The Effect of Metformin on Polycystic Ovary Syndrome in Overweight Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective. Metformin is an important component of PCOS treatment. At present, the effect of metformin in overweight women with PCOS has not been evaluated. Therefore, we conducted a systematic review to assess the effects of metformin in overweight women with PCOS and to analyze the effects of metformin in overweight women with PCOS. Methods. We searched the PubMed, Cochrane Library, Embase, CNKI, VIP, and Wanfang databases for studies published before March 2020. Randomized controlled trials were identified to study the effects of metformin in overweight women with PCOS. Data from studies including body mass index (BMI), waist circumference (WC), follicle-stimulating hormone (FSH), homeostasis model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), triglycerides (TG), fasting blood glucose (FBG), fasting insulin, testosterone, and androstenedione were pooled. Qualified trials were selected, and methodological quality was strictly assessed. Two reviewers chose the studies independently of each other. Results. Twelve trials were included. The intervention group and the control group had significant differences in the changes in body mass index (BMI) (WMD = −1.25, 95% CI (−1.60, −0.91), p<0.00001) and waist circumference (WC) (WMD = −1.41, 95% CI (−2.46, −0.37), p=0.008) after metformin. The comprehensive results show that, in all studies, overweight women with polycystic ovary syndrome treated with metformin had significantly improved endocrine and metabolic indicators, including testosterone, follicle-stimulating hormone, luteinizing hormone, and low-density lipoprotein cholesterol. However, metformin did not regulate the secretion indexes of fasting insulin, homeostasis model assessment of insulin resistance, sex hormone-binding globulin, high-density lipoprotein cholesterol, total cholesterol, triglycerides, fasting blood glucose, and androstenedione. Conclusions. Compared with control interventions, metformin appears to be an effective intervention for overweight women with PCOS.

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Endotrophin as a novel marker in PCOS and its relation with other adipokines and metabolic parameters: a pilot study

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211049607 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110496

Author(s):

Gurhan Guney ◽

Mine Islimye Taskin ◽

Ozgur Baykan ◽

Ertan Adali ◽

Selin Gul Tezcan ◽

...

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Density Lipoprotein ◽

Resistance Index ◽

Total Testosterone ◽

Model Assessment ◽

Homeostasis Model Assessment ◽

Ovary Syndrome ◽

Significant Difference

Background: Polycystic ovary syndrome is known to be the most common hormonal disorder in women of reproductive age. Current evidence shows that regulatory proteins secreted from the adipose tissue called adipokines may have a role in polycystic ovary syndrome. We planned to investigate the role of endotrophin that has never been researched in polycystic ovary syndrome before and its correlation with other metabolic parameters and adipokines such as adiponectin and ghrelin in patients with polycystic ovary syndrome. Methods: Forty-three women ( n: 43) with polycystic ovary syndrome and 43 ( n: 43) women as a control group were enrolled in this cross-sectional study. Serum levels of endotrophin, adiponectin, and ghrelin levels were measured with the enzyme-linked immunosorbent assay method. High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol levels, luteinizing hormone/follicle-stimulating hormone ratio, total testosterone, and triglyceride levels were measured. Homeostasis model assessment for insulin resistance index, body mass index, Ferriman Gallwey Score, and waist-to-hip ratio were also evaluated. Results: Total testosterone, homeostasis model assessment for insulin resistance, C-reactive protein, luteinizing hormone/follicle-stimulating hormone ratio, and triglyceride levels were higher in patients with polycystic ovary syndrome ( p < 0.01). No difference was detected between the groups in terms of body mass index, Ferriman Gallwey Score, waist-to-hip ratio, total cholesterol, low-density lipoprotein, and high-density lipoprotein levels ( p > 0.05). We did not observe any significant difference in adiponectin and ghrelin levels between the groups ( p > 0.05). Patients with polycystic ovary syndrome had significantly higher endotrophin levels ( p < 0.01). According to our regression analyses [area under the curve: 0.973 (0.935–1.000), 95% confidence interval, 95.2% sensitivity, and 100% specificity], it was shown that endotrophin greater than 92 ng/ml and homeostasis model assessment for insulin resistance greater than 2.5 might be good predictors for polycystic ovary syndrome diagnosis. Conclusion: We demonstrated that endotrophin level is higher in patients with polycystic ovary syndrome and may have predicted polycystic ovary syndrome with increased homeostasis model assessment for insulin resistance index. There was no significant difference in adiponectin and ghrelin levels in the polycystic ovary syndrome group. Endotrophin may have a role in polycystic ovary syndrome etiology rather than other adipokines.

