Diyetiniz Suçlu Olabilir Mi? Polikistik Over Sendromunda Diyet İnflamatuar İndeksinin, Lipid Birikim Ürünü İndeksi ve Visseral Adipozite İndeksi Üzerindeki Rolünün İncelenmesi

Öz

Amaç: Bu çalışma, polikistik over sendromu (PKOS) olan kadınlarda Diyet İnflamatuar İndeksi’nin (Dİİ) çeşitli adipozite indeksleriyle ilişkisini incelemeyi amaçlamıştır. Gereç ve Yöntemler: Çalışmaya, İstanbul'da bir PKOS polikliniğine başvuran 18 - 44 yaş arası altmış iki kadın dahil edildi. Sosyodemografik veriler, antropometrik ölçümler, Dİİ'yi hesaplamak için 3 günlük besin tüketim kaydı ve adipozite indeksleri için yüksek yoğunluklu lipoprotein (HDL) kolesterol ve trigliserit (TG) düzeylerine ilişkin retrospektif veriler toplandı. Visseral Adipozite İndeksi (VAI) ve Lipid Birikim Ürünü (LAP) indeksi, elde edilen antropometrik verilere ve belirtilen kan parametrelerine dayanarak hesaplandı. Veriler, düşük ve yüksek Dİİ gruplarına ayrıldığından, sürekli değişkenler arasındaki grup farklarını değerlendirmek amacıyla, verilerin dağılımına bağlı olarak Mann-Whitney U testi uygulanmıştır. Bulgular: Kadınların ortalama yaşı 26,3 ± 6,1 yıl, beden kütle indeksi (BKİ) 25,1 ± 5,9 kg/m² idi ve %35,5'i fazla kilolu veya obezdi. Medyan Dİİ değeri 1,5'ti. Yüksek Dİİ'li kadınların daha yüksek VAI ve LAP değerleri olmasına rağmen fark, istatistiksel olarak anlamlı değildi. Bunun yanı sıra, yüksek Dİİ'li kadınların protein, toplam lif, omega-3 yağ asitleri, tekli doymamış yağ asitleri (TDYA), A, K ve B vitaminleri (B12 hariç), C vitamini, demir, kalsiyum, çinko, potasyum ve magnezyum alımları anlamlı olarak daha düşüktü. Sonuç: Bu bulgular, diyet kaynaklı inflamasyonun PKOS'ta metabolik bozukluklara katkıda bulunabileceğini düşündürmekte ve hastalığın yönetiminde anti-inflamatuar diyet yaklaşımlarının önemini vurgulamaktadır.

Anahtar Kelimeler

• Polikistik over sendromu
• diyet inflamatuar indeksi
• viseral adipozite indeksi
• lipid birikim ürünü indeksi
• adipozite indeksleri

Is Your Diet to Blame? Unveiling the Role of Dietary Inflammatory Index in Lipid Accumulation Product Index and Visceral Adiposity Index in Polycystic Ovary Syndrome

Öz

Aim: The present study sought to examine how the Dietary Inflammatory Index (DII) is related to different adiposity indices in women diagnosed with polycystic ovary syndrome (PCOS). Material and Methods: The study enrolled sixty-two women aged 18 - 44 years who applied to a PCOS outpatient clinic in Istanbul. Sociodemographic data, anthropometric measurements, 3-day food records for calculating DII, and retrospective data on high-density lipoprotein (HDL) cholesterol levels and triglyceride (TG) for adiposity indices were collected. Visceral Adiposity Index (VAI) and Lipid Accumulation Product (LAP) were computed based on the obtained anthropometric data and specified blood parameters. Since the data were divided into low and high DII groups, the Mann-Whitney U test was employed based on the statistical distribution to evaluate group differences between continuous variables. Results: The mean age of women was 26.3 ± 6.1 years, with a body mass index (BMI) of 25.1 ± 5.9 kg/m², and 35.5% were overweight or obese. The median DII value was 1.5. Although women with high DII had higher VAI and LAP values, the difference was not statistically significant. Additionally, women with high DII had significantly reduced dietary intakes of protein, total fiber, omega-3 fatty acids, monounsaturated fatty acids (MUFAs), vitamins A, K, and B vitamins (except B12), vitamin C, iron, calcium, zinc, potassium, and magnesium. Conclusion: These findings suggest that diet-induced inflammation may contribute to metabolic disturbances in PCOS, emphasizing the importance of anti-inflammatory dietary approaches in managing the condition.

