Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome

Empirical Dietary Inflammatory Pattern is positively associated with polycystic ovary syndrome: A case control study

Polycystic ovary syndrome (PCOS), as the most common endocrine disorder in women of reproductive age, is influenced by various factors. Because there is evidence linking inflammation with chronic diseases, we hypothesized that there is a relationship between an empirical dietary inflammatory pattern score (EDIP) with odds of PCOS among the adult population. This case control study was conducted on Tehranian women in Iran. A total of 494 participants (203 women with PCOS in the case group and 291 healthy people in the control group), aged 18 to 45 years, were recruited for the study. Demographic information, anthropometric indices, physical activity level, and dietary intake were collected by a trained nutritionist. EDIP score was calculated to estimate overall dietary inflammatory potential based on 18 food groups. Statistical analysis was performed with SPSS version 19. Based on the results, the mean age of participants in the case and control groups were 28.98 ± 5.43 and 30.15 ± 6.21 years, respectively. Individuals with PCOS had a significantly higher difference in EDIP score compared with healthy participants (2.03 ± 1.13 vs 1.70 ± 0.93, P < .001). Also, the odds ratio and 95% confidence interval for the risk of PCOS across quartiles of EDIP showed a significant direct relationship (P = .003). In conclusion, our study showed that there was a direct association between PCOS risk and EDIP score. Findings suggest that inflammatory index might be a potential mechanism linking diet and PCOS development.

Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet

BACKGROUND

Hyperandrogenism is among the most common endocrine disorders in women. Clinically, it manifests as hirsutism, acne, and alopecia. A healthy lifestyle, including nutritious dietary patterns and physical activity, may influence the clinical manifestation of the disease. This study determined the effect of a low-glycemic index anti-inflammatory diet on testosterone levels and sex hormone-binding globulin (SHBG) and clinical symptoms in hyperandrogenic women at their reproductive age.

METHODS

The study included 44 overweight and obese women diagnosed with hyperandrogenism. The anthropometrics (weight, height, body mass index, waist circumference, hip circumference), physical activity, and dietary habits were assessed using valid questionnaires, scales, stadiometer, and tape meter. The significant p-value was <0.001. Serum testosterone and SHBG levels were measured using automated immunoassay instruments.

RESULTS

The intervention based on a low-glycemic index diet with anti-inflammatory elements and slight energy deficit decreased total testosterone levels (p<0.003), increased SHBG levels (p<0.001), and decreased the free androgen index (FAI; p<0.001). Post-intervention, overall well-being was much higher than in the pre-intervention period (p<0.001), and stress was diminished (p<0.001). Western nutritional patterns positively correlate with clinical hyperandrogenism progression, whereas several factors of the low-glycemic index diet with anti-inflammatory elements and slight energy deficit positively associate with reduced clinical hyperandrogenism symptoms.

CONCLUSIONS

In overweight and obese women, proper selection of diet, introduction of moderate physical activity, and reduction in weight, stress factors, and alcohol consumption translate into several positive effects, including reduced FAI and symptoms such as acne, hirsutism, menstrual disorders, and infertility.

Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder experienced by women. PCOS is a lifelong condition associated with reproductive, metabolic, and psychological presentations. PCOS is also linked with increased prevalence of cardiometabolic risk factors. While an association between body weight and PCOS has been noted, cardiometabolic risk factors are prevalent in individuals with PCOS across body weights. Currently, no consensus exists as to the most appropriate lifestyle strategy for mitigating cardiometabolic risk in PCOS. A large proportion of the literature is focused on weight loss for individuals with PCOS who are overweight or experience obesity, despite PCOS being prevalent across body sizes. The aim of this narrative review is to assess dietary and lifestyle interventions aimed at reducing cardiometabolic risk in individuals with PCOS across body sizes. A total of 51 articles are included in this review. Overall, randomized controlled trials are limited and most studies focus on weight loss, excluding individuals classified within a healthy body weight range. Studies that modified the dietary pattern without an energy deficit saw improvements in cardiometabolic risk. Thus, less restrictive dietary approaches may be effective at reducing cardiometabolic risk in this population. This review also highlights the need for more sustainable lifestyle interventions that meet the needs of individuals with PCOS of varying body weights.