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A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome

Acta Endocrinologica ◽

10.1530/eje-11-0616 ◽

2012 ◽

Vol 166 (1) ◽

pp. 99-105 ◽

Cited By ~ 57

Author(s):

Wei Wei ◽

Hongmin Zhao ◽

Aili Wang ◽

Ming Sui ◽

Kun Liang ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Area Under The Curve ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Sex Hormone Binding Globulin ◽

Metabolic Effects ◽

Model Assessment ◽

Ovary Syndrome ◽

Insulin Sensitizer

ObjectivePolycystic ovary syndrome (PCOS) is a frequent reproductive and metabolic disorder associated with insulin resistance (IR). Berberine (BBR) is an isoquinoline derivative alkaloid extracted from Chinese medicinal herbs that has been used as an insulin sensitizer. BBR may have a potential therapeutic value for PCOS. The aim of this study was to evaluate the effects of BBR in comparison to metformin (MET) on the metabolic features of women with PCOS.Design and methodsEighty-nine subjects with PCOS and IR subjects were randomized into one of three treatment groups: BBR+compound cyproterone acetate (CPA; n=31), MET+CPA (n=30), and placebo+CPA (n=28) for 3 months. Clinical characteristics of the women and metabolic and hormonal parameters were assessed before and after the period of treatment.ResultsTreatment with BBR in comparison to MET showed decrease in waist circumference and waist-to-hip ratio (WHR; P<0.01), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDLC; P<0.05) as well as increase in high-density lipoprotein cholesterol (HDLC) and sex hormone-binding globulin (SHBG; P<0.05). Similarly, treatment with BBR in comparison to placebo showed decrease in WHR, fasting plasma glucose, fasting insulin, homeostasis model assessment for IR, area under the curve of insulin, TC, LDLC, and TG (P<0.05) as well as increase in HDLC and SHBG (P<0.01).ConclusionsIntake of BBR improved some of the metabolic and hormonal derangements in a group of treated Chinese women with PCOS. Main effects could be related to the changes in body composition in obesity and dyslipidemia. Further controlled studies are needed for the assessment of the potential favorable metabolic effects of BBR in women with PCOS.

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Anti-Müllerian Hormone Accelerates Pathological Process of Insulin Resistance in Polycystic Ovary Syndrome Patients

Hormone and Metabolic Research ◽

10.1055/a-1499-7718 ◽

2021 ◽

Vol 53 (08) ◽

pp. 504-511

Author(s):

Xiang-Juan Li ◽

Hui Wang ◽

Dan-Yang Lu ◽

Tian-Tian Yu ◽

Kamran Ullah ◽

...

