Excess adipose tissue and chronic subclinical inflammation in patients with polycystic ovary syndrome
- Authors: Kirillova E.D.1, Krechetova L.V.1, Vtorushina V.V.1, Ivanets T.Y.1, Chernukha G.E.1
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Affiliations:
- Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
- Issue: No 4 (2023)
- Pages: 111-119
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/462788
- DOI: https://doi.org/10.18565/aig.2023.56
- ID: 462788
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Abstract
Objective: To analyze the serum levels of proinflammatory markers in patients with polycystic ovary syndrome (PCOS) and assess their association with body composition and metabolic parameters.
Materials and methods: This single-center cross-sectional study included 148 women with PCOS (mean age 25.1 (5.5) years). Of these, 118 had PCOS (mean age 25.1 (5.5) years), 14 were overweight and obese without PCOS (mean age 26.1 (7.4) years) and 16 were somatically healthy women (mean age 25.3 (5.1) years). All participants underwent comprehensive clinical, laboratory, and instrumental examination.
Results: Patients with PCOS had significantly higher levels of IL-6, TNF-α, and CRP than those in the control group; however, there were no statistically significant differences in the levels of IL-1, leptin, and adiponectin. PCOS patients had signs of chronic subclinical inflammation in the form of elevated IL-6 and CRP levels in 39% and 37% of the cases, respectively. Hidden obesity was diagnosed in 65.0% of PCOS patients with a normal BMI, manifesting as excess visceral adipose tissue in 46.2% of cases. This group was seven times more likely to have elevated CRP levels and nearly four times more likely to be insulin resistant than patients with normal total body fat percentage.
Conclusion: It is appropriate to recommend adipose tissue densitometry and assessment of levels of proinflammatory markers to identify risk groups for pregnancy complications, cardiovascular disease, and type 2 diabetes mellitus in patients with PCOS with normal BMI and for further correction of modifiable risk factors by lifestyle changes, drug therapy, and pre-pregnancy care.
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About the authors
Ekaterina D. Kirillova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Author for correspondence.
Email: emiroshina.md@gmail.com
ORCID iD: 0000-0002-3723-5052
Junior Reseasrcher at the Department of Gynecological Endocrinology
Russian Federation, MoscowLyubov V. Krechetova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: k_l_v_@mail.ru
ORCID iD: 0000-0001-5023-3476
Dr. Med. Sci., Head of the Laboratory of Clinical Imunology
Russian Federation, MoscowValentina V. Vtorushina
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: v_vtorushina@oparina4.ru
PhD, Immunologist at the Laboratory of Clinical Immunology
Russian Federation, MoscowTatyana Yu. Ivanets
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: t_ivanets@oparina4.ru
ORCID iD: 0000-0002-7990-0276
Dr. Med. Sci., Head of the Clinical Diagnostic Laboratory
Russian Federation, MoscowGalina E. Chernukha
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: c-galina1@yandex.ru
ORCID iD: 0000-0002-9065-5689
Dr. Med. Sci., Professor, Chief Researcher, Department of Gynecological Endocrinology
Russian Federation, MoscowReferences
- Deswal R., Narwal V., Dang A., Pundir C.S. The prevalence of polycystic ovary syndrome: a brief systematic review. J. Hum. Reprod. Sci. 2020; 13(4): 261-71. https://dx.doi.org/10.4103/jhrs.JHRS_95_18.
- Goodman N.F., Cobin R.H., Futterweit W., Glueck J.S., Legro R.S., Carmina E.; American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society. American association of clinical endocrinologists, American college of endocrinology, and androgen excess and pcos society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 2. Endocr. Pract. 2015; 21(12): 1415-26. https://dx.doi.org/10.4158/ EP15748.DSCPT2.
- Zhu S., Li Z., Hu C., Sun F., Wang C., Yuan H. et al. Imaging-based body fat distribution in polycystic ovary syndrome: a systematic review and meta-analysis. Front. Endocrinol. (Lausanne). 2021; 9(12): 697223. https://dx.doi.org/10.3389/fendo.2021.697223.
- Chernukha G.E., Miroshina E.D., Kuznetsov S.Yu., Ivanov I.A. Body mass index, body composition, and metabolic profile of patients with polycystic ovary syndrome. Obstetrics and Gynecology. 2021; (10): 103-11. (in Russian). https://dx.doi.org/10.18565/aig.2021.10.103-111.
- Kelly C.C.J., Lyall H., Petrie J.R., Gould G.W., Connell J.M.C., Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome. J. Clin. Endocrinol. Metab. 2001; 86(6): 2453-5. https://dx.doi.org/10.1210/jcem.86.6.7580.
- Escobar Morreale H.F., Laque-Ramirez M., Gonzalez F. Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and meta-analysis. Fertil. Steril. 2011; 95(3): 1048-58. https://dx.doi.org/10.1016/ j.fertnstert.2010.11.036.
- Mu L., Li R., Lai Y., Zhao Y., Qiao J. Adipose insulin resistance is associated with cardiovascular risk factors in polycystic ovary syndrome. J. Endocrinol. Invest. 2019; 42(5): 541-8. https://dx.doi.org/10.1007/s40618-018-0949-2.
