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Amisi CA. Markers of insulin resistance in Polycystic ovary syndrome women: An update. World J Diabetes 2022; 13:129-149. [PMID: 35432749 PMCID: PMC8984569 DOI: 10.4239/wjd.v13.i3.129] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/14/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 5%-10% of women of reproductive age. The importance of this syndrome lies in the magnitude of associated comorbidities: infertility, metabolic dysfunction, cardiovascular disease (CVD), plus psychological and oncological complications. Insulin resistance (IR) is a prominent feature of PCOS with a prevalence of 35%-80%. Without adequate management, IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS. Furthermore, epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance, gestational diabetes mellitus and type 2 diabetes. In addition, metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS. Indeed, the severity of IR in women with PCOS is associated with the amount of abdominal obesity, even in lean women with PCOS. Given these drastic implications, it is important to diagnose and treat insulin resistance as early as possible. Many markers have been proposed. However, quantitative assessment of IR in clinical practice remains a major challenge. The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp. However, it is not used routinely because of the complexity of its procedure. Consequently, there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations. Despite this, many of them are either difficult to apply in routine clinical practice or useless for women with PCOS. Considering this difficulty, there is still a need for an accurate marker for easy, early detection and assessment of IR in women with PCOS. This review highlights markers of IR already used in women with PCOS, including new markers recently reported in literature, and it establishes a new classification for these markers.
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Affiliation(s)
- Chantal Anifa Amisi
- Endocrinology and Diabetes Unit, Department of Medicine, Universita Campus Bio-medico di Rome, Rome 00128, Italy
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Foroozanfard F, Asemi Z, Bazarganipour F, Taghavi SA, Allan H, Aramesh S. Comparing pregnancy, childbirth, and neonatal outcomes in women with different phenotypes of polycystic ovary syndrome and healthy women: a prospective cohort study. Gynecol Endocrinol 2020; 36:61-65. [PMID: 31264483 DOI: 10.1080/09513590.2019.1631278] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The aim of this study was to compare pregnancy, childbirth, and neonatal outcomes in women with different phenotypes of polycystic ovary syndrome (PCOS) with healthy women. A prospective cohort study from the beginning to the end of pregnancy for 41 pregnant women with PCOS (case) and 49 healthy pregnant women (control) was completed. Based on the presence or absence of menstrual dysfunction (M), hyperandrogenism (HA), and polycystic ovaries (PCO) on ultrasound, the PCOS (case) group were divided into three phenotypes (HA + PCO (n = 22), M + PCO (n = 9), HA + M+PCO (n = 10). Pre-eclampsia, gestational diabetes, and lower birth weight among newborns were significantly higher in the PCOS case group compared to the control group especially in the phenotype HA + M+PCO (p < .05). High BMI (β = 2.40; p=.03) was the strongest predictor of pre-eclampsia in patients with PCOS. High androgen levels (free androgen index) (β = 13.71, 3.02; p < .05), was the strongest predictor of developing diabetes during pregnancy and reduced birth weight baby, respectively.These results suggest that PCOS, particularly in phenotype HA + M+PCO (p < .05), is a risk factor for adverse pregnancy and neonatal outcomes including gestational diabetes, pre-eclampsia, and reduced weight babies.
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Affiliation(s)
- Fatemeh Foroozanfard
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Abdolvahab Taghavi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Helen Allan
- Centre for Critical Research in Nursing & Midwifery, School of Health & Education, Middlesex University, London, UK
| | - Shahintaj Aramesh
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
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Bilal M, Haseeb A, Rehman A. Relationship of Polycystic Ovarian Syndrome with Cardiovascular Risk Factors. Diabetes Metab Syndr 2018; 12:375-380. [PMID: 29396250 DOI: 10.1016/j.dsx.2018.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. The two main documented pathogenic mechanisms are hyperinsulinemia and hyperandrogenemia but there is growing evidence for increased predisposition to cardiovascular disease, dyslipidemia, and type 2 diabetes mellitus. Our study aims to analyze the association of PCOS with cardiovascular risk factors. METHODS This is a prospective study which targeted 100 PCOS patients from Civil Hospital Karachi over a period of one year (July 2016 to July 2017). An equal number of age-matched healthy control participants were also included in the study. The student's t-test was used to assess the significance of differences using SPSS version (19). The statistical significance was set at a p-value of <.05. RESULTS The most frequently presented feature associated with PCOS was primary infertility seen in 72% of the patients. Mean arterial pressure, fasting glucose and insulin levels and insulin resistance was found to be significantly different in PCOS patients as compared to their controls. A classic atherosclerotic lipid profile demonstrating elevated total cholesterol and low-density lipoprotein-C (LDL-C) levels and decreased serum high density lipoprotein-C(HDL-C) was observed in our study. CONCLUSION This study established a significant yet independent association of PCOS with major cardiovascular risk factors. This association can effectively progress into CVD outcomes which necessitates early intervention programs and preventative strategies to reduce mortality from cardiovascular events. This study lays out the framework for conducting further researches on the PCOS women while exploring novel cardiovascular risk factors.
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Affiliation(s)
| | - Abdul Haseeb
- Aga Khan University Hospital, Karachi, Pakistan.
| | - Abdur Rehman
- Dow University Of Health Sciences, Karachi, Pakistan.
