Leptin involvement in reproductive performance

A heliocentric view of leptin

Leptin is significantly broadening our understanding of the mechanisms underlying neuroendocrine function. Initially, based on a rather static view of the hormone, most investigations focused on the effects of leptin on food intake control and body-weight homeostasis, with attention primarily focused on the implications of leptin as a lipostatic factor and central satiety agent. However, the almost ubiquitous distribution of leptin receptors in peripheral tissues provided a fertile area for investigation and a more dynamic view of leptin started to unfold. This adipocyte-derived circulating peptidic hormone, with a tertiary structure resembling that of members of the long-chain helical cytokine family, has generated an enormous interest in the interaction as well as integration between brain targets and peripheral signals. Considerable evidence for systemic effects of leptin on specific tissues and metabolic pathways indicates that leptin operates both directly and indirectly to orchestrate complex pathophysiological processes. Disentangling the biochemical and molecular mechanisms in which leptin is involved represents one of the major challenges ahead.

Maternal nutritional status is inversely associated with lactational amenorrhea in Sub-Saharan Africa: results from demographic and health surveys II and III

Breast-feeding is positively associated with the duration of postpartum amenorrhea; thus it is a major determinant of fertility in countries where effective contraceptive methods are not widely available. The objective of these analyses was to examine the association between maternal nutritional status and lactational amenorrhea (LA) among breast-feeding women. Women who were not pregnant, who were breast-feeding, who were not using hormonal contraceptives and who had a child </=2 y old at the time of survey were included in the analyses. Multivariate logistic regression was used to examine this association with the use of Demographic and Health Surveys data collected in seven Sub-Saharan African countries between 1990 and 1994. Analyses were adjusted for nine confounders, including breast-feeding behavior, child nutritional status and child age. Within-country analyses consistently showed the trend of low maternal body mass index (BMI) associated with a higher likelihood of being amenorrheic. Pooled analyses (n = 9839) were performed using two child age groups (<9 mo and 9-24 mo). The <9 mo pooled analysis showed that women with BMI < 18.5 kg/m2 (odds ratio; 95% confidence interval: 1.6; 1.2-2.3) were more likely to remain amenorrheic at the time of the survey than their "better-nourished" counterparts. The 9-24 mo pooled analysis showed that the differential probability of being amenorrheic between undernourished and "better-nourished" women increased with time postpartum, where the adjusted difference in the median duration of amenorrhea associated with maternal nutritional status among breast-feeding women was 1.4 mo. These results suggest that maternal nutritional status plays an independent role in the return of ovulation after delivery.

Leptin: physiology and pathophysiology

The identification and sequencing of the ob gene and its product, leptin, in late 1994 opened new insights in the study of the mechanisms controlling body weight and led to a surge of research activity. During this time, a considerable body of knowledge regarding leptin's actions has been accumulated and the field continues to expand rapidly. Currently there is particular interest in the interaction of leptin with other peripheral and neural mechanisms to regulate body weight, reproduction and immunological response. In this review, we attempt to place the current state of knowledge about leptin in the broader perspective of physiology, including its structural characteristics, receptors, binding proteins, signalling pathways, regulation of adipose tissue expression and production, secretion patterns, clearance mechanisms and functional effects. In addition, leptin's involvement in the pathophysiology of obesity, anorexia nervosa, diabetes mellitus, polycystic ovary syndrome, acquired immunodeficiency syndrome, cancer, nephropathy, thyroid disease, Cushing's syndrome and growth hormone deficiency will be reviewed.