Evaluation of insulin resistance and vitamin D levels in patients with polycystic ovary syndrome

Year 2022, Volume: 4 Issue: 2, 66 - 72, 29.04.2022

Soner Cander , Pınar Şişman , Özen Öz Gül

https://doi.org/10.46310/tjim.1027019

Cited By: 1

Abstract

Background: Polycystic ovary syndrome (PCOS) is associated with many long term health problems such as increased risk of obesity, type 2 diabetes, metabolic syndrome and cardiovascular risk factors. Several reports indicated that PCOS patients have lower vitamin D status compared to healthy subjects. In our study we aimed to investigate whether vitamin D deficiency has effect on the pathogenesis of insulin resistance in PCOS.
Material and Methods: Fourty eight patients with PCOS and 24 healthy controls were included in the study. Following the physical examination and anthropometric measurements of the patients and healthy subjects, glycemic control data, lipid values, parathormone, vitamin D status and hormonal parameters were studied.
Results: In our study, vitamin D levels were significantly lower in PCOS patients (19.7±26.9 ng/mL) compared with controls (31.9±35 ng/mL, p<0.01). Vitamin D levels were found to be lower in the obese PCOS group compared to those with non-obese, but not significant. Statistically significant inverse correlation was found between vitamin D levels and body mass index (BMI). It was also found between vitamin D and low density cholesterol (LDL-C).
Conclusions: Our findings revealed increased likelihood of metabolic and dyslipidemic manifestations in PCOS patients compared to control group, while no significant difference was noted in vitamin D levels among PCOS patients in terms of co-morbid obesity. The detection of lower vitamin D levels in PCOS patients suggested that this may be one of the causes of insulin resistance and metabolic complications in these patients.

