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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 7-10

Risk factors in obese Egyptian women with polycystic ovary syndrome


1 Department of Biochemistry, Faculty of Science, Helwan University, Helwan, Egypt
2 Department of Biological Anthropology, National Research Centre, Cairo, Egypt
3 Department of Clinical Genetics, National Research Centre, Cairo, Egypt
4 Private Laboratory, Cairo, Egypt

Date of Submission16-Aug-2017
Date of Acceptance01-Nov-2017
Date of Web Publication26-Mar-2018

Correspondence Address:
Hala T El Bassyouni
Prof. of Clinical Genetics, Department of Clinical Genetics, National Research Centre, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MXE.MXE_1_17

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  Abstract 

Background
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women in the childbearing age causing metabolic anomalies. Women with PCOS present with ovulatory dysfunction, abnormal hormones, hyperandrogenemia, obesity, and hyperinsulinemia. The aim of the work was to predict the cardiometabolic risk factors in Egyptian obese women with PCOS in relation to the phenotypic variability of PCOS.
Patients and methods
A total of 90 adult females in the reproductive age were examined. Overall, 40 women were diagnosed by means of ultrasound to be having PCOS, who were compared with 50 healthy women with no risk of any metabolic syndrome and within normal weight. BMI was calculated, and systolic/diastolic blood pressure was recorded. Fasting blood glucose, fasting blood insulin, aspartate aminotransferase, alanine aminotransferase, and lipid profile were estimated. Homeostatic model assessment of insulin resistance (IR) was calculated.
Results
BMI, fasting blood glucose, fasting blood insulin, homeostatic model assessment of IR, and alanine aminotransferase were significantly increased and high-density lipoprotein-cholesterol was significantly decreased in the PCOS group. The increase in blood pressure was not significant.
Conclusion
The cardiometabolic risk factors in Egyptian obese women with PCOS were type 2 diabetes mellitus, IR, obesity, dyslipidemia, and nonalcoholic fatty liver disease, but hypertension was not a crucial risk factor. Further research studies are needed to establish the relationship between PCOS and cardiometabolic profile, as this may be essential in the management of these cases.

Keywords: body mass index, homeostatic model assessment of insulin resistance, obesity, polycystic ovary syndrome, type 2 diabetes mellitus


How to cite this article:
Shousha WG, Zaki ME, El Bassyouni HT, Abdo SM, Mohamed SM. Risk factors in obese Egyptian women with polycystic ovary syndrome. Middle East J Med Genet 2018;7:7-10

How to cite this URL:
Shousha WG, Zaki ME, El Bassyouni HT, Abdo SM, Mohamed SM. Risk factors in obese Egyptian women with polycystic ovary syndrome. Middle East J Med Genet [serial online] 2018 [cited 2024 Mar 29];7:7-10. Available from: http://www.mxe.eg.net/text.asp?2018/7/1/7/228072


  Introduction Top


In 1935, Stein and Leventhal described polycystic ovary syndrome (PCOS), in which an association among amenorrhea, hirsutism, obesity, and polycystic ovaries was discovered. The authors described bilaterally enlarged ovaries, with multiple cysts located mainly in the subcapsular region, and a hypertrophied stroma (Marcondes et al., 2007).

PCOS is the most common endocrinopathy problem in the childbearing age, and it occurs in ∼5–10% of women, causing not only reproductive but also metabolic abnormalities (Hart et al.,2004). Patients with PCOS present with hyperinsulinemia, obesity, ovulatory dysfunction, abnormal hormones, and hyperandrogenemia. It results from the interaction of multiple genes along with environmental factors (Shaikh et al., 2014). PCOS is accompanied by an unfavorable cardiometabolic profile during early life (Gunning and Fauser, 2017).

PCOS was categorized into four phenotypic groups (Głuszak et al.,2012). This could offer appropriate guidance for screening risk factors of PCOS. Besides, it may help in choosing the appropriate treatment options (Sharami1 et al., 2016).

Dyslipidemia and endothelial dysfunction, which increases the cardiovascular risk, are frequently associated with PCOS and obesity (Kravariti et al., 2005; Rajendran et al., 2009). Obese women with PCOS are known to acquire the most atherogenic lipid profiles (Bargiota and Kandarakis, 2012; Fauser et al., 2012). The most important feature for unfavorable metabolic and cardiovascular risk in patients with PCOS is obesity (Gateva and Kamenov, 2012).

An essential component of this disease is insulin resistance (IR). This occurs in 30–40% of women with PCOS, and the molecular basis of which is yet to be discovered. However, the pathogenesis of PCOS-IR may be caused by mitochondrial dysfunction owing to mt-tRNA mutations (Ding et al., 2017).


  Patients and methods Top


The ethical approval statement: Informed consent was obtained from all the patients according to the guidelines of the Ethical Committee of the National Research Centre (NRC).

A total of 90 adult females in the reproductive age were included in the study. A total of 40 women with ultrasound diagnosis of PCOS were compared with 50 healthy women, with no risk of metabolic syndrome and who were age matched. The systolic/diastolic blood pressure was recorded, and the BMI was calculated. Fasting blood samples were collected in plain tubes and centrifuged at 3000g for 10 min to obtain sera, which were stored at −70 to −80°C until assayed. Blood samples were collected on EDTA tubes, which were stored as whole blood at 20–24°C.

