Effects of dietary intake on glucose metabolism and reproductive hormones in women with polycystic ovary syndrome. Ann. Nutr. Metab

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EFFECTS OF DIETARY INTAKE ON GLUCOSE

METABOLISM AND REPRODUCTIVE

HORMONES IN WOMEN WITH POLYCYSTIC

OVARY SYNDROME

Introduction

Subjects and Methods

Abstract

Ting

Ting--WenWen WangWangaa_,_{, Jane C}_{Jane C--J}_{J Chao}_Chaoaa_{, Hsiao}_,_Hsiao--Jui_{Jui Wei}_Weibb_,_{, Robert}_{Robert Young}_Youngbb_,, Chian

Chian--MeyMey LiawLiawbb_,_{, Ya}_Ya--Hui_{Hui Tsai}_Tsaiaa_{, Yea}_,_Yea--Lih_{Lih Lin}_Linaa_,_{, Szu}_Szu--Shun_{Shun Wang}_Wangaa

a_{School of Nutrition and Health Sciences, Taipei Medical University,}b_{Infertility Center, Taiwan Adventist Hospital, Taipei, Taiwan}

Polycystic ovary syndrome (PCOS) is probably the most prevalent endocrine disorder in women and the most common cause of anovulatory infertility. Hyperinsulinemia in conjunction with hyperandrogenism was reported in 1980, and subsequently the presence of insulin resistance in women with PCOS has been well documented in several studies. Polycystic ovary syndrome has varied onset and clinical symptoms. Asian women display stigmata of insulin resistance at a lower body mass index (BMI) than other populations. Therefore, we designed a cross-sectional study to investigate the Chinese population at a single period and to observe blood glucose levels in Chinese patients with PCOS compared with other infertility patients. We also evaluated dietary intake associated with blood glucose and sex hormone levels in PCOS women.

Table 1 Demographic characteristics of non-polycystic

ovary syndrome and polycystic ovary syndrome groups1

Non-PCOS (n = 36) PCOS (n = 31) P value Age (years) 35.2 ± 3.9 31.7 ± 4.0 < 0.001 Weight (kg) 54.6 ± 7.9 61.6 ± 13.2 < 0.05 BMI (kg/m2₎ _{21.6 ± 2.8} _{23.9 ± 4.9} _{< 0.05} Body fat (%) 27.5 ± 4.5 30.4 ± 6.1 < 0.05 Visceral fat mass (kg) 1.7 ± 0.8 2.3 ± 1.3 < 0.05

WC (cm) 72.2 ± 9.9 74.4 ± 10.3 NS WHR 0.81 ± 0.06 0.82 ± 0.08 NS FSH (ng/ml) 7.8 ± 2.7 6.3 ± 1.6 < 0.01 LH (mIU/ml) 3.7± 2.0 5.1 ± 3.1 < 0.05 LH /FSH ratio 0.8± 0.5 0.5 ± 0.44 < 0.05 Estradiol (pg/ml) 36.0 ± 17.3 30.7 ± 7.9 NS Testosterone (ng/ml) 0.4 ± 0.2 0.5 ± 0.2 < 0.05 SHBG (nmol/ml) 68.7 ± 33.7 50.9 ± 32.6 < 0.05 FAI 2.5 ± 1.5 5.2 ± 3.6 < 0.001

1_{Data are presented as mean  SD.}

BMI, body mass index; WC, waist circumference; WHR, waist-to-hip ratio; FSH, follicle stimulating hormone; LH, luteinizing hormone; SHBG, sex hormone-binding globulin; FAI, free androgen index; NS, not significant.

From August to December 2008, 67 patients who were out-patients in the Infertility Center of Taiwan Adventist Hospital were recruited in this study. This study was approved by and conducted in accordance with the guidelines of the Taiwan Adventist Hospital Investigational Review Board, and all patients provided written informed consent. A total of 31 patients with PCOS served as the PCOS group, and the remaining 36 infertility patients were in the non-PCOS group as a control. The PCOS women were diagnosed according to the presence of chronic anovulation associated with clinical or biochemical hyperandrogenism.