Keywords

polycyctic ovary syndrome, vitamin D levels, obesity, insulin resistance

References

• LajtaiK,NagyCT,TarszabóR,BenkőR,HadjadjL,Sziva RE, Gerszi D, Bányai B, Ferdinandy P, Nádasy GL, Giricz Z, Horváth EM, Várbíró S. Effects of vitamin D deficiency on proliferation and autophagy of ovarian and liver tissues in a rat model of polycystic ovary syndrome. Biomolecules. 2019 Sep 10;9(9):471. doi: 10.3390/biom9090471.
• de Medeiros SF, Yamamoto MMW, Souto de Medeiros MA, Barbosa BB, Soares JM, Baracat EC. Changes in clinical and biochemical characteristics of polycystic ovary syndrome with advancing age. Endocr Connect. 2020 Feb;9(2):74-89. doi: 10.1530/EC-19-0496.
• Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/ jc.2013-2350.
• Mohammadi M. Oxidative stress and polycystic ovary syndrome: A brief review. Int J Prev Med. 2019 May 17;10:86. doi: 10.4103/ijpvm.IJPVM_576_17.
• Oz Gul O, Cander S, Gul CB, Budak F, Oral B, Ersoy C. Cytokine signal suppressor (SOCS) 1-1478 CA/del gene polymorphism in Turkish patients with polycystic ovary syndrome. J Obstet Gynaecol. 2017 Oct;37(7):896-901. doi: 10.1080/01443615.2017.1309011.
• Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005 Apr;90(4):1929-35. doi: 10.1210/jc.2004-1045.
• Gul OO, Cander S, Gul B, Açıkgoz E, Sarandol E, Ersoy C. Evaluation of insulin resistance and plasma levels for visfatin and resistin in obese and non-obese patients with polycystic ovary syndrome. Eur Cytokine Netw. 2015 Oct- Dec;26(4):73-8. doi: 10.1684/ecn.2015.0370.
• Ionica M, Aburel OM, Vaduva A, Petrus A, Rațiu S, Olariu S, Sturza A, Muntean DM. Vitamin D alleviates oxidative stress in adipose tissue and mesenteric vessels from obese patients with subclinical inflammation. Can J Physiol Pharmacol. 2020 Feb;98(2):85-92. doi: 10.1139/cjpp-2019- 0340.
• Masjedi F, Keshtgar S, Agah F, Karbalaei N. Association between sex steroids and oxidative status with vitamin D levels in follicular fluid of non-obese PCOS and healthy women. J Reprod Infertil. 2019 Jul-Sep;20(3):132-42.
• Ngo DT, Chan WP, Rajendran S, Heresztyn T, Amarasekera A, Sverdlov AL, O’Loughlin PD, Morris HA, Chirkov YY, Norman RJ, Horowitz JD. Determinants of insulin responsiveness in young women: Impact of polycystic ovarian syndrome, nitric oxide, and vitamin D. Nitric Oxide. 2011 Oct 30;25(3):326-30. doi: 10.1016/j. niox.2011.06.005.
• Wehr E, Pilz S, Schweighofer N, Giuliani A, Kopera D, Pieber TR, Obermayer-Pietsch B. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol. 2009 Oct;161(4):575-82. doi: 10.1530/EJE-09-0432.
• Bednarska S, Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: What’s new? Adv Clin Exp Med. 2017 Mar-Apr;26(2):359-67. doi: 10.17219/ acem/59380.
• Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004 Jun;89(6):2745-9. doi: 10.1210/ jc.2003-032046.
• Thomson RL, Spedding S, Buckley JD. Vitamin D in the aetiology and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2012 Sep;77(3):343-50. doi: 10.1111/j.1365-2265.2012.04434.x.
• Voulgaris N, Papanastasiou L, Piaditis G, Angelousi A, Kaltsas G, Mastorakos G, Kassi E. Vitamin D and aspects of female fertility. Hormones (Athens). 2017 Jan;16(1):5-21. doi: 10.14310/horm.2002.1715.
• He C, Lin Z, Robb SW, Ezeamama AE. Serum vitamin D levels and polycystic ovary syndrome: A systematic review and meta-analysis. Nutrients. 2015 Jun 8;7(6):4555-77. doi: 10.3390/nu7064555.
• Holick MF. Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357(3):266-81. doi: 10.1056/NEJMra070553.
• Escobar-Morreale HF, Luque-Ramírez M, González F. Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertil Steril. 2011 Mar 1;95(3):1048-58.e1-2. doi: 10.1016/j. fertnstert.2010.11.036.
• González F. Inflammation in polycystic ovary syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012 Mar 10;77(4):300-5. doi: 10.1016/j. steroids.2011.12.003.
• Rahsepar M, Mahjoub S, Esmaelzadeh S, Kanafchian M, Ghasemi M. Evaluation of vitamin D status and its correlation with oxidative stress markers in women with polycystic ovary syndrome. Int J Reprod Biomed. 2017 Jun;15(6):345-50.
• Rojas J, Chávez M, Olivar L, Rojas M, Morillo J, Mejías J, Calvo M, Bermúdez V. Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int J Reprod Med. 2014;2014:719050. doi: 10.1155/2014/719050.
• Teegarden D, Donkin SS. Vitamin D: emerging new roles in insulin sensitivity. Nutr Res Rev. 2009 Jun;22(1):82-92. doi: 10.1017/S0954422409389301.
• Hahn S, Haselhorst U, Tan S, Quadbeck B, Schmidt M, Roesler S, Kimmig R, Mann K, Janssen OE. Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes. 2006 Nov;114(10):577-83. doi: 10.1055/s-2006-948308.
• Ruiz-Ojeda FJ, Anguita-Ruiz A, Leis R, Aguilera CM. Genetic factors and molecular mechanisms of vitamin D and obesity relationship. Ann Nutr Metab. 2018;73(2):89- 99. doi: 10.1159/000490669.
• Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015 Apr;16(4):341-9. doi: 10.1111/obr.12239.
• YaoY,ZhuL,HeL,DuanY,LiangW,NieZ,JinY,Wu X, Fang Y. A meta-analysis of the relationship between vitamin D deficiency and obesity. Int J Clin Exp Med. 2015 Sep 15;8(9):14977-84.
• Freundlich M, Quiroz Y, Zhang Z, Zhang Y, Bravo Y, Weisinger JR, Li YC, Rodriguez-Iturbe B. Suppression of renin-angiotensin gene expression in the kidney by paricalcitol. Kidney Int. 2008 Dec;74(11):1394-402. doi: 10.1038/ki.2008.408.
• Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med. 2001 Dec 1;111(8):607-13. doi: 10.1016/s0002-9343(01)00948-2.
• Mahmoudi T, Gourabi H, Ashrafi M, Yazdi RS, Ezabadi Z. Calciotropic hormones, insulin resistance, and the polycystic ovary syndrome. Fertil Steril. 2010 Mar 1;93(4):1208-14. doi: 10.1016/j.fertnstert.2008.11.031.
• Li HW, Brereton RE, Anderson RA, Wallace AM, Ho CK. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metabolism. 2011 Oct;60(10):1475-81. doi: 10.1016/j.metabol.2011.03.002.
• Güdücü N, Görmüs U, Kutay SS, Kavak ZN, Dünder I. 25-Hydroxyvitamin D levels are related to hyperinsulinemia in polycystic ovary syndrome. Gynecol Endocrinol. 2014 Aug;30(8):557-60. doi: 10.3109/09513590.2014.910189.