Do trends of adiposity and metabolic parameters vary in women with different ovarian reserve status? A population-based cohort study

Association between anti-mullerian hormone and metabolic syndrome: insights from a prospective community-based study

BACKGROUND

Limited studies have investigated the relationship between Anti-Müllerian hormone (AMH) and metabolic syndrome (MetS), yielding inconclusive results. This study aimed to examine the relationship between AMH levels and MetS and its components in women from a general population.

METHODS

This prospective study recruited 769 women. Generalized Estimating Equation (GEE) models analyzed longitudinal trends of MetS components. Cox proportional hazard models evaluated effect of age-specific AMH tertiles on MetS occurrence, adjusting for confounders.

RESULTS

The GEE analysis indicated that women in the third tertile exhibited higher mean FPG compared to those in the first tertile of age-specific AMH (3 mg/dL; 95% CI: 0.40, 5.60; P = 0.024); however, this association became non-significant after adjustment. Notably, the second tertile showed a significant decrease in FPG mean changes over time (-0.69 mg/dL; 95% CI: -1.31, -0.07; P Interaction = 0.030). Women in the second and third tertiles of age-specific AMH demonstrated lower mean HDL-C compared to the first tertile (-2.96 mg/dL; 95% CI: -4.67, -1.26; P < 0.001 and -2.63 mg/dL; 95% CI: -4.31, -0.96; P = 0.002, respectively). The association between HDL-C changes and the second tertile remained significant after adjustment (-1.91 mg/dL; 95% CI: -3.68, -0.14; P = 0.034). No significant associations were observed between age-specific AMH tertiles and TG and SBP/DBP. Cox models revealed no significant differences in the hazard ratio of MetS between AMH tertiles after adjusting for confounders.

CONCLUSION

Despite minor variations in MetS components, AMH levels did not affect MetS risk in women from a general population.

The association between reproductive history and abdominal adipose tissue among postmenopausal women: results from the Women's Health Initiative

STUDY QUESTION

What is the association between reproductive health history (e.g. age at menarche, menopause, reproductive lifespan) with abdominal adiposity in postmenopausal women?

SUMMARY ANSWER

Higher visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) tissue levels were observed among women with earlier menarche, earlier menopause, and greater parity.

WHAT IS KNOWN ALREADY

Postmenopausal women are predisposed to accumulation of VAT and SAT. Reproductive health variables are known predictors of overall obesity status in women, defined by BMI.

STUDY DESIGN, SIZE, DURATION

This study is a secondary analysis of data collected from the baseline visit of the Women's Health Initiative (WHI). The WHI is a large prospective study of postmenopausal women, including both a randomized trial and observational study. There were 10 184 women included in this analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Data were collected from a reproductive health history questionnaire, dual-energy x-ray absorptiometry scans, and anthropometric measures at WHI baseline. Reproductive history was measured via self-report, and included age at menarche, variables related to pregnancy, and age at menopause. Reproductive lifespan was calculated as age at menopause minus age at menarche. Statistical analyses included descriptive analyses and multivariable linear regression models to examine the association between reproductive history with VAT, SAT, total body fat, and BMI.

MAIN RESULTS AND THE ROLE OF CHANCE

Women who reported early menarche (<10 years) or early menopause (<40 years) had the highest levels of VAT. Adjusted multivariable linear regression results demonstrate women who experienced menarche >15 years had 23 cm2 less VAT (95% CI: -31.4, -14.4) and 47 cm2 less SAT (95% CI: -61.8, -33.4) than women who experienced menarche at age 10 years or earlier. A similar pattern was observed for age at menopause: compared to women who experienced menopause <40 years, menopause at 50-55 years was associated with 19.3 cm2 (95% CI: -25.4, -13.3) less VAT and 27.4 cm2 (-29.6, 10.3) less SAT. High parity (>3 pregnancies) was also associated with VAT and SAT. For example, adjusted beta coefficients for VAT were 8.36 (4.33, 12.4) and 17.9 (12.6, 23.2) comparing three to four pregnancies with the referent, one to two pregnancies.

LIMITATIONS, REASONS FOR CAUTION

The WHI reproductive health history questionnaire may be subject to poor recall owing to a long look-back window. Residual confounding may be present given lack of data on early life characteristics, such as maternal and pre-menarche characteristics.

WIDER IMPLICATIONS OF THE FINDINGS

This study contributes to our understanding of reproductive lifespan, including menarche and menopause, as an important predictor of late-life adiposity in women. Reproductive health has also been recognized as a sentinel marker for chronic disease in late life. Given established links between adiposity and cardiometabolic outcomes, this research has implications for future research, clinical practice, and public health policy that makes use of reproductive health history as an opportunity for chronic disease prevention.