0 20 40 60 80 100 120 140 Fasting 2-hours Non-PCOS PCOS

Figure 1 Blood glucose of the non-PCOS

and PCOS groups

B lo o d g lu co se ( m g /d l) 0 10 20 30 40 50 60 70 80 90 Fasting 2-hours Non-PCOS PCOS In su lin (  IU /m l)

Figure 2 Blood insulin level of the

non-PCOS and non-PCOS groups

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Non-PCOS PCOS

Figure 3 HOMA-IR of the non-PCOS (1.39

± 0.71) and PCOS (2.21 ± 1.19) groups

＊_{P < 0.05.} H O M A -I R

Table 2 Dietary pattern of non-polycystic ovary syndrome and

polycystic ovary syndrome groups1`

Non-PCOS (n = 36) PCOS (n = 31) P value

Energy (kcal) 1601 ± 224 1752 ± 254 < 0.05 Carbohydrate (g) 212.4 ± 33.9 216.1 ± 47.7 NS (% of energy) 54 49 < 0.05 Fat (g) 53.7 ± 12.5 64.1 ± 12.1 < 0.05 (% of energy) 30 33 < 0.05 Protein (g) 59.7 ± 20.6 69.0 ± 25.3 NS (% of energy) 16 18 NS Dietary fiber (g) 15.2 ± 8.0 11.7 ± 4.1 < 0.05 1_{Data are presented as mean  SD.}

NS, not significant.

Blood insulin level and HOMA-IR were significant differences between the two groups. PCOS patients had increased calorie and fat intake compared with non-PCOS patients, but had less carbohydrate as the percentage of energy and dietary fiber intake, indicating unbalanced dietary intake in PCOS patients.

Objective: To understand the relationship of dietary intake on

glucose metabolism and reproductive hormones in patients with polycystic ovary syndrome (PCOS) in Taiwan.

Design: Cross-sectional study.

Setting: Infertility Center, Taiwan Adventist Hospital.

Patients: Thirty-one patients with PCOS and thirty-six control

infertility patients.

Intervention(s): None.

Main Outcomes Measure(s): Hormones assay, 75-g oral glucose

tolerance test, 24-hour recall and 3-d dietary record.

Results: PCOS patients increased BMI and body fat percentage compared with non-PCOS patients. Significant positive correlations were observed between calorie intake and fasting blood glucose (r = 0.47, P < 0.05), fasting insulin (r = 0.37, P < 0.05), insulin resistance (r = 0.41, P < 0.05). Plasma testosterone concentration was positively correlated with dietary carbohydrate intake (r = 0.40, P < 0.01). Postprandial glucose concentration was positively correlated with dietary fat intake (r = 0.45, P < 0.05).

Conclusions:PCOS women with greater BMI and body fat impair

glucose metabolism and insulin sensitivity. Fat and carbohydrate

intake is positively correlated with plasma testosterone and postprandial glucose concentrations, respectively.

(NSC 97-2320-B-038 –034 –MY3)

Table 3 Pearson’s correlation coefficient between sex hormones and dietary intake or lifestyle1

Energy Carbohydrate Fat Protein FSH Non-PCOS 0.21 0.11 0.15 -0.30 PCOS 0.01 -0.12 0.01 0.16 SHBG Non-PCOS -0.44* 0.11 -0.13 -0.01 PCOS -0.24 0.13 -0.18 0.03 Testosterone Non-PCOS -0.25 -0.33 -0.09 0.35 PCOS 0.21 0.40* -0.29 -0.24 FAI Non-PCOS 0.42* -0.44 0.28 0.31 PCOS 0.30 -0.01 0.05 -0.05 Fasting glucose Non-PCOS 0.45* -0.3 0.39 0.01 PCOS 0.47* -0.12 -0.03 0.24 Postprandial glucose Non-PCOS 0.41* -0.23 0.18 0.13 PCOS 0.10 -0.26 0.45* -0.18 Fasting insulin Non-PCOS 0.43* -0.22 0.28 0.0001 PCOS 0.37* -0.23 0.11 0.12 Postprandial insulin Non-PCOS 0.44* -0.28 0.24 0.13 PCOS 0.36 -0.09 0.15 -0.06 HOMA-IR Non-PCOS 0.47* -0.25 0.34 0.0001 PCOS 0.41* -0.22 0.15 0.15

1_{adjusted for age,}*_{P < 0.05.}

PSQI, Pittsburgh sleep quality index; PSS, perceived stress scale; FSH, follicle stimulating hormone; SHBG, sex hormone-binding globulin; FAI, free androgen index.

Effects of dietary intake on glucose metabolism and reproductive hormones in women with polycystic ovary syndrome. Ann. Nutr. Metab