Androgen-Induced Cardiovascular Risk in Polycystic Ovary Syndrome: The Role of T Lymphocytes

An estimated 15-20% of reproductive-age women are affected by polycystic ovary syndrome (PCOS). PCOS is associated with substantial metabolic and cardiovascular long-term consequences. In young women with PCOS, several cardiovascular risk factors may be found, including chronic inflammation, high blood pressure, and elevated leukocytes. These women are at an increased risk of cardiovascular diseases (CVD), not only during the reproductive years, but also with aging and menopause; therefore, the early prevention and treatment of future cardiovascular adverse effects are necessary. The fundamental characteristic of PCOS is hyperandrogenemia, which is associated with increased pro-inflammatory cytokines and T lymphocytes. Whether these factors play a role in the pathophysiology of hypertension, a risk factor of CVD, due to PCOS is not well established. This review will briefly discuss how a modest increase in androgens in females is linked to the development of hypertension through pro-inflammatory cytokines and T lymphocyte subsets and the promotion of renal injury. Moreover, it reveals a few existing research gaps in this area, including the lack of specific therapy directed at androgen-induced inflammation and immune activation, thus emphasizing the necessity to explore the systemic inflammation in women with PCOS to halt the inevitable inflammatory process targeting the underlying abnormalities of CVD.

Sodium-glucose cotransporter 2 inhibitor ameliorates high fat diet-induced hypothalamic-pituitary-ovarian axis disorders

High-fat diet (HFD) consumption is known to be associated with ovulatory disorders among women of reproductive age. Previous studies in animal models suggest that HFD-induced microglia activation contributes to hypothalamic inflammation. This causes the dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis, leading to subfertility. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of lipid-soluble antidiabetic drugs that target primarily the early proximal tubules in kidney. Recent evidence revealed an additional expression site of SGLT2 in the central nervous system (CNS), indicating a promising role of SGLT2 inhibitors in the CNS. In type 2 diabetes patients and rodent models, SGLT2 inhibitors exhibit neuroprotective properties through reduction of oxidative stress, alleviation of cerebral atherosclerosis and suppression of microglia-induced neuroinflammation. Furthermore, clinical observations in patients with polycystic ovary syndrome (PCOS) demonstrated that SGLT2 inhibitors ameliorated patient anthropometric parameters, body composition and insulin resistance. Therefore, it is of importance to explore the central mechanism of SGLT2 inhibitors in the recovery of reproductive function in patients with PCOS and obesity. Here, we review the hypothalamic inflammatory mechanisms of HFD-induced microglial activation, with a focus on the clinical utility and possible mechanism of SGLT2 inhibitors in promoting reproductive fitness.

The dietary inflammatory index is directly associated with polycystic ovary syndrome: A case-control study

INTRODUCTION

The association between diet and polycystic ovary syndrome (PCOS) might be mediated by the inflammatory properties of the diet. The study aimed to investigate the relationships between the dietary inflammatory index (DII) with odds of PCOS among the adult population.

METHODS

In the hospital-based case-control study, 203 patients with PCOS and 291 non-PCOS controls were enroled. DII was calculated via a validated 147-item quantitative food frequency questionnaire (FFQ). Thirty-six macro- and micronutrients were extracted from FFQ and used to calculate DII. Employing a case-control design, odds ratios (ORs) and 95% confidence intervals (CIs) were obtained, with a dose-response effect confirmed by the test for trend (p for trend).

RESULTS

The mean ± SD age and body mass index (BMI) of the study participants were 29.67 ± 5.92 years and 24.51 ± 4.71 kg/m² , respectively. Compared with controls subjects, PCOS patients had significantly higher weight, BMI, and waist circumferences, but had lower physical activity. PCOS subjects had higher intakes of carbohydrate, cholesterol, and refined grains, but lower intakes of polyunsaturated fatty acids, fibre, vitamin B₁₂ , vitamin D, and dairy as compared to controls. Compared with participants in the lowest quartile of DII, those in the highest quartile had a significantly higher OR for PCOS after further adjustment for potential confounders (OR = 1.75, 95% CI: 0.95-3.22).