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Maxel T, Svendsen PF, Smidt K, Lauridsen JK, Brock B, Pedersen SB, Rungby J, Larsen A. Expression Patterns and Correlations with Metabolic Markers of Zinc Transporters ZIP14 and ZNT1 in Obesity and Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2017; 8:38. [PMID: 28303117 PMCID: PMC5332389 DOI: 10.3389/fendo.2017.00038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 02/14/2017] [Indexed: 12/29/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is associated with infertility, increased androgen levels, and insulin resistance. In adipose tissue, zinc facilitates insulin signaling. Circulating zinc levels are altered in obesity, diabetes, and PCOS; and zinc supplementation can ameliorate metabolic disturbances in PCOS. In adipose tissue, expression of zinc influx transporter ZIP14 varies with body mass index (BMI), clinical markers of metabolic syndrome, and peroxisome proliferator-activated receptor gamma (PPARG). In this study, we investigated expression levels of ZIP14 and PPARG in subcutaneous adipose tissue of 36 PCOS women (17 lean and 19 obese women) compared with 23 healthy controls (7 lean and 16 obese women). Further, expression levels of zinc transporter ZIP9, a recently identified androgen receptor, and zinc efflux transporter ZNT1 were investigated, alongside lipid profile and markers of glucose metabolism [insulin degrading enzyme, retinol-binding protein 4 (RBP4), and glucose transporter 4 (GLUT4)]. We find that ZIP14 expression is reduced in obesity and positively correlates with PPARG expression, which is downregulated with increasing BMI. ZNT1 is upregulated in obesity, and both ZIP14 and ZNT1 expression significantly correlates with clinical markers of altered glucose metabolism. In addition, RBP4 and GLUT4 associate with obesity, but an association with PCOS as such was present only for PPARG and RBP4. ZIP14 and ZNT1 does not relate to clinical androgen status and ZIP9 is unaffected by all parameters investigated. In conclusion, our findings support the existence of a zinc dyshomeostasis in adipose tissue in metabolic disturbances including PCOS-related obesity.
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Affiliation(s)
- Trine Maxel
- Faculty of Health, Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Pernille Fog Svendsen
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Kamille Smidt
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Birgitte Brock
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Bønlykke Pedersen
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology (MEA), Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Rungby
- Center for Diabetes Research, Department of Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Agnete Larsen
- Faculty of Health, Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Paul C, Laganà AS, Maniglio P, Triolo O, Brady DM. Inositol's and other nutraceuticals' synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome: state-of-the-art and future perspectives. Gynecol Endocrinol 2016; 32:431-8. [PMID: 26927948 DOI: 10.3109/09513590.2016.1144741] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The incidence of metabolic syndrome (MetS), type II diabetes (T2D) and polycystic ovarian syndrome (PCOS) has been progressively increasing. Insulin resistance (InsR) seems to play a key role in a majority of phenotypes of these conditions, altering metabolic homeostasis, within muscle, liver, adipose and other tissues. Hyperinsulinemia is often associated with InsR and causes hormonal imbalances especially within ovaries and adrenals. Inositol is a polyalcohol, naturally occurring as nine stereoisomers, including D-chiro-inositol (DCI) and myo-inositol (MI), which have prominent roles in the metabolism of glucose and free fatty acids. MI and DCI have been classified as insulin-sensitizers and seem to adequately counteract several InsR-related metabolic alterations with a safe nutraceutical profile. Based on our analysis of selected studies that investigated MI and/or DCI, we conclude that supplementation with MI and/or DCI complement each other in their metabolic actions and act in synergy with other insulin sensitizing drugs and/or nutraceuticals. Nevertheless, considering the possible severe bias due to different methodologies across published studies, we conclude that there is a need for further studies on larger cohorts and with greater statistical power. These should further clarify outcomes and suitable therapeutic dosages of MI and DCI, possibly based on each patient's clinical status.
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Affiliation(s)
- Cristiana Paul
- a Independent Nutrition Research Consultant , Los Angeles, CA , USA
| | - Antonio Simone Laganà
- b Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina , Messina , Italy
| | - Paolo Maniglio
- c Department of Obstetrics, Gynecology and Urology, Sant'Andrea Hospital , Sapienza University of Rome , Rome , Italy , and
| | - Onofrio Triolo
- b Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina , Messina , Italy
| | - David M Brady
- d Human Nutrition Institute, University of Bridgeport , Bridgeport, CT , USA
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Yildizhan B, Anik Ilhan G, Pekin T. The impact of insulin resistance on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome. J OBSTET GYNAECOL 2016; 36:893-896. [PMID: 27140180 DOI: 10.3109/01443615.2016.1168376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was performed to assess insulin resistance (IR) in lean women with polycystic ovary syndrome (PCOS). Retrospective analysis of 100 consecutive lean (body mass index <25 kg/m2) PCOS subjects was performed. Subjects were divided into two groups according to homeostasis model assessment IR index (HOMA-IR), as IR + and IR-. A HOMA-IR value >2.5 was used to indicate IR. A total of 100 lean PCOS subjects were enrolled in the study, of which 47% were insulin resistant. Comparison of group means showed significantly higher values for waist-to-hip ratio (WHR), diastolic blood pressure and Ferriman-Gallwey score (FGS) in IR + group. HOMA-IR values were found to be positively correlated with WHR (r = 0.500, p < 0.01), systolic blood pressure (r = 0.265, p < 0.01), diastolic blood pressure (r = 0.273, p < 0.01), estradiol levels (r = 0.218, p < 0.05), FGS (r = 0.456, p < 0.01) and total testosterone levels (r = 0.291, p < 0.01). When evaluating PCOS subjects, the insulin resistant group should be separated as unique and IR should also be evaluated in lean women with PCOS.