Lipid profile including total cholesterol (Ellefson and Caraway, 1976), low-density lipoprotein cholesterol (Okada et al., 1996), high-density lipoprotein cholesterol (HDL-C) (William et al., 1972), triglycerides (Bucolo and David, 1973), and fasting blood glucose (FBG) (Tietz, 1995) were measured by direct enzymatic colorimetric method. Liver enzymes including aspartate aminotransferase and alanine aminotransferase (ALT) were estimated using the Kinetic method according to the International Federation of Clinical Chemistry (IFCC, 1986). Fasting blood insulin was measured by enzyme-linked immunosorbent assay technique (Olsson and Carlsson, 2005). Then homeostatic model assessment of insulin resistance (HOMA-IR) was calculated using the following equation (Turner et al., 1993):



Statistical analysis was performed using statistical package for the social sciences version 16 software on a DELL laptop computer (SPSS; SPSS Inc., Chicago, Illinois, USA). The results were assessed as mean ± SD by one-way analysis of variance, where P value of less than 0.05 was considered statistically significant.


  Results Top


The BMI in patients with PCOS group was highly significant (0.001) than that in the control group, whereas the increase in fasting blood insulin and blood pressure in the patients with PCOS group was nonsignificant. Some metabolic parameters (FBG and HOMA-IR) were significantly increased (0.005 and 0.006 respectively) in patients with PCOS, whereas the increase in total cholesterol, triglycerides and low-density lipoprotein cholesterol was nonsignificant (0.2, 0.8, 0.4 respectively). Moreover, HDL-C was significantly decreased [Table 1].
Table 1: Anthropometric, clinical, and biochemical parameters in the polycystic ovary syndrome group compared with the control group

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There was significant increase in the HDL-C (0.01) in the patient group than the control group, whereas the increase in the other lipid parameters was nonsignificant [Table 2].
Table 2: Lipid parameters in the polycystic ovary syndrome group compared with the control group

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As a hepatitis marker, the increase in ALT was highly significant (0.002) in the PCOS group in comparison with the control group. Furthermore, there was a highly significant increase in the ALT/aspartate aminotransferase ratio (0.004) [Table 3].
Table 3: Liver enzymes in polycystic ovary syndrome group compared with the control group

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  Discussion Top


PCOS is associated with intricate pathophysiological, hormonal, and metabolic threats leading to an increased risk of cardiovascular, obesity, and fatty liver diseases. This stresses the importance of early diagnosis (Alpergin et al., 2017).

In our study, women with PCOS appear to attain a higher risk of increased prothrombotic state, dyslipidemia, glucose intolerance, IR, and hyperinsulinemia. This puts them at a higher risk of cardiovascular disease (CVD), vascular dysfunction, subclinical atherosclerosis, type 2 diabetes mellitus, and fatty liver disease. Moreover, obesity, an independent risk factor for CVD, is more prevalent in PCOS. Variations in the secretion and/or function of adipokines and adipose tissue-derived proinflammatory factors were observed in patients with PCOS. These factors have a significant influence on the cardiometabolic risks through the regulation of metabolism, insulin sensitivity, and the phenotypic variability of PCOS (Randeva, 2017).

In the present study, there were significant changes in some metabolic parameters between the patients with PCOS group and the control group. A highly significant increase in BMI, FBG, and HOMA-IR and a significant decrease in HDL-C were found in patients with PCOS.

Dyslipidemia is one of the most common cardiometabolic complications of PCOS. Additionally, nonalcoholic fatty liver disease (NAFLD) indices increase the incidence of CVD in women with PCOS (Blagojevic et al., 2017). However, in the current study, the HDL-C decreased significantly in women with PCOS compared with healthy women, whereas the other lipid profile parameters were nonsignificantly increased. The patients with PCOS group in our study may be at increased risk of NAFLD syndrome, owing to the highly significant increase in ALT compared with the control group.

In the study of Inan and Karadag (2016), the patients with PCOS had lower systolic/diastolic blood pressure measurements, whereas Zaki et al. (2017) reported a significant increase in systolic/diastolic blood pressure compared with the control. However, in our study, the systolic/diastolic blood pressure ratio in the PCOS group was higher than the control group, though this did not attain a statistical significance. This may be because of the heterogeneity of PCOS.


  Conclusion Top


The cardiometabolic risk factors in Egyptian obese women with PCOS were type 2 diabetes mellitus, IR, obesity, dyslipidemia, and NAFLD, bbut hypertension was not a crucial risk factor. Further research studies are needed to establish the relationship between PCOS and cardiometabolic profile, as this may be essential in management of these cases. [25]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Alpergin S, Ebru S, Bolandnazar Z, Sabatini M, Rogowski M, Chiellini G, et al. (2017). Metabolic profiling reveals reprogramming of lipidmetabolic pathways in treatment of polycystic ovarysyndrome with 3-iodothyronamine. Physiol Rep 5:e13097.  Back to cited text no. 1
    
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Bargiota A, Kandarakis D (2012). The effects of old, new emergingmedicines on metabolic aberrations in PCOS. Ther Adv Endocrinol Metab 3:27–47.  Back to cited text no. 2
    
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  [Table 1], [Table 2], [Table 3]



 

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