CONCLUSION

Our data suggest that high DII was associated with an increased odds of PCOS diagnosis. Prospective dietary intervention studies and observational prospective cohorts are required to confirm these findings.

Dietary Total Antioxidant Capacity and Risk of Polycystic Ovary Syndrome: A Case-Control Study

Among multiple factors that affect the etiology of polycystic ovary syndrome (PCOS), diet has<br />an important contribution. Chronic oxidative stress has also been implicated in the development of PCOS. The<br />present study is an attempt to evaluate dietary total antioxidant capacity (TAC) and its relationship with odds of<br />PCOS in Iran.<br />Materials and Methods: The study was carried out as a case-control study in hospital outpatient clinics, Tehran,<br />Iran. Totally, 310 female participants with a history of PCOS and 602 age-matched controls took part in this<br />study between June 2015 and December 2018. A reproducible and valid 168-item semi-quantitative food frequency<br />inventory was utilized to determine the entire antioxidants of the usual diet in order to calculate dietary<br />TAC. The relationship of dietary TAC with odds of PCOS were assessed adjusting for potential confounders<br />through an estimation of two multivariable conditional regression models. The first tertile was presented as a<br />reference category.<br />Results: In a fully adjusted model, the highest tertile of dietary TAC was associated with a reduced odds of<br />PCOS [odds ratio (OR): 0.81, 95% confidence interval (95% CI): 0.59, 0.96, P for trend: 0.038). In addition, PCOS odds decreased in the highest tertile of α-tocopherol intake (OR: 0.73, 95% CI: 0.56, 0.88, P for trend:<br />0.023). The adjusted ORs in the highest tertile of vitamin C, β-carotene and magnesium were 0.79 (95% CI: 0.83-0.97), 0.81 (95% CI: 0.67-0.98) and 0.91 (95% CI: 0.55-0.9 8) respectively, with a significant trend.<br />Conclusion: Our results provide evidence that there was a relationship between high TAC diets and lower odds of<br />PCOS.

Evaluation of the relationship between serum ferritin and insulin resistance and visceral adiposity index (VAI) in women with polycystic ovary syndrome

PURPOSE

There is a relationship between polycystic ovary syndrome (PCOS) and adipose tissue dysfunction (ADD), but this relationship is not clear. It has been recently shown that iron accumulation in adipose tissue is among the causes of adipose tissue dysfunction. Data on adipose tissue dysfunction in women with PCOS are insufficient. In this study, we aimed to evaluate the relationship between serum ferritin levels (iron accumulation biomarker) and visceral adiposity index (an indicator of adipose tissue dysfunction).

METHODS

The study is a case-control study. Women with diagnosed PCOS with 2003 Rotterdam Diagnostic Criteria (n = 40) were compared with non-PCOS group (n = 40). In this study, the cholesterol ratios, the homeostatic model evaluation index for insulin resistance (HOMA-IR) and the quantitative insulin sensitivity control index were calculated using biochemical parameters, and the visceral adiposity index (VAI) and the lipid accumulation product (LAP) were calculated using both anthropometric and biochemical parameters. In this study, insulin resistance was evaluated by HOMA-IR and adipose tissue dysfunction was evaluated by VAI index.

RESULTS

According to the results of this study, women with PCOS have a worse metabolic status than women without PCOS. However, this has been shown only in overweight and obese women, not in women with normal weight.