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Affiliation(s)
- Begum Yildizhan
- a Department of Obstetrics and Gynecology , Marmara University , Istanbul , Turkey
| | - Gokce Anik Ilhan
- a Department of Obstetrics and Gynecology , Marmara University , Istanbul , Turkey
| | - Tanju Pekin
- a Department of Obstetrics and Gynecology , Marmara University , Istanbul , Turkey
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Iwata MC, Porquere L, Sorpreso ICE, Baracat EC, Soares Júnior JM. Association of oral contraceptive and metformin did not improve insulin resistance in women with polycystic ovary syndrome. Rev Assoc Med Bras (1992) 2015; 61:215-9. [PMID: 26248242 DOI: 10.1590/1806-9282.61.03.215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE OBJECTIVE to compare clinical and laboratory parameters in women with polycystic ovary syndrome (PCOS) using metformin or combined oral contraceptive (COC) after 6 months. METHODS retrospective study analyzing records of patients with PCOS using the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society criteria. The groups were: I-COC (21 tablets, pause of 7 days; n=16); II-metformin (850 mg 12/12h, n=16); III-COC plus metformin (n=9). Body mass index (BMI), acne (% of improvement), modified Ferriman-Gallway index and menstrual cycle index (MCI), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), androstenedione (A) and homeostasis model assessment: insulin resistance (HOMA-IR) index were assessed Results: isolated use of COC compared to metformin was better regarding to acne, Ferriman index, MCI, LH, TT and A levels. On the other hand, metformin was better in the HOMA-IR index (4.44 and 1.67 respectively, p=0.0007). The association COC plus metformin, compared to metformin alone shows the maintenance of improvement of acne, Ferriman index, MCI, and testosterone levels. The HOMA-IR index remained lower in the metformin alone group (4.19 and 1.67, respectively; p=0,046). The comparison between COC plus metformin and COC alone, in turn, shows no difference in the improvement of acne, Ferriman index, MCI, LH, TT and A levels, indicating that the inclusion of metformin did not lead to additional benefits in these parameters. Still, the HOMA-IR index was similar in both groups (4.19 and 4.44 respectively; p=0.75), showing that the use of metformin associated with COC may not improve insulin resistance as much as it does if used alone. CONCLUSION our data suggest that the combination of metformin and contraceptive does not improve insulin resistance as observed with metformin alone.
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Affiliation(s)
- Margareth Chiharu Iwata
- Department of Gynecological Endocrinology, Gynecology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Aziz M, Sidelmann JJ, Faber J, Wissing MLM, Naver KV, Mikkelsen AL, Nilas L, Skouby SO. Polycystic ovary syndrome: cardiovascular risk factors according to specific phenotypes. Acta Obstet Gynecol Scand 2015; 94:1082-9. [PMID: 26123797 DOI: 10.1111/aogs.12706] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 06/23/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is associated with obesity and insulin resistance. The objective of this cross-sectional study was to investigate the impact of insulin resistance and body mass index (BMI) on inflammatory and hemostatic variables associated with long-term risk of cardiovascular disease in women with PCOS. MATERIAL AND METHODS 149 premenopausal women with PCOS were recruited consecutively from April 2010 to February 2012 at three Danish University Hospitals. The study was conducted at the Department of Gynecology and Obstetrics, Herlev University Hospital, Denmark. PCOS was diagnosed in accordance with the Rotterdam criteria and the women were classified into four phenotypes according to BMI and insulin resistance measured by the homeostasis model assessment of insulin resistance index. Body composition was determined by dual-energy X-ray absorptiometry. Main outcome measures were the biomarkers C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), and von Willebrand factor antigen. RESULTS Normal weight insulin-resistant PCOS women were characterized by abdominal obesity and elevated levels of plasma PAI-1. Overweight/obese insulin-resistant PCOS women had increased levels of both PAI-1 and CRP. Of the three Rotterdam criteria, only hyperandrogenemia was significantly associated with the hemostatic risk marker of long-term cardiovascular disease risk. CONCLUSIONS Surrogate risk markers for cardiovascular disease are elevated in women with PCOS, especially insulin-resistant and overweight/obese women.