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Fasting Blood Glucose ◽

Density Lipoprotein ◽

Pathological Process ◽

Model Assessment ◽

High Concentration ◽

Ovary Syndrome

AbstractInsulin resistance (IR) is one of the most common features of polycystic ovary syndrome (PCOS), which is related to obesity. Whether increased anti-Müllerian hormone (AMH) levels in PCOS are involved in the pathogenesis of insulin resistance remains unclear. We investigated serum levels of leptin and AMH along with basic clinical and metabolic parameters in 114 PCOS patients and 181 non-PCOS women. PCOS patients presented higher fasting blood glucose, insulin concentrations and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) in addition to body mass index (BMI), lipids profiles and hormone levels. HOMA-IR showed a positive correlation with BMI, AMH, leptin, and low-density lipoprotein-cholesterol (LDL-c) levels. Interestingly, AMH is strongly positively correlated with HOMA-IR and insulin concentrations for 1st and 2nd hours of glucose treatment after fasting. Among PCOS women with BMI≥25 kg/m2, high AMH level group showed an increased HOMA-IR when compared to normal AMH level. However, among PCOS women with normal BMI, women with high AMH presented an elevated fasting insulin levels but not HOMA-IR when compared to normal AMH group. In vitro treatment of isolated islet cells with high concentration of leptin (200 ng/ml) or high leptin plus high concentration of AMH (1 ng/ml) significantly enhanced insulin secretion. Importantly, co-treatment of AMH plus leptin upregulates the expression of pro-apoptotic proteins, such as Bax, caspase-3, and caspase-8 after incubating with a high level of glucose. These results suggest that AMH may involve in the pathological process of pancreatic β-cells in obese PCOS women.

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Influence of vitamin D supplementation on lipid levels in polycystic ovary syndrome patients: a meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/0300060520935313 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093531

Author(s):

Bihui Jin ◽

Lingbo Qian ◽

Xiaohua Fu ◽

Jing Zhu ◽

Jing Shu

Keyword(s):

Polycystic Ovary ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Low Density Lipoprotein Cholesterol ◽

Ovary Syndrome ◽

Randomized Controlled ◽

Cholesterol Levels ◽

Atherogenic Lipid

Objective Observational studies have shown that circulating vitamin D (VitD) deficiency is associated with atherogenic lipid patterns among polycystic ovary syndrome (PCOS) patients. However, interventional studies have shown inconsistent results. The aim of this meta-analysis was to investigate how VitD supplementation influences lipid indices in PCOS patients. Methods The authors searched four electronic databases through August 2019 to identify randomized controlled trials (RCTs) that assessed the effect of VitD intervention on serum lipids among PCOS patients. Mean differences were generated for statistical evaluation. Results We included eight studies and performed nine comparisons across 467 participants. VitD supplementation reduced serum triglyceride levels (−11.88 mg/dL; 95% confidence interval [CI]: −17.03 to −6.73), total cholesterol (−9.09 mg/dL; 95% CI: −14.90 to −3.29), low-density lipoprotein cholesterol (−5.22 mg/dL; 95% CI: −10.32 to −0.13), and very-low-density lipoprotein cholesterol (−2.43 mg/dL; 95% CI: −3.69 to −1.17) compared with no VitD supplementation. However, high-density lipoprotein cholesterol levels showed no differences with or without VitD supplementation (−0.39 mg/dL; 95% CI: −1.39 to 0.61). Conclusions VitD supplementation improved serum lipid levels among PCOS patients, but serum high-density lipoprotein cholesterol levels were not changed. VitD intervention might benefit PCOS patients who are at high risk of an atherogenic lipid profile.

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Dietary Sulfur-Containing Amino Acids Are Associated with Higher Prevalence of Overweight/Obesity in Northern Chinese Adults, an Internet-Based Cross-Sectional Study

Annals of Nutrition and Metabolism ◽

10.1159/000490194 ◽

2018 ◽

Vol 73 (1) ◽

pp. 44-53 ◽

Cited By ~ 2

Author(s):

Yan-chuan Li ◽

Yu-zheng Li ◽

Rui Li ◽

Li Lan ◽

Chun-long Li ◽

...

Keyword(s):