CONCLUSION

As a result, the presence of obesity in women with PCOS exacerbates metabolic status.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The Efficacy of an Energy-Restricted Anti-Inflammatory Diet for the Management of Obesity in Younger Adults

There is growing evidence of the dietary impact on obesity-induced low-grade chronic inflammation and the associated chronic non-communicable diseases modification. We determined changes in body composition and cardiometabolic and inflammatory status of participants with obesity after 24 weeks of a dietary intervention based on an energy-reduced anti-inflammatory diet and examined the relationship of these changes with changes in the inflammatory potential of the diet. The anthropometric and body composition parameters of 81 participants (average age of 43 years, 74 women) were assessed. Metabolic status was determined using the glycemic and lipid statuses, and the cardiometabolic index and inflammatory status were determined using the concentration of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α). The inflammatory potential of the diet was assessed using the Dietary Inflammatory Index (DII^®). Intervention with an anti-inflammatory diet resulted in a significant reduction in body weight and visceral adipose tissue and caused improvements in the participants’ cardiometabolic and inflammatory statuses. The anti-inflammatory diet was shown to be effective regarding obesity management. The study data could advance current scientific knowledge in the field of inflammation and diet, provide guidelines for obesity management, and find its application in routine clinical practice.

Diets with lower carbohydrate concentrations improve insulin sensitivity in women with polycystic ovary syndrome: A meta-analysis

OBJECTIVE

Women with polycystic ovary syndrome (PCOS) are associated with increased levels of insulin resistance (IR). Other than treatment with insulin-sensitizing drugs, specialized diets have also been implemented to reduce the patient's IR. However, the capacity of certain diets, concerning with the severity of the patient's IR, to improve insulin sensitivity has not fully been explored. Therefore, we conducted a meta-analysis to determine in PCOS subjects from low to severe IR, if hypocaloric diets improve insulin sensitivity.

STUDY DESIGN

PubMed, SCOPUS, EBSCO, and LILACS databases and retrieved studies' bibliographies were searched for prospective studies that investigated the association between diets and IR in PCOS women until October 2018. Diet was defined as a modification of the patients' nutrition intake according to caloric restriction, change in protein intake, or by using a specialized diet. IR measures (HOMA1-IR), pre- and post-intervention were extracted. Using Comprehensive Meta-Analysis software, depending on the level heterogeneity, determined by the ψ²-based Q-test and the I²-test, fixed-effects or random-effects models were used to calculate the pooled standard paired differences (SPD) and 95 %CI.

RESULTS

20 publications (25 studies) fulfilled the inclusion criteria. Due to the heterogeneity of the diets, the random-effects model was used. In 48 % of the studies, the diets led to a decrease of IR, where 44 % had no effect. In 2 studies, the diets increased IR. Overall, the diets decreased IR (SPD=-0.58; 95 %CI: -0.81 to -0.36). Subjects with severe IR (HOMA1-IR>4.2) had a marked improvement (SPD=-1.22; 95 %CI: -1.61 to -0.84). Moreover, diets low in carbohydrate (<50 %) was also determined to improve IR (SPD=-0.86; 95 %CI: -1.23 to -0.50).

CONCLUSIONS

Here, we demonstrate that diets are more likely to improve IR in PCOS women with severe IR. Therefore, it is crucial to determine a subject's IR status before considering any intervention containing a diet.

Effects of Stachys sylvatica hydroalcoholic extract on the ovary and hypophysis-gonadal axis in a rat with polycystic ovary syndrome

Background

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women. The purpose of this study is to evaluate the effects of Stachys sylvatica hydroalcoholic extract on biochemical and histological parameters in a rat model of polycystic ovary syndrome. Thirty adult female Wistar rats with an average weight of 180 g were divided into five groups of six rats. Animals were divided into groups of control, PCOS (intramuscular injection of 2 mg estradiol valerate, Aburaihan Co., Iran/rat, once), and treated with hydroalcoholic extract of Stachys sylvatica. After 60 days of PCOS induction, 100, 250, and 500 mg/kg BW Stachys sylvatica hydroalcoholic extract were injected intraperitoneally. The control group was just injected with olive oil as a solvent. After 10 days of treatment, animals were weighed and then sacrificed and blood samples were taken from their heart for hormonal studies. Ovaries of all groups were cut for histological studies and fixed in formaldehyde, and 7-μm sections were prepared by microtome and stained using hematoxylin–eosin. The data were analyzed by one-way ANOVA and Tukey-Kramer post hoc test with the SPSS software. The significant level was p < 0.05.