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Affiliation(s)
- Mubeena Aziz
- Department of Gynecology and Obstetrics, Faculty of Health and Medical Sciences, Copenhagen University, Herlev University Hospital, Herlev, Denmark
| | - Johannes J Sidelmann
- Unit for Thrombosis Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Faber
- Department of Endocrinology, Faculty of Health and Medical Sciences, Copenhagen University, Herlev University Hospital, Herlev, Denmark
| | - Marie-Louise M Wissing
- Department of Gynecology and Obstetrics, Faculty of Health and Medical Sciences, Copenhagen University, Holbaek University Hospital, Holbaek, Denmark
| | - Klara V Naver
- Department of Gynecology and Obstetrics, Faculty of Health and Medical Sciences, Copenhagen University, Hvidovre University Hospital, Hvidovre, Denmark
| | - Anne-Lis Mikkelsen
- Department of Gynecology and Obstetrics, Faculty of Health and Medical Sciences, Copenhagen University, Holbaek University Hospital, Holbaek, Denmark
| | - Lisbeth Nilas
- Department of Gynecology and Obstetrics, Faculty of Health and Medical Sciences, Copenhagen University, Hvidovre University Hospital, Hvidovre, Denmark
| | - Sven O Skouby
- Department of Gynecology and Obstetrics, Faculty of Health and Medical Sciences, Copenhagen University, Herlev University Hospital, Herlev, Denmark
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Techatraisak K, Chayachinda C, Wongwananuruk T, Dangrat C, Indhavivadhana S, Rattanachaiyanont M, Thongnoppakhun W. No association between CYP17 -34T/C
polymorphism and insulin resistance in Thai polycystic ovary syndrome. J Obstet Gynaecol Res 2015; 41:1412-7. [DOI: 10.1111/jog.12733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/26/2015] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kitirat Techatraisak
- Division of Gynaecologic Endocrinology Department of Obstetrics and Gynaecology; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Chenchit Chayachinda
- Division of Gynaecologic Endocrinology Department of Obstetrics and Gynaecology; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Thanyarat Wongwananuruk
- Division of Gynaecologic Endocrinology Department of Obstetrics and Gynaecology; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Chongdee Dangrat
- Division of Gynaecologic Endocrinology Department of Obstetrics and Gynaecology; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Suchada Indhavivadhana
- Division of Gynaecologic Endocrinology Department of Obstetrics and Gynaecology; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Manee Rattanachaiyanont
- Division of Gynaecologic Endocrinology Department of Obstetrics and Gynaecology; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Wanna Thongnoppakhun
- Division of Molecular Genetics, Department of Research and Development; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
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Jamil AS, Alalaf SK, Al-Tawil NG, Al-Shawaf T. A case-control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. Reprod Health 2015; 12:7. [PMID: 25595199 PMCID: PMC4417246 DOI: 10.1186/1742-4755-12-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/09/2015] [Indexed: 01/08/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is associated with an increased risk of insulin resistance (IR), metabolic syndrome (MetS), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Metabolic aspects of the four PCOS phenotypes remain to be fully defined. The aim of this study was to compare metabolic parameters and insulin resistance among the four PCOS phenotypes defined according to the Rotterdam criteria and to determine predictors of these complications. Methods A total of 526 reproductive-aged women were included in this observational case–control study. Of these, 263 were diagnosed as a PCOS based on Rotterdam criteria and 263 infertile women with no evidence of PCOS were recruited as controls. Biochemical, metabolic and insulin resistance parameters were compared in the two groups and the frequency of MetS and IR were compared among the four phenotypes. Data were analyzed for statistical significance using Student’s t-test and one way analysis of variance followed by a post-hoc test (least significant difference). Chi-square tests were used to compare proportions. Univariate and multivariate logistic regression analyses were also applied. Results IR was identified in 112 (42.6%) of the PCOS women and 45 (17.1%) of the control (P <0.001). There were no significant differences in the frequency of IR and MetS between the four PCOS phenotypes. Homeostatic model assessment for IR (HOMA-IR) ≥3.8 was the most common IR parameter in PCOS and control groups. Women with oligo-anovulation (O) and PCO morphology (P) had a significantly lower level of 2-h postprandial insulin compared to women with O, P and hyperandrogenism (H) phenotypes. Logistic regression analysis showed that body mass index, waist circumference, triglyceride/high-density lipoprotein ratio (cardiovascular risk), HOMA-IR and glucose abnormalities (T2DM) were associated with increased risk of having MetS (P < 0.05). Conclusions PCOS women with (O + P) show milder endocrine and metabolic abnormalities. Although, there were no significant differences in IR, MetS and glucose intolerance between the four PCOS phenotypes, women with PCOS are at higher risk of impaired glucose tolerance and undiagnosed diabetes.
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Affiliation(s)
- Avin S Jamil
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, P.O. Box 383-65, Erbil, Iraq.
| | - Shahla K Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, P.O. Box 383-65, Erbil, Iraq.
| | - Namir G Al-Tawil
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
| | - Talha Al-Shawaf
- Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and The London Medical College, Queen Mary University, London, UK. .,Department of Primary Care and Public Health, Imperial College, London, UK.
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Spits C, Guzman L, Mertzanidou A, Jacobs K, Ortega-Hrepich C, Gilchrist RB, Thompson JG, De Vos M, Smitz J, Sermon K. Chromosome constitution of human embryos generated after in vitro maturation including 3-isobutyl-1-methylxanthine in the oocyte collection medium. Hum Reprod 2014; 30:653-63. [PMID: 25475586 DOI: 10.1093/humrep/deu329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