STUDY FUNDING/COMPETING INTEREST(S)

HRB and AOO are supported by the National Institute of Health National Institute of Aging (R01AG055018-04). JWB reports royalties from 'ACSM'S Body Composition Assessment Book' and consulting fees from the WHI. The remaining authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

The Relationship Between Anti-Müllerian Hormone and Body Composition Components in Patients With Polycystic Ovary Syndrome of Reproductive Age

To investigate and analyze the relationship between body composition components, including Body Mass Index (BMI), body fat percentage, waist-to-hip ratio, and visceral fat index, and Anti-Müllerian Hormone (AMH) levels in patients diagnosed with Polycystic Ovary Syndrome (PCOS), The study aims to provide a comprehensive understanding of how various aspects of body composition impact AMH levels. This study enrolled 167 women with PCOS of reproductive age. Serum AMH level and body composition were measured, and the correlation between body composition elements and AMH levels was analyzed. AMH level was negatively correlated with body weight, BMI, fat-free mass, body fat percentage, waist-hip ratio, and visceral fat level (P < 0.01). And negatively correlated with skeletal muscle ratio ( P = 0.003). AMH level remained significantly associated with BMI ( P = 0.028), body fat percentage ( P = 0.040), waist-hip ratio (P = 0.003), and visceral fat level ( P = 0.040) after age was included and a multiple linear regression model was established. After adjusting for age, BMI was still significantly associated with AMH (P = 0.029). At the same time, there was no obvious linear correlation between BSA and AMH. The results showed that AMH levels were significantly different among the three groups (9.53 ± 5.12 vs 6.98 ± 3.35 vs 6.38 ± 3.38, P < 0.001; ng/mL). The level of AMH in the non-central obesity group was higher than that in the central obesity group (9.68 ± 5.22vs7.09 ± 3.83, P < 0.001; ng/mL). In PCOS patients, those who are more obese have lower AMH levels, indicating poorer Ovarian Reserve. BMI may independently affect AMH levels, apart from age, BSA, and other factors. Ovarian function in centrally obese patients is poorer than in those with non-central obesity.

Correlation of AMH with Cardiometabolic Markers in Polycystic Ovarian Syndrome: Systematic Review and Meta-Analysis

Objective

The purpose of this systematic review and meta-analysis was to determine whether there is a connection between polycystic ovarian syndrome (PCOS)-affected women's levels of the anti-Mullerian hormone (AMH) and certain cardiometabolic indicators.

Materials and Methods

To find pertinent recent research published between 2017 and 2023, a thorough search was done in PubMed. Studies were included if they looked into the relationship between PCOS-related women's AMH levels and cardiometabolic markers. To determine pooled effect estimates, data from the included studies were examined using random-effects models.

Results

Five papers were included in the meta-analysis since they satisfied the inclusion requirements. The meta-analysis found substantial positive relationships between AMH levels and markers of insulin resistance, fasting blood sugar levels, and dyslipidemia measures such as total cholesterol (SMD: 0.68, 95% confidence interval: 0.34-1.00, P < 0.001).

Conclusion

This systematic review and meta-analysis show that AMH levels in PCOS-affected women significantly positively correlate with markers of insulin resistance, fasting glucose levels, and dyslipidemia parameters. These findings imply that the pathogenesis of the cardiometabolic abnormalities seen in PCOS may include AMH. AMH may be used as a biomarker to estimate the cardiometabolic risk in PCOS-affected women, but more studies are required to determine its clinical applicability.

Anti-Mullerian hormone and cardiometabolic status: a systematic review

BACKGROUND

To summarise the relationship between Anti-mullerian hormone (AMH) levels and cardiometabolic status in different populations.

METHODS

PubMed, Scopus, and Embase were searched for retrieving observational studies published up to February 2022 investigating the relationship between AMH level and cardiometabolic status.

RESULTS

Of 3,643 studies retrieved from databases, a total of 37 observational studies were included in this review. The majority of the included studies revealed an inverse association between AMH and lipid profiles, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and a positive correlation with high-density lipoprotein (HDL). While some studies have revealed a significant inverse association between AMH and glycemic parameters, including fasting plasma glucose (FPG), fasting insulin, and HOMA-IR, others found no such relationships. There is also an inconsistency among studies regarding the association of AMH with adiposity indices and blood pressure. Evidence indicates a significant association between AMH and some vascular markers, such as intima-media thickness and coronary artery calcification. Of 3 studies evaluating the relationship between AMH and cardiovascular events, two studies showed an inverse relationship between AMH levels and cardiovascular (CVD), whereas another study showed no significant association.