Anahtar Kelimeler

• Polycystic ovary syndrome
• dietary inflammatory index
• visceral adiposity index
• lipid accumulation product
• adiposity indices

Kaynakça

1. 1. Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261–71.
2. 2. Salari N, Nankali A, Ghanbari A, Jafarpour S, Ghasemi H, Dokaneheifard S, et al. Global prevalence of polycystic ovary syndrome in women worldwide: a comprehensive systematic review and meta-analysis. Arch Gynecol Obstet [Internet]. 2024;310(3):1303–14. Available from: https://doi.org/10.1007/ s00404-024-07607-x
3. 3. Wang Q, Lang J, Zhi Y, Zhu X, Fu Y. Predicting factors of ovarian responses in infertile women with polycystic ovary syndrome undergoing IVF / ICSI. J Assist Reprod Genet [Internet]. 2025; Available from: https://doi.org/10.1007/s10815- 024-03386-1
4. 4. Naghshband Z, Kumar L, Mandappa S, Niranjana Murthy AS, Malini SS. Visceral adiposity index and lipid accumulation product as diagnostic markers of metabolic syndrome in South Indians with polycystic ovary syndrome. J Hum Reprod Sci. 2021;14(3):234–43.
5. 5. Zhuang S, Jing C, Yu L, Ji L, Liu W, Hu X. The relationship between polycystic ovary syndrome and infertility: a bibliometric analysis. Ann Transl Med. 2022;10(6):318–318.
6. 6. Barber TM, McCarthy MI, Wass JAH, Franks S. Obesity and Polycystic Ovary Syndrome. Clin Endocrinol (Oxf). 2006;65(2):137–45.
7. 7. Oh JY, Sung YA, Lee HJ. The visceral adiposity index as a predictor of insulin resistance in young women with polycystic ovary syndrome. Obesity. 2013;21(8):1690–4.
8. 8. Khanna D, Peltzer C, Kahar P, Parmar MS. Body Mass Index (BMI): A Screening Tool Analysis. Cureus. 2022;14(1994):1–6.