STUDY QUESTION Do cleavage-stage embryos obtained from oocytes matured in vitro after pre-incubation with a phosphodiesterase inhibitor (IBMX) carry more chromosomal abnormalities than those generated from oocytes matured in vivo? SUMMARY ANSWER The rate and type of chromosomal abnormalities in normally developing cleavage-stage embryos generated with an in vitro maturation (IVM) system including pre-incubation with IBMX are not different from those observed in supernumerary embryos obtained from oocytes matured in vivo. WHAT IS KNOWN ALREADY Very limited information is available about the chromosomal constitution of IVM embryos. Previous studies were carried out using FISH on single biopsied blastomeres or arrested whole embryos and only provided fragmentary information on chromosomal abnormalities in IVM embryos. There is no systematic study of chromosomal abnormalities in all blastomeres of human Day 3 embryos with good morphology. STUDY DESIGN, SIZE, DURATION Between July 2012 and December 2012, 16 young (age <35 years old) egg donors underwent 18 IVM cycles for the generation of research embryos. Eighteen embryos developed to Day 3 and were analysed using array comparative genomic hybridization (aCGH). PARTICIPANTS/MATERIALS, SETTING, METHODS Immature oocytes were retrieved from 2 to 10 mm follicles after mild ovarian stimulation with gonadotrophins but without hCG ovulation trigger. At collection, oocytes were pre-incubated with 3-isobutyl-1-methylxanthine (IBMX), a phosphodiesterase inhibitor and matured in vitro. After IVM culture, mature oocytes were microinjected with sperm from a single donor. Embryos were cultured to Day 3 after ICSI and all blastomeres of 18 good-morphology embryos were collected individually for aCGH. MAIN RESULTS AND THE ROLE OF CHANCE Oocyte maturation rate in vitro was 50.2% (120/239). The mean fertilization rate was 68.3% (82/120) and 30.5% (25/82) of fertilized oocytes developed into a morphologically good quality embryo on Day 3 after ICSI. Of these, 18 embryos that developed well up to Day 3 were analysed using aCGH. Eighty of the 123 blastomeres analysed showed at least one chromosomal abnormality. Three out of eighteen embryos had completely normal cells. A single embryo carried a meiotic abnormality, 11 embryos were mosaic and three were chaotic. Although the aneuploidy data of this study are too limited to allow statistical analysis, these data are comparable to our own published data on the chromosome constitution of whole day 3 and day 4 embryos after conventional ART. LIMITATIONS, REASONS FOR CAUTION Array CGH technology determines relative quantification of chromosomal domains but does not allow for the visualization of chromosomal rearrangements, assessment of ploidy or detection of uniparental isodisomy. Conclusions drawn on segmental abnormalities should be treated with caution. Although the limited number of embryos analysed here precludes firm conclusions, they provide valuable data on possible causes of the reduced potential of IVM embryos. WIDER IMPLICATIONS OF THE FINDINGS This is the first study to describe the complete chromosome complement of all single blastomeres of good-morphology day 3 embryos obtained with IVM (including the presence of IBMX in a pre-incubation medium). The results demonstrate that a high proportion of good-morphology embryos are aneuploid and that there is no obvious increase in aneuploidies as a result of IVM which seems to suggest that the reduced efficiency of IVM technology compared with standard IVF may be accounted for by factors other than aneuploidy, such as cytoplasmic defects or reduced endometrial receptivity. STUDY FUNDING/COMPETING INTERESTS This study was funded by the TBM (Applied Biomedical Research with Societal Finality) programme of the IWT (Agency for Innovation through Science and Technology - Flanders, 110680) and by a Methusalem grant of the Vrije Universiteit Brussel. C.S. is a post-doctoral fellow of the Fund for Scientific Research Flanders (FWO - Vlaanderen). K.J. is a PhD student funded by the FWO. The University of Adelaide owns a patent family associated with IVM technologies that is licensed to Cook Medical. R.B.G. and J.G.T. are inventors. The remaining authors have no conflict of interest to declare.
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Affiliation(s)
- C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, 1090 Brussels, Belgium Centre for Reproductive Medicine, UZ Brussel, 1090 Brussels, Belgium
| | - L Guzman
- Research Group Follicle Biology, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - A Mertzanidou
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, 1090 Brussels, Belgium Centre for Reproductive Medicine, UZ Brussel, 1090 Brussels, Belgium
| | - K Jacobs
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, 1090 Brussels, Belgium Centre for Reproductive Medicine, UZ Brussel, 1090 Brussels, Belgium
| | - C Ortega-Hrepich
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, 1090 Brussels, Belgium Centre for Reproductive Medicine, UZ Brussel, 1090 Brussels, Belgium
| | - R B Gilchrist
- Discipline of Obstetrics & Gynaecology, School of Women's & Children's Health, University of New South Wales, Sydney, Australia
| | - J G Thompson
- Robinson Research Institute, School of Paediatrics and Reproductive Health, ARC Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, Australia
| | - M De Vos
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, 1090 Brussels, Belgium Centre for Reproductive Medicine, UZ Brussel, 1090 Brussels, Belgium Research Group Follicle Biology, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - J Smitz
- Research Group Follicle Biology, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, 1090 Brussels, Belgium Centre for Reproductive Medicine, UZ Brussel, 1090 Brussels, Belgium
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Hosseinpanah F, Barzin M, Keihani S, Ramezani Tehrani F, Azizi F. Metabolic aspects of different phenotypes of polycystic ovary syndrome: Iranian PCOS Prevalence Study. Clin Endocrinol (Oxf) 2014; 81:93-9. [PMID: 24428207 DOI: 10.1111/cen.12406] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 11/28/2013] [Accepted: 01/08/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare insulin resistance (IR) and metabolic characteristics of different phenotypes of polycystic ovary syndrome (PCOS) and healthy controls in a representative sample of reproductive-aged Iranian women. DESIGN Cross-sectional community-based study. PATIENTS Of 915 participants, 136 met Rotterdam criteria for PCOS and were divided in four subgroups: ovulatory dysfunction with polycystic ovaries (Anovu + PCO), hyperandrogenism with PCO (HA + PCO), hyperandrogenism with ovulatory dysfunction (HA + Anovu) and full Rotterdam (HA + Anovu + PCO). Also 423 subjects served as normal controls, and the rest of participants were analysed as isolated HA, Anovu or PCO subgroups. MEASUREMENTS Anthropometric measures, biochemical parameters and IR were compared between different groups. IR was defined using the homeostatic model assessment-IR (HOMA-IR). RESULTS Overall prevalence of IR in PCOS and normal women were 26·5% and 23·9%, respectively (P = 0·03). After age and BMI adjustment, there was no difference regarding metabolic characteristics between different PCOS phenotypes. Also metabolic characteristics, fasting insulin and HOMA-IR were comparable in PCOS subjects with hyperandrogenism and the nonhyperandrogenic phenotype (Anovu + PCO). In regression analysis, only overweight and obesity (BMI ≥ 25 kg/m(2) ) had an independent association with IR (OR: 2·49, CI: 1·06-5·82, P = 0·03). CONCLUSIONS In a representative sample of an Iranian PCOS population, there is no significant difference between different PCOS phenotypes or between PCOS women and normal subjects regarding their metabolic characteristics. These findings suggest that overall metabolic screening may not always be required for all women diagnosed with PCOS. Larger-scale population-based studies are needed to further assess these issues.