CONCLUSIONS

The results of this systematic review suggest that serum AMH levels can be associated with CVD risk. This may provide new insight into the use of AMH concentrations as a predictive marker for assessing the risk of cardiovascular disease, although more well-design longitudinal studies are still necessary for this area. Future studies on this topic will hopefully provide an opportunity to run a meta-analysis; it will increase the persuasiveness of this interpretation.

Does the addition of serum antimüllerian hormone concentrations to the Framingham Risk Score and Pooled Cohort Equations improve the prediction of cardiovascular disease?

The present study revealed that the addition of serum antimüllerian hormone concentrations to Framingham Risk Score and Pooled Cohort Equations could potentially improve the risk prediction of cardiovascular disease.

Objective

The current study aimed to examine the added value of serum antimüllerian hormone (AMH) concentration to the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) in predicting the risk of cardiovascular disease (CVD) in women of reproductive age.

Methods

Women 30 years and older were considered eligible for this population-based prospective study. The univariate and multivariate Cox proportional hazard models were used to evaluate the association between the serum concentrations of AMH and the risk of CVD.

Results

In the enhanced model, which integrated AMH into FRS and PCE and was adjusted for family history of premature CVD, AMH showed a significant association with the risk of CVD during a 19-year follow-up of 800 women (hazard ratio, 0.77 [95% CI, 0.60-0.99] and hazard ratio, 0.64 [95% CI, 0.48-0.84], respectively). According to the likelihood-ratio test, the addition of AMH measurements to FRS and PCE could significantly improve the risk prediction of CVD (P = 0.02 and P < 0.001, respectively); however, the integration of this biomarker did not improve the classification of risk categories.

Conclusions

The present findings revealed that the addition of serum AMH concentrations to FRS and PCE could potentially improve the risk prediction of CVD.

Antimüllerian hormone and adiposity across midlife among women in Project Viva

OBJECTIVE

This study aimed to examine the association of antimüllerian hormone (AMH) with concurrent and prospective measures of adiposity during approximately 9 years of follow-up.

METHODS

Participants were 697 parous women from the Project Viva prebirth cohort without polycystic ovarian syndrome. We measured AMH at approximately 3 years postpartum (baseline). Outcomes were weight, body mass index (BMI), and waist circumference assessed at baseline, 4, and 9 years later; % body fat was assessed by bioimpedance at the 4- and 9-year visit. We used linear mixed-effect models including all outcome time points and accounting for age across follow-up and hormonal contraception prescription. In an additional model, we further adjusted for height.

RESULTS

Median AMH was 1.97 ng/mL (interquartile range, 0.83-4.36 ng/mL), 29.1% had AMH <1.0 ng/mL, and mean age at AMH measurement was 36.7 years (SD, 4.9 y; range, 20-48 y). AMH was inversely associated with average weight, BMI, and waist circumference over follow-up. In age-adjusted models, women with AMH <1.0 versus ≥1.0 ng/mL were 4.92 kg (95% CI, 2.01-7.82 kg) heavier, had a 2.51 cm (95% CI, 0.12-4.89 cm) greater waist circumference, and a 1.46 kg/m 2 (95% CI, 0.44-2.48 kg/m 2 ) greater BMI across the 9 years of follow-up. Findings were similar after covariate adjustment and when AMH was modeled continuously. AMH was also inversely associated with higher fat mass %; however, the CI crossed the null.

CONCLUSION

Low AMH at baseline was associated with greater adiposity concurrently and across approximately 9 years of follow-up. Whether low AMH is a useful marker of metabolic risk across midlife requires further research.

Mitochondrial Dysfunction in Obesity and Reproduction

Mounting evidence suggests a role for mitochondrial dysfunction in the pathogenesis of many diseases, including type 2 diabetes, aging, and ovarian failure. Because of the central role of mitochondria in energy production, heme biosynthesis, calcium buffering, steroidogenesis, and apoptosis signaling within cells, understanding the molecular mechanisms behind mitochondrial dysregulation and its potential implications in disease is critical. This review will take a journey through the past and summarize what is known about mitochondrial dysfunction in various disorders, focusing on metabolic alterations and reproductive abnormalities. Evidence is presented from studies in different human populations, and rodents with genetic manipulations of pathways known to affect mitochondrial function.