Results

The Stachys sylvatica extract can improve obesity in the PCOS group. The histological and hormonal results showed that PCOS induction can decrease the number of preantral, antral, and Graafian follicles as well as corpus luteum in comparison with the control (p < 0.001), whereas the number of cystic follicles increased significantly (p < 0.001). After treatment with Stachys sylvatica hydroalcoholic extract (500 mg/kg), a significant increase was observed in all these parameters. In addition, the number of cystic follicles decreased significantly (p < 0.001). The level of LH and FSH hormones decreased significantly (p < 0.01) in the PCOS group compared with the control. In contrast, the estrogen level increased significantly (p < 0.01). In the 250 and 500 mg/kg group, treatment with the extract could increase FSH and decrease estrogen concentration significantly relative to the PCOS group (p < 0.01). Results of antral follicle morphometry indicated an increase in follicle diameter and theca thickness, but the thickness of the granulosa layer decreased significantly. An improvement in these measurements was observed in the treated PCOS groups with all doses.

Conclusions

It can be concluded that Stachys sylvatica hydroalcoholic extract can improve some symptoms of polycystic ovary syndrome because of components such as iridoids, flavonoids, and sesquiterpenes with antioxidant and anti-inflammatory effects. In this experiment, 500 mg/kg dose of extract was considered as the most effective dose.

Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome

High carbohydrate intake and low-grade inflammation cooperate with insulin resistance and hyperandrogenism to constitute an interactive continuum acting on the pathophysiology of polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age characterised by oligo-anovulatory infertility and cardiometabolic disorders. The role of insulin in PCOS is pivotal both in regulating the activity of ovarian and liver enzymes, respectively involved in androgen production and in triggering low-grade inflammation usually reported to be associated with an insulin resistance, dyslipidaemia and cardiometabolic diseases. Although an acute hyperglycaemia induced by oral glucose loading may increase inflammation and oxidative stress by generating reactive oxygen species through different mechanisms, the postprandial glucose increment, commonly associated with the Western diet, represents the major contributor of chronic sustained hyperglycaemia and pro-inflammatory state. Together with hyperinsulinaemia, hyperandrogenism and low-grade inflammation, unhealthy diet should be viewed as a key component of the 'deadly quartet' of metabolic risk factors associated with PCOS pathophysiology. The identification of a tight diet-inflammation-health association makes the adoption of healthy nutritional approaches a primary preventive and therapeutic tool in women with PCOS, weakening insulin resistance and eventually promoting improvements of reproductive life and endocrine outcomes. The intriguing nutritional-endocrine connections operating in PCOS underline the role of expert nutritionists in the management of this syndrome. The aim of the present review is to provide an at-a-glance overview of the possible bi-directional mechanisms linking inflammation, androgen excess and carbohydrate intake in women with PCOS.

Cardiometabolic risk in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Besides hyperandrogenism, oligomenorrhea and fertility issues, it is associated with a high prevalence of metabolic disorders and cardiovascular risk factors. Several genetic polymorphisms have been identified for possible associations with cardiometabolic derangements in PCOS. Different PCOS phenotypes differ significantly in their cardiometabolic risk, which worsens with severity of androgen excess. Due to methodological difficulties, longer time-scale data about cardiovascular morbidity and mortality in PCOS and about possible beneficial effects of different treatment interventions is missing leaving many issues regarding cardiovascular risk unresolved.

The role of stress in PCOS

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting a remarkable proportion of premenopausal women. Different studies have shown that stress is widely encountered in women with PCOS. Areas covered: As PCOS is a multifaceted disorder, 'stress' incorporates different translations. We performed a literature review, focusing on the most recent data, regarding the multipotent role of stress in the syndrome. Expert commentary: Stress is believed to be an important component of PCOS. It encompasses different definitions that are all equivalent, like metabolic, inflammatory, oxidative and emotional stress. However, the type of stress that distinguishes PCOS is metabolic stress. It becomes evident early in life and constitutes the pathophysiological heart of the syndrome. Metabolic stress along with the other types of stress are the progenitors of severe long-term health implications, which exacerbate further the reproductive, metabolic and psychological derangements of the syndrome, leading to an endless cycle of chronic illness.