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Affiliation(s)
- Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Impact of PCOS on early embryo cleavage kinetics. Reprod Biomed Online 2014; 28:508-14. [DOI: 10.1016/j.rbmo.2013.11.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 11/22/2013] [Accepted: 11/26/2013] [Indexed: 12/19/2022]
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14
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Naver KV, Grinsted J, Larsen SO, Hedley PL, Jørgensen FS, Christiansen M, Nilas L. Increased risk of preterm delivery and pre-eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG 2014; 121:575-81. [PMID: 24418062 DOI: 10.1111/1471-0528.12558] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), and to examine the role of hyperandrogenaemia. DESIGN Cohort study. SETTING Singleton pregnancies in women with PCOS identified at a private fertility clinic during 1997-2010 and a background population including all singleton deliveries at Hvidovre Hospital, Denmark, in 2005. POPULATION A cohort of 459 women with PCOS and a background population of 5409 women. METHODS Obstetric outcomes were extracted from national Danish registries and odds ratios (ORs) were calculated by multiple logistic regression analysis, adjusting for age, parity, and body mass index. MAIN OUTCOME MEASURES Risk of pre-eclampsia, preterm delivery, and small for gestational age offspring in the entire PCOS population and in a subsample with hyperandrogenaemia. RESULTS Women with PCOS had an increased risk of preterm delivery <37 weeks of gestation (OR 2.28; 95% confidence interval, 95% CI, 1.51-3.45; P < 0.0001). The elevated risk was confined to hyperandrogenic women with PCOS: preterm delivery before 37 weeks of gestation (OR 2.78; 95% CI 1.62-4.77; P < 0.0001), and was not seen in normoandrogenic women with PCOS (OR 1.35; 95% CI 0.54-3.39; P = 0.52). The overall risk of pre-eclampsia was not elevated (OR 1.69; 95% CI 0.99-2.88; P = 0.05) compared with the background population, but was significantly increased in the hyperandrogenic subsample (OR 2.41; 95% CI 1.26-4.58; P < 0.001). The risk of small for gestational age offspring was similar in all groups. CONCLUSION Women with PCOS had an increased risk of preterm delivery compared with the background population. The increased risk was confined to hyperandrogenic women with PCOS who had a two-fold increased risk of preterm delivery and pre-eclampsia.
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Affiliation(s)
- K V Naver
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
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15
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Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall'Alda M, Spiazzi G, Zanolin ME, Bonora E. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:E628-37. [PMID: 23476073 DOI: 10.1210/jc.2012-3908] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT/OBJECTIVE Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women. PATIENTS/DESIGN A total of 137 consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of diagnostic and metabolic features. Insulin sensitivity was measured by the glucose clamp technique. RESULTS Among women with PCOS, 84.7% had hyperandrogenism, 84.7% had chronic oligoanovulation, and 89% had polycystic ovaries. According to the individual combinations of these features, 69.4% of women had the classic phenotype, 15.3% had the ovulatory phenotype, and 15.3% had the normoandrogenic phenotype. Most subjects (71.4%) were insulin resistant. However, insulin resistance frequency differed among phenotypes, being 80.4%, 65.0%, and 38.1%, respectively, in the 3 subgroups (P < .001). Although none of the PCOS diagnostic features per se was associated with the impairment in insulin action, after adjustment for covariates, the classic phenotype and, to a lesser extent, the ovulatory phenotype were independently associated with insulin resistance, whereas the normoandrogenic phenotype was not. Metabolic syndrome frequency was also different among phenotypes (P = .030). CONCLUSIONS There is a scale of metabolic risk among women with PCOS. Although no single diagnostic features of PCOS are independently associated with insulin resistance, their combinations, which define PCOS phenotypes, may allow physicians to establish which women should undergo metabolic screening. In metabolic terms, women belonging to the normoandrogenic phenotype behave as a separate group.
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Affiliation(s)
- Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Piazzale Stefani, Verona, Italy.
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16
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Association study of gene LPP in women with polycystic ovary syndrome. PLoS One 2012; 7:e46370. [PMID: 23056290 PMCID: PMC3463595 DOI: 10.1371/journal.pone.0046370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/29/2012] [Indexed: 11/19/2022] Open
Abstract
Background Previous genome-wide association study (GWAS) of polycystic ovary syndrome (PCOS) in Han Chinese population has found that SNPs in LPP gene were nominally significant in PCOS patients (P around 10E-05). Replication of the GWAS was applied to further confirm the relationship between LPP gene and PCOS. Methods Three polymorphisms of LPP gene (rs715790, rs4449306, rs6782041) were selected and replicated in additional 1132 PCOS cases and 1142 controls. Genotyping of LPP gene was carried out by Taqman-MGB method. Results In rs715790, the allele frequency is significantly different between the PCOS group and the control group. Meta-analysis showed that the allele frequencies of the three SNPs rs715790 (Pmeta = 1.89E-05, OR = 1.23), rs4449306 (Pmeta = 3.0E-04, OR = 1.10), rs6782041 (Pmeta = 2.0E-04, OR = 1.09), were significantly different between PCOS cases and controls. Conclusions Our results suggest that LPP gene might be a novel candidate for PCOS.