9. 9. Nascimento JXPT, Chein MBDC, De Sousa RML, Ferreira ADS, Navarro PA, Brito LMO. Importance of lipid accumulation product index as a marker of CVD risk in PCOS women. Lipids Health Dis [Internet]. 2015;14(1):1–8. Available from: http://dx.doi.org/10.1186/s12944-015-0061-y
10. 10. Kahn HS. The “lipid accumulation product” performs better than the body mass index for recognizing cardiovascular risk: A population-based comparison. BMC Cardiovasc Disord. 2005;5:1–10.
11. 11. Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, et al. Visceral adiposity index: A reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920–2.
12. 12. Anik Ilhan G, Yildizhan B, Pekin T. The impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome. Gynecol Endocrinol [Internet]. 2019;35(3):233–6. Available from: https://doi.org/10.108 0/09513590.2018.1519794
13. 13. Durmus U, Duran C, Ecirli S. Visceral adiposity index levels in overweight and/or obese, and non-obese patients with polycystic ovary syndrome and its relationship with metabolic and inflammatory parameters. J Endocrinol Invest. 2017;40(5):487–97.
14. 14. Wiltgen D, Benedetto IG, Mastella LS, Spritzer PM. Lipid accumulation product index: A reliable marker of cardiovascular risk in polycystic ovary syndrome. Hum Reprod. 2009;24(7):1726–31.
15. 15. Aboeldalyl S, James C, Seyam E, Ibrahim EM, Shawki HED, Amer S. The role of chronic inflammation in polycystic ovarian syndrome—a systematic review and meta-analysis. Int J Mol Sci. 2021;22(5):1–31.
16. 16. Clemente-Suárez VJ, Beltrán-Velasco AI, Redondo-Flórez L, Martín-Rodríguez A, Tornero-Aguilera JF. Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients. 2023;15(12).
17. 17. Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean diet as a tool to combat inflammation and chronic diseases. An overview. Biomedicines. 2020;8(8):1–13.
18. 18. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population- based dietary inflammatory index. Public Health Nutr. 2014;17(8):1689–96.
19. 19. Mtintsilana A, Micklesfield LK, Chorell E, Olsson T, Shivappa N, Hebert JR, et al. Adiposity mediates the association between the dietary inflammatory index and markers of type 2 diabetes risk in middle-aged black South African women. Nutrients. 2019;11(6):1–19.
20. 20. Saghafi-Asl M, Mirmajidi S, Asghari Jafarabadi M, Vahid F, Shivappa N, Hébert JR, et al. The association of dietary patterns with dietary inflammatory index, systemic inflammation, and insulin resistance, in apparently healthy individuals with obesity. Sci Rep [Internet]. 2021;11(1):1–8. Available from: https://doi.org/10.1038/s41598-021-86993-7
21. 21. Rahimlou M, Ahmadi AR, Cheraghian B, Baghdadi G, Ghalishourani SS, Nozarian S, et al. The association between dietary inflammatory index with some cardio-metabolic risk indices among the patients with type 2 diabetes from Hoveyzeh cohort study: a cross-sectional study. BMC Endocr Disord. 2024;24(1):1–12.
22. 22. Zirak Sharkesh E, Keshavarz SA, Nazari L, Abbasi B. The dietary inflammatory index is directly associated with polycystic ovary syndrome: A case-control study. Clin Endocrinol (Oxf). 2022;96(5):698–706.
23. 23. Yousefi Rad E, Kavei P, Akbari S, Vahid F, Hebert JR, Falahi E, et al. Association between Dietary Inflammatory Index (DII) and the Risk of Polycystic Ovary Syndrome: A Case-Control Study. J Nutr Food Secur. 2024;9(2):214–22.
24. 24. Alissa EM, Algarni SA, Khaffji AJ, Al Mansouri NM. Association of diet diversity score with visceral adiposity in women with polycystic ovarian syndrome. Hum Nutr Metab [Internet]. 2021;23:200116. Available from: https://doi.org/10.1016/j. hnm.2020.200116
25. 25. Bilginer MC, Tüfekçi D, Emur Günay Y, Usta O, Coşkun H, Üçüncü O, et al. Evaluation of Insulin Resistance Measurement Methods in Patients with Polycystic Ovary Syndrome. Turkish J Diabetes Obes. 2022;6(1):24–31.
26. 26. European Society of Human Reproduction and Embryology. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod. 2004;19(1):41–7.
27. 27. World Health Organization Regional Office for Europe. Body mass index - BMI [Internet]. [cited 2021 Feb 10]. Available from: https://www.euro.who.int/en/health-topics/disease- prevention/nutrition/a-healthy-lifestyle/body-mass-index- bmi#
28. 28. Cavicchia PP, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr. 2009;139(12):2365–72.
29. 29. Rakıcıoğlu N, Tek N, Ayaz A, Pekcan A. Yemek ve Besin Fotoğraf Kataloğu Ölçü ve Miktarlar. Ankara: Ata Ofset Matbaacılık; 2010.
30. 30. Kutluay Merdol T. Toplu beslenme yapılan kurumlar için standard yemek tarifleri. Ankara: Hatipoğlu Yayınları; 2003.
31. 31. Adanaş Aydın G, Özgen G. The relation of visceral adiposity index and lipid accumulation product with metabolic, anthropometric, and hormonal parameters in patients with polycystic ovary syndrome. J Surg Med. 2020;4(8):664–8.
32. 32. Gönülalan G, Saçkan F. The Importance of New Anthropometric Measurements in Detecting Cardio Metabolic Risk and Insulin Resistance in Patients with Polycystic Ovary Syndrome: Single Center Experience. Turkish J Diabetes Obes. 2021;5(1):25–32.
33. 33. Shreenidhi RA, Mahey R, Rajput M, Cheluvaraju R, Upadhyay AD, Sharma JB, et al. Utility of Visceral Adiposity Index and Lipid Accumulation Products to Define Metabolically-Unhealthy Polycystic Ovary Syndrome in Asian Indian Women - A Cross Sectional Study. J Hum Reprod Sci. 2024;17(1):50–7.
34. 34. Mario FM, Graff SK, Spritzer PM. Adiposity Indexes as Phenotype- Specific Markers of Preclinical Metabolic Alterations and Cardiovascular Risk in Polycystic Ovary Syndrome: A Cross-Sectional Study. Exp Clin Endocrinol Diabetes. 2017;125(5):307–15.
35. 35. Alenezi SA, Elkmeshi N, Alanazi A, Alanazi ST, Khan R, Amer S. The Impact of Diet-Induced Weight Loss on Inflammatory Status and Hyperandrogenism in Women with Polycystic Ovarian Syndrome (PCOS)—A Systematic Review and Meta- Analysis. J Clin Med. 2024;13(16).
36. 36. Wang Q, Sun Y, Xu Q, Liu W, Wang P, Yao J, et al. Higher dietary inflammation potential and certain dietary patterns are associated with polycystic ovary syndrome risk in China: A case-control study. Nutr Res [Internet]. 2022;100:1–18. Available from: https://doi.org/10.1016/j.nutres.2021.12.006
37. 37. Azarbayjani K, Jahanian Sadatmahalleh S, Mottaghi A, Nasiri M. Association of dietary inflammatory index with C-reactive protein and interleukin-6 in women with and without polycystic ovarian syndrome. Sci Rep [Internet]. 2024;14(1):1–10. Available from: https://doi.org/10.1038/s41598-024-53958-5
38. 38. Khan I, Kwon M, Shivappa N, Hébert JR, Kim MK. Positive association of dietary inflammatory index with incidence of cardiovascular disease: Findings from a korean population-based prospective study. Nutrients. 2020;12(2).
39. 39. Shivappa N, Hébert JR, Rietzschel ER, De Buyzere ML, Langlois M, Debruyne E, et al. Associations between dietary inflammatory index and inflammatory markers in the Asklepios Study. Br J Nutr. 2015;113(4):665–71.
40. 40. Zaeemzadeh N, Jahanian Sadatmahalleh S, Ziaei S, Kazemnejad A, Movahedinejad M, Mottaghi A, et al. Comparison of dietary micronutrient intake in PCOS patients with and without metabolic syndrome. J Ovarian Res. 2021;14(1):1–9.
41. 41. Kazemi M, Kim JY, Wan C, Xiong JD, Michalak J, Xavier IB, et al. Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women. Vol. 28, Human Reproduction Update. 2022. 910–955 p.
42. 42. Yuan J, Wen X, Jia M. Efficacy of omega-3 polyunsaturated fatty acids on hormones, oxidative stress, and inflammatory parameters among polycystic ovary syndrome: A systematic review and meta-analysis. Ann Palliat Med. 2021;10(8):8991– 9001.