Amino Acids ◽

Low Density Lipoprotein ◽

Fasting Blood Glucose ◽

Density Lipoprotein ◽

Serum Triglyceride ◽

Postprandial Glucose ◽

Lipid Profiles ◽

Model Assessment ◽

Cross Sectional ◽

Sulfur Containing

Background/aims: Elevation of plasma sulfur-containing amino acids (SAAs) is generally associated with higher body mass index (BMI) and unfavorable lipid profiles. It is not known how dietary SAAs relate to these associations in humans. Methods: A convenient tool named internet-based dietary questionnaire for Chinese (IDQC) was used to estimate dietary SAAs intake. A total of 936 participants were randomly recruited and asked to complete the IDQC. Furthermore, 90 subjects were randomly selected to perform a subgroup study. The associations between dietary SAAs and prevalence of obesity, lipid profiles, and status of insulin resistance (IR), inflammation and oxidative stress were assessed. Results: Dietary total SAAs and cysteine of overweight/obese participants were significantly higher. Dietary total SAAs and cysteine were positively associated with BMI and waist circumference. Higher dietary total SAAs were associated with higher prevalence of overweight/obesity. Higher dietary total SAAs and cysteine also associated with higher serum triglyceride (total cholesterol), low density lipoprotein, fasting blood glucose, 2 h-postprandial glucose, and homeostasis model assessment of IR. In the subgroup study, positive associations between dietary SAAs and inflammation biomarkers were also observed. Conclusions: Dietary SAAs are associated with higher prevalence of overweight/obesity, unfavorable lipid profiles and status of IR, and inflammation.

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A Copeptin as a Predictor Marker for Insulin Resistance Among Women with Polycystic Ovary Syndrome

Current Women s Health Reviews ◽

10.2174/1573404817666211208152049 ◽

2021 ◽

Vol 17 ◽

Author(s):

Alaa Ibrahim Ali ◽

Wassan Nori Mohammed Hassan ◽

Sumaya Alrawi

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary ◽

Transvaginal Ultrasound ◽

Predictive Marker ◽

University Hospital ◽

Sex Hormone Binding Globulin ◽

Total Testosterone ◽

Model Assessment ◽

Homeostasis Model Assessment ◽

Wide Range

Background: A polycystic ovarian syndrome (PCOS) is a common endocrine syndrome in which women have a wide range of clinical presentations; insulin resistance was linked to its pathogenesis. Objective: We aimed to investigate the copeptin role as a predictive marker of insulin resistance among PCOS women. Material and Methods: In University Hospital, we included 280 women, with 140 of them being healthy controls. 140 out of 280 cases of PCOS subdivided into two groups depending on the insulin resistance; group 1 with homeostasis model assessment for the insulin resistance < 2.5. Group 2 with homeostasis model assessment for the insulin resistance >2.5. The evaluation of body mass index and blood pressure for all besides the blood sampling for estimation of a follicular stimulating hormone, luteinizing hormone, prolactin, estradiol, sex hormone-binding globulin, total testosterone, fasting insulin dehydroepiandrosterone sulfate, C-reactive protein, plasma glucose, free androgen index, and plasma copeptin using the Copeptin-Human EIA Kit besides the transvaginal ultrasound for ovarian assessment. Results: When compared to other groups, PCOS women with positive insulin resistance >2.5 had a significantly higher plasma copeptin level. The ROC curve calculated a 1.94 pmol/L; plasma copeptin cutoff value for detecting the insulin resistance in PCOS with 88% sensitivity value and 36% specificity, AUC was 0.88. Conclusion: The significant positive relationship between serum copeptin and insulin resistance with high sensitivity implies its usefulness as a marker of insulin resistance among PCOS patients with a high prediction of its complication.

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Abstract #1002545: Prediction of Gut Microbial Community Structure and Function in Polycystic Ovary Syndrome with High Low-density Lipoprotein Cholesterol

Endocrine Practice ◽

10.1016/j.eprac.2021.04.753 ◽

2021 ◽

Vol 27 (6) ◽

pp. S135

Author(s):

Xuping zhu ◽

Yanyu Li ◽

yanmin Jiang ◽

Jisheng Zhang ◽

Ru Duan ◽

...