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17
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Adipose expression of adipocytokines in women with polycystic ovary syndrome. Fertil Steril 2012; 98:235-41. [DOI: 10.1016/j.fertnstert.2012.03.056] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 03/26/2012] [Accepted: 03/30/2012] [Indexed: 01/04/2023]
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18
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Palomba S, Falbo A, Russo T, Rivoli L, Orio M, Cosco AG, Vero R, Capula C, Tolino A, Zullo F, Colao A, Orio F. The risk of a persistent glucose metabolism impairment after gestational diabetes mellitus is increased in patients with polycystic ovary syndrome. Diabetes Care 2012; 35:861-7. [PMID: 22338097 PMCID: PMC3308296 DOI: 10.2337/dc11-1971] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/20/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the hypothesis that the risk of persistent glucose impairment after gestational diabetes mellitus (GDM) is increased in patients with polycystic ovary syndrome (PCOS). RESEARCH DESIGN AND METHODS The prospective case-control study included 42 pregnant patients with PCOS and GDM and 84 pregnant control patients with GDM but without clinical and biochemical hyperandrogenism, polycystic ovaries, and oligo-anovulation. The case and control subjects were matched one to two for age and BMI. The glycemic profiles were studied in all subjects 6 weeks, 12 weeks, and 18 months after delivery. The incidence and the relative risk (RR) were calculated for overall persistence of an abnormal glycemic pattern and for each specific alteration, i.e., impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus (DM). RESULTS At 18 months after delivery, the incidences of IFG, IGT, and IFG-IGT were significantly (P < 0.05) higher in the cases than in the controls. At the 18-month follow-up, the RR for the composite outcome of glucose metabolism impairment in PCOS women was 3.45 (95% CI 1.82-6.58). CONCLUSIONS Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM.
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Affiliation(s)
- Stefano Palomba
- Department of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
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Abstract
To clarify the necessity of improving glucose metabolism in polycystic ovary syndrome (PCOS) women as early as possible, 111 PCOS women with normal glucose tolerance and 92 healthy age-matched controls were recruited to investigate glucose levels distribution, insulin sensitivity and β cell function. 91 PCOS women and 33 controls underwent hyperinsulinemic-euglycemic clamp to assess their insulin sensitivity, which was expressed as M value. β cell function was estimated by homeostatic model assessment (HOMA)-β index after adjusting insulin sensitivity (HOMA-βad index). Compared with lean controls, lean PCOS women had similar fasting plasma glucose (FPG), higher postprandial plasma glucose (PPG) (6.03±1.05 vs. 5.44±0.97 mmol/L, P<0.05), lower M value but similar HOMA-βad index, while overweight/obese PCOS women had higher levels of both FPG (5.24±0.58 vs. 4.90±0.39, P<0.05) and PPG (6.15±0.84 vs. 5.44±0.97 mmol/L, P<0.05), and lower levels of both M value and HOMA-βad index. Linear regression and ROC analysis found BMI was independently associated with M value and HOMA-βad index in PCOS women separately, and the cutoff of BMI indicating impaired β cell function of PCOS women was 25.545kg/m². In conclusion, insulin resistance and dysregulation of glucose metabolism were common in Chinese PCOS women with normal glucose tolerance. BMI ≥ 25.545kg/m² indicated impaired β cell function in PCOS women with normal glucose tolerance.
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Affiliation(s)
- Weiping Li
- Department of Endocrinology, The First Affiliated Hospital of Shantou University Medcial College, Shantou, China
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20
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Rabøl R, Svendsen PF, Skovbro M, Boushel R, Schjerling P, Nilas L, Madsbad S, Dela F. Skeletal muscle mitochondrial function in polycystic ovarian syndrome. Eur J Endocrinol 2011; 165:631-7. [PMID: 21798960 DOI: 10.1530/eje-11-0419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Polycystic ovarian syndrome (PCOS) is associated with skeletal muscle insulin resistance (IR), which has been linked to decreased mitochondrial function. We measured mitochondrial respiration in lean and obese women with and without PCOS using high-resolution respirometry. METHODS Hyperinsulinemic-euglycemic clamps (40 mU/min per m(2)) and muscle biopsies were performed on 23 women with PCOS (nine lean (body mass index (BMI) <25 kg/m(2)) and 14 obese (BMI >25 kg/m(2))) and 17 age- and weight-matched controls (six lean and 11 obese). Western blotting and high-resolution respirometry was used to determine mitochondrial function. RESULTS Insulin sensitivity decreased with PCOS and increasing body weight. Mitochondrial respiration with substrates for complex I and complex I+II were similar in all groups, and PCOS was not associated with a decrease in mitochondrial content as measured by mitochondrial DNA/genomic DNA. We found no correlation between mitochondrial function and indices of insulin sensitivity. CONCLUSIONS In contrast to previous reports, we found no evidence that skeletal muscle mitochondrial respiration is reduced in skeletal muscle of women with PCOS compared with control subjects. Furthermore, mitochondrial content did not differ between our control and PCOS groups. These results question the causal relationship between reduced mitochondrial function and skeletal muscle IR in PCOS.
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Affiliation(s)
- Rasmus Rabøl
- Department of Biomedical Sciences, Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3b, DK-2200 Copenhagen N, Denmark.
