome and aging: Health implications after menopause. Maturitas 2020; 139:12-19. [DOI: 10.1016/j.maturitas.2020.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022]
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Association between Periodontal Diseases and Polycystic Ovary Syndrome: A Systematic Review. J Clin Med 2020; 9:jcm9051586. [PMID: 32456146 PMCID: PMC7290429 DOI: 10.3390/jcm9051586] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/09/2023] Open
Abstract
Background: A convergent association between polycystic ovary syndrome (PCOS) and periodontal disease, in particular chronic periodontitis (CP), has recently been proposed. The underlying molecular mechanisms of this association are not fully understood, though it is thought that chronic inflammation is responsible. Therefore, the aim of this study was to evaluate the association between periodontal disease—gingivitis and CP—and PCOS. Materials and Methods: The PICO (Participants, Intervention, Control, and Outcomes) question was as follows: “Is there an association between PCOS and CP?” A systematic review of three databases—PubMed, Embase and Scopus—was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Original studies in human cohorts carried out in the last 10 years and including a control group were eligible for inclusion. Letters to the editor, case reports, and reviews were not considered. Results: Ten articles met all the selection criteria and provided a positive answer to the PICO question. Our review of these articles revealed an association between CP and PCOS, since periodontal parameters were altered more frequently in patients with these conditions than in healthy young women. This altered periodontal response in PCOS was associated with a proinflammatory status that seemed to increase susceptibility to periodontal disease. Conclusion: Patients with PCOS appear to be more susceptible to developing periodontal diseases than women without the pathology.
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Abstract
PURPOSE OF REVIEW Women should enter pregnancy in the best possible health. There is increasing recognition of the importance of nutrition for reproductive health; however, key dietary factors in relation to optimizing fertility are nonexistent. The purpose of this review is to investigate dietary factors, preconception, and the association with fertility and later health in pregnancy. RECENT FINDINGS This article summarizes recent literature assessing preconception dietary intake and the association with fertility, time to pregnancy, and also the relationship with polycystic ovary syndrome and gestational diabetes; these conditions associate with each other, and also with infertility. The impact of paternal diet is also reported. SUMMARY There is recent interest investigating diet and time to pregnancy, suggesting higher intakes of fruit, minimal intake of fast food and sugar sweetened beverages, and a diet lower in glycemic load, may improve time to pregnancy. There is minimal recent literature on paternal diet and impact on fertility. Present advice to women with polycystic ovary syndrome is in line with international recommendations for lifestyle management to improve reproductive outcomes; and for gestational diabetes, prepregnancy may be an optimal time to improve dietary intakes, particularly through consumption of an overall healthy dietary pattern or a Mediterranean-style dietary pattern.
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Abstract
Polycystic ovary syndrome (PCOS), characterized by hormonal imbalance and ovarian dysfunction, often starts during adolescence. Inconsistent diagnostic criteria, variable provider knowledge, and lack of consensus pose specific challenges for the care of women with PCOS. These factors encourage inaccurate diagnosis with both under and overdiagnosis. This unfavorable diagnostic experience exasperates affected women and limits timely opportunities for intervention to minimize associated comorbidities, especially during the transition from pediatric to adult care. Recognition of these issues in the care of adolescents and women with PCOS inspired the development of the International Evidence-Based PCOS Guidelines, which emphasize the prevention, screening, and treatment of PCOS across the reproductive lifespan. The Guidelines and accompanying meta-analyses focus on three major categories of associated comorbidities: (1) reproductive; (2) metabolic; and (3) psychological. With the exception of infertility, this article considers common manifestations and comorbidities associated with PCOS throughout the lifecycle. Healthy lifestyle interventions with prevention of excess weight gain comprise the primary intervention for all comorbidities. Hence, early identification of girls "at risk" for PCOS and those with PCOS is a priority. Extensive guidelines for provider and patient education aim to decrease the medical, psychosocial, and economic burdens attributable to PCOS and its associated comorbidities.