Keyword(s):

Community Structure ◽

Polycystic Ovary ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Structure And Function ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Ovary Syndrome ◽

And Function ◽

Gut Microbial Community

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Effects of thyroid hormone and depression on common components of central obesity

Journal of International Medical Research ◽

10.1177/0300060519851624 ◽

2019 ◽

Vol 47 (7) ◽

pp. 3040-3049 ◽

Cited By ~ 1

Author(s):

Fu-Man Du ◽

Hong-Yu Kuang ◽

Bin-Hong Duan ◽

Da-Na Liu ◽

Xin-Yang Yu

Keyword(s):

Central Obesity ◽

Low Density Lipoprotein ◽

Fasting Blood Glucose ◽

Density Lipoprotein ◽

Epidemiological Studies ◽

Thyroid Stimulating Hormone ◽

Model Assessment ◽

Free Triiodothyronine ◽

Serum Tsh ◽

Tsh Levels

Objective We investigated the prevalence of abnormal thyroid function and depression in centrally obese participants, and to analyze the relationship of thyroid hormones and depression with components of central obesity. Methods We randomly selected 858 centrally obese participants and 500 non-obese controls in this study. For all participants, we measured serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), body mass index (BMI), waist–hip ratio (WHR), fasting blood glucose and insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipid concentrations, and blood pressure. Depression was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale. Results Centrally obese participants had a higher prevalence of hypothyroidism and depression than non-obese controls. Serum FT4 levels negatively correlated with BMI and serum TSH levels and positively correlated with BMI, WHR, total triglycerides (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C). After excluding participants with hypothyroidism and hyperthyroidism, serum FT4 levels showed negative correlation and serum TSH levels showed positive correlation with BMI in the remaining centrally obese participants. CES-D scores positively correlated with BMI. Conclusion We found high prevalences of hypothyroidism and depression among centrally obese participants. FT4 and TSH are important in weight regulation. Depression positively correlated with obesity.

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Decreased Sex Hormone-Binding Globulin Indicated Worse Biometric, Lipid, Liver, and Renal Function Parameters in Women with Polycystic Ovary Syndrome

International Journal of Endocrinology ◽

10.1155/2020/7580218 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Xi Luo ◽

Xin-Ming Yang ◽

Wang-Yu Cai ◽

Hui Chang ◽

Hong-Li Ma ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Renal Function ◽

Polycystic Ovary ◽

Density Lipoprotein ◽

Metabolic Parameters ◽

Sex Hormone Binding Globulin ◽

Hormone Binding ◽

Ovary Syndrome ◽

Renal Functions

Objective. To investigate the relationships between sex hormone-binding globulin (SHBG) and comprehensive metabolic parameters including biometric, glycemic, lipid, liver, and renal functions of women with polycystic ovary syndrome (PCOS). Study Design and Methods. A total of 1000 women diagnosed as PCOS by modified Rotterdam criteria were enrolled in a randomized controlled trial. SHBG and comprehensive metabolic parameters were measured at the baseline visit. Metabolic parameters included biometric parameters, glucose and lipid panels, and liver and renal function parameters. An independent t-test and linear regression were performed to investigate the associations between SHBG and metabolic parameters. Logistic regression was used to detect the relationship between SHBG and the presence of metabolic syndrome. Results. In comparative analyses, PCOS women with lower SHBG levels had higher body mass index, waist circumference, insulin, homeostatic model assessment-insulin resistance (HOMA-IR) index, systolic and diastolic blood pressure, triglycerides, apolipoprotein B (APOB), low-density lipoprotein (LDL), aspartate transferase (AST), alanine transferase (ALT), and blood urea nitrogen (BUN), but lower high-density lipoprotein (HDL) and apolipoprotein A1 (APOA1). In linear regression, SHBG was inversely associated with waist circumference, systolic blood pressure, triglyceride, LDL, APOB, ALT, AST, and BUN but positively associated with HDL and APOA1 after adjusting the BMI. In logistic regression, SHBG is a protective predictor for metabolic syndrome (odds ratio = 0.96; 95% confidence interval: 0.95–0.97). The area under the receiver-operator characteristic curve is 0.732 with a 95% confidence interval of 0.695–0.770. SHBG <26.75 mmol/L is the cutoff point with the best Youden index, which has a sensitivity of 0.656 and specificity of 0.698. Conclusions. Lower SHBG was associated with worsening biometric, lipid, liver, and renal functions but not glycemic parameters among women with PCOS. SHBG can be used as a tool to screen metabolic syndrome. This trial is registered with NCT01573858 and ChiCTR-TRC-12002081.

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