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21
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Koiou E, Dinas K, Tziomalos K, Toulis K, Kandaraki EA, Kalaitzakis E, Katsikis I, Panidis D. The phenotypes of polycystic ovary syndrome defined by the 1990 diagnostic criteria are associated with higher serum vaspin levels than the phenotypes introduced by the 2003 criteria. Obes Facts 2011; 4:145-150. [PMID: 21577021 PMCID: PMC6450045 DOI: 10.1159/000327935] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Patients with polycystic ovary syndrome (PCOS) diagnosed with the 1990 criteria (i.e. presence of oligo- and/or anovulation (ANOV) and hyperandrogenemia and/or hyperandrogenism (HA) with or without polycystic ovaries (PCO)) appear to have a more adverse metabolic profile than patients diagnosed with the additional criteria introduced in 2003 (i.e. presence of HA and PCO without ANOV and presence of ANOV and PCO without HA). Vaspin is a novel adipokine that appears to preserve insulin sensitivity. We aimed to assess serum vaspin levels in patients with different PCOS phenotypes. METHODS We studied 100 patients with PCOS diagnosed with the 1990 criteria (group I), 100 patients with PCOS diagnosed with the additional 2003 criteria (group II) and 50 healthy controls. RESULTS Serum vaspin levels were higher in groups I and II than in controls (p < 0.001 and p = 0.001, respectively) and in group I when compared to group II (p = 0.045). In patients with PCOS, serum vaspin levels were independently correlated with BMI (p < 0.001) and the homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.002). CONCLUSIONS PCOS is associated with elevated serum vaspin levels. This increase might represent a compensatory mechanism to preserve insulin sensitivity. Moreover, serum vaspin levels reflect the severity of PCOS and are significantly increased in its 'classical' phenotypes.
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Affiliation(s)
- Ekaterini Koiou
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
| | - Konstantinos Dinas
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Toulis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
| | - Eleni A. Kandaraki
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
| | - Emmanuil Kalaitzakis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
| | - Ilias Katsikis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
| | - Dimitrios Panidis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital
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Yang S, Li Q, Zhong L, Song Y, Tian B, Cheng Q, Qing H, Xia W, Luo M, Mei M. Serum pigment epithelium-derived factor is elevated in women with polycystic ovary syndrome and correlates with insulin resistance. J Clin Endocrinol Metab 2011; 96:831-6. [PMID: 21209034 DOI: 10.1210/jc.2010-2140] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Serum pigment epithelium-derived factor (PEDF) is highly expressed in adipose tissue and plays an important role in insulin resistance (IR). However, there are no data on serum PEDF levels and their relationship with IR in polycystic ovary syndrome (PCOS) women. OBJECTIVE To quantitate serum PEDF levels and examine their relationship with IR in women with PCOS. PARTICIPANTS AND DESIGN Ninety-six PCOS women and 63 healthy age-matched controls were recruited. Ninety-six PCOS women and 20 controls underwent hyperinsulinemic-euglycemic clamp to assess their insulin sensitivity, which was expressed as M value. IR was also estimated by homeostasis model assessment 2 (HOMA2-IR). SETTING The study was performed at a clinical research center. RESULTS PCOS women had lower M value and higher HOMA2-IR as compared with controls. Serum PEDF levels were much higher in PCOS women than in controls (5.45 ± 1.85 vs. 3.97 ± 0.98 μg/ml, P < 0.01). Spearman correlation analysis showed that in PCOS women, PEDF positively correlated with body mass index, waist circumference, HOMA2-IR, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and systolic blood pressure and negatively correlated with M value and high-density lipoprotein cholesterol. Multiple linear regression analysis revealed that in PCOS women, after adjustment for body mass index, systolic blood pressure, and serum lipids (triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), PEDF was still associated with M value or HOMA2-IR. CONCLUSIONS The serum PEDF level is elevated in women with PCOS and is associated with IR. PEDF may play a role in the pathogenesis of IR in PCOS.
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Affiliation(s)
- Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Street, Chongqing 400016, China
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23
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Yang S, Li Q, Song Y, Tian B, Cheng Q, Qing H, Zhong L, Xia W. Serum complement C3 has a stronger association with insulin resistance than high-sensitivity C-reactive protein in women with polycystic ovary syndrome. Fertil Steril 2011; 95:1749-53. [PMID: 21316661 DOI: 10.1016/j.fertnstert.2011.01.136] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare the association of complement C3 (C3) versus high-sensitivity C-reactive protein (hs-CRP) with insulin resistance (IR) in women with polycystic ovary syndrome (PCOS). DESIGN Cross-sectional analysis. SETTING Clinical research center in China. PATIENT(S) One hundred thirty-three women with PCOS and 116 healthy, age-matched controls were recruited. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) One hundred one women with PCOS and 20 controls underwent hyperinsulinemic-euglycemic clamp to assess their insulin sensitivity, which was expressed as an M value. RESULT(S) Compared with controls, women with PCOS had a lower M value and higher C3 (1.37 ± 0. 34 vs. 1.10 ± 0.22 g/L) and hs-CRP levels (1.46 ± 2.29 vs. 0.49 ± 0.88 mg/L). In women with PCOS, C3 and hs-CRP negatively correlated with M value (r = -0.61 and r = -0.47, respectively). By regression analysis, C3 was found to have a greater impact on the M value (standardized coefficient β = -0.24) than did hs-CRP (standardized coefficient β = -0.13). After adjusting for body mass index (BMI), women with PCOS in the upper quartile were 4.30 times more likely to exhibit IR compared with those in the lower quartiles, whereas hs-CRP was not a statistically significant predictor of IR in women with PCOS. CONCLUSION(S) Compared with hs-CRP, serum C3 might be a stronger inflammatory marker of IR in women with PCOS.
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Affiliation(s)
- Shumin Yang
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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