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Ollila MM, Kiviniemi A, Stener-Victorin E, Tulppo M, Puukka K, Tapanainen J, Franks S, Morin-Papunen L, Piltonen T. Effect of polycystic ovary syndrome on cardiac autonomic function at a late fertile age: a prospective Northern Finland Birth Cohort 1966 study. BMJ Open 2019; 9:e033780. [PMID: 31843853 PMCID: PMC6924836 DOI: 10.1136/bmjopen-2019-033780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Previous studies of women in their 20s and 30s have reported impaired autonomic function in women with polycystic ovary syndrome (PCOS). We aimed to study, for the first time, whether PCOS is associated with impaired cardiac autonomic function independent of metabolic and hormonal status in their late reproductive years. DESIGN A prospective Northern Finland Birth Cohort 1966 (NFBC1966) study including 5889 women born in 1966 and followed through the age of 46. At that age, n=3706/5123 women (72%) answered the postal questionnaires and n=3280/5123 women (64%) participated in the clinical examination. SETTING General community. PARTICIPANTS The sample included women presenting both irregular menses (oligomenorrhoea or amenorrhoea) and hirsutism at age 31 (n=125) or with formally diagnosed PCOS by age 46 (n=181) and women without PCOS symptoms or diagnosis (n=1577). PRIMARY AND SECONDARY OUTCOME MEASURES Heart rate variability parameters: the root mean square of successive R-R differences (rMSSD), spectral power densities (LF: low frequency and HF: high frequency) and baroreflex sensitivity (BRS). RESULTS We found that parasympathetic activity (assessed by rMSSD: 19.5 (12.4; 31.9) vs 24.3 (16.1; 34.8) ms, p=0.004 and HF: 172 (75; 399) vs 261 (112; 565) ms2, p=0.002) and BRS (6.13±3.12 vs 6.99±3.52 ms/mm Hg, p=0.036) were lower in women with PCOS compared with the controls. However, in the multivariate regression analysis, PCOS, body mass index and the free androgen index did not significantly associate with rMSSD, whereas blood pressure, insulin resistance and triglycerides did. CONCLUSIONS We report here for the first time that late reproductive-aged women with PCOS display impaired cardiac autonomic function manifested as decreased vagal activity. Metabolic status, rather than hyperandrogenaemia and PCOS per se, was the strongest contributing factor. Given the link between cardiac morbidity and impaired autonomic function, the findings underline the importance of screening and treating metabolic abnormalities early on in women with PCOS.
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Affiliation(s)
- Meri-Maija Ollila
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Antti Kiviniemi
- Research Unit of Internal Medicine, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Mikko Tulppo
- Research Unit of Internal Medicine, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Katri Puukka
- NordLab Oulu, Department of Clinical Chemistry, University of Oulu and Oulu University Hospital, Medical Research Centre Oulu, Oulu, Finland
| | - Juha Tapanainen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
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29
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Stepto NK, Patten RK, Tassone EC, Misso ML, Brennan L, Boyle J, Boyle RA, Harrison CL, Hirschberg AL, Marsh K, Moreno-Asso A, Redman L, Thondan M, Wijeyaratne C, Teede HJ, Moran LJ. Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough? Sports Med 2019; 49:1143-1157. [PMID: 31166000 PMCID: PMC6905185 DOI: 10.1007/s40279-019-01133-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.
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Affiliation(s)
- Nigel K Stepto
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia.
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia.
- Department Medicine Western Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, VIC, Australia.
| | - Rhiannon K Patten
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Leah Brennan
- School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia
- Centre for Eating, Weight and Body Image, Melbourne, VIC, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Russell A Boyle
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Department of Gynecology and Reproductive Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kate Marsh
- Private Practice, Sydney, NSW, Australia
| | - Alba Moreno-Asso
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
- Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia
| | - Leanne Redman
- Reproductive Endocrinology and Women's Health Laboratory, Clinical Sciences Division Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Mala Thondan
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
- Harp Family Medical Centre, Kew East, VIC, Australia
| | - Chandrika Wijeyaratne
- Faculty of Medicine, University of Colombo and De Soyza Hospital for Women Colombo, Colombo, Sri Lanka
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
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