- Ramamoorthy S., Bhuvaneswari K. A cross-sectional study on the status of inflammatory markers in polycystic ovary syndrome (PCOS) in Indian population. Biomed. Pharmacol. J. 2019; 12: 1975-83. https://dx.doi.org/10.13005/bpj/1829.
- Lin Y.S., Tsai S.J., Lin M.W., Yang C.T., Huang M.F., Wu M.H. Interleukin-6 as an early chronic inflammatory marker in polycystic ovary syndrome with insulin receptor substrate-2 polymorphism. Am. J. Reprod. Immunol. 2011; 66(6): 527-33. https://dx.doi.org/10.1111/j.1600-0897.2011.01059.x.
- Fulghesu A.M., Sanna F., Uda S., Magnini R., Portoghese E., Batetta B. IL-6 serum levels and production is related to an altered immune response in polycystic ovary syndrome girls with insulin resistance. Mediators Inflamm. 2011; 2011: 389317. https://dx.doi.org/10.1155/2011/389317.
- Borst S.E. The role of TNF-alpha in insulin resistance. Endocrine. 2004; 23(2-3): 177-82. https://dx.doi.org/10.1385/ENDO:23:2-3:177.
- Goswami S., Choudhuri S., Bhattacharya B., Bhattacharjee R., Roy A., Mukhopadhyay S. et al. Chronic inflammation in polycystic ovary syndrome: A case-control study using multiple markers. Int. J. Reprod. Biomed. 2021; 19(4): 313-20. https://dx.doi.org/10.18502/ijrm.v19i4.9057.
- Choi Y.S., Yang H.I., Cho S., Jung J.A., Jeon Y.E., Kim H.Y. et al. Serum asymmetric dimethylarginine, apelin, and tumor necrosis factor-α levels in non-obese women with polycystic ovary syndrome. Steroids. 2012; 77(13): 1352-8. https://dx.doi.org/10.1016/j.steroids.2012.08.005.
- De Luca C., Olefsky J.M. Inflammation and insulin resistance. FEBS Lett. 2008; 582: 97-105. https://dx.doi.org/10.1016/j.febslet.2007.11.057.
- Shoelson S.E., Lee J., Goldfine A.B. Inflammation and insulin resistance. J. Clin. Invest. 2006; 116(7): 1793-801. https://dx.doi.org/10.1172/JCI29069.
- Zatterale F., Longo M., Naderi J., Raciti G.A., Desiderio A., Miele C. et al. Chronic adipose tissue inflammation linking obesity to insulin resistance and Type 2 diabetes. Front. Psychol. 2020; 10: 1607. https://dx.doi.org/10.3389/fphys.2019.01607.
- Ministry of Health of Russian Federation. Clinical guidelines "Polycystic ovary syndrome". Moscow; 2021. (in Russian).
- Sumner A.E., Cowie C.C. Ethnic differences in the ability of triglyceride levels to identify insulin resistance. Atherosclerosis. 2008; 196(2): 696-703. https://dx.doi.org/10.1016/j.atherosclerosis.2006.12.018.
- Ministry of Health of Russian Federation. Clinical guidelines "Type 2 diabetes in adults". Moscow; 2019. (in Russian).
- Sim S.J., Park H.S. The cut-off values of body fat to identify cardiovascular risk among Korean adults. Korean J. Obes. 2004; 13(1): 14-21.
- Dudeja V., Misra A., Pandey R.M., Devina G., Kumar G., Vikram N.K. BMI does not accurately predict overweight in Asian Indians in northern India. Br. J. Nutr. 2001; 86(1): 105-12. https://dx.doi.org/10.1079/bjn2001382.
- Goh V.H., Tain C.F., Tong T.Y., Mok H.P., Wong M.T. Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population. J. Lipid Res. 2004; 45(10): 1892-8. https://dx.doi.org/10.1194/ jlr.M400159-JLR200.
- Miazgowski T., Krzyżanowska-Świniarska B., Dziwura-Ogonowska J., Widecka K. The associations between cardiometabolic risk factors and visceral fat measured by a new dual-energy X-ray absorptiometry-derived method in lean healthy Caucasian women. Endocrine. 2014; 47(2): 500-5. https://dx.doi.org/10.1007/s12020-014-0180-7.
- Palomba S., de Wilde M.A., Falbo A., Koster M.P., La Sala G.B., Fauser B.C. Pregnancy complications in women with polycystic ovary syndrome. Hum. Reprod. Update. 2015; 21(5): 575-92. https://dx.doi.org/10.1093/humupd/dmv029.
- Abraham Gnanadass S., Divakar Prabhu Y., Valsala Gopalakrishnan A. Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update. Arch. Gynecol. Obstet. 2021; 303(3): 631-43. https://dx.doi.org/10.1007/s00404-020-05951-2.
- Yureneva S.V., Komedina V.I., Kuznetsov S.Yu. Diagnostic value of anthropometric characteristics of obesity in women during the menopause transition. Obstetrics and Gynecology. 2022; (2): 72-9. (in Russian). https://dx.doi.org/10.18565/aig.2022.2.72-79.
- Aboeldalyl S., James C., Seyam E., Ibrahim E.M., Shawki H.E., Amer S. The role of chronic inflammation in polycystic ovarian syndrome-a systematic review and meta-analysis. Int. J. Mol. Sci. 2021; 22(5): 2734. https://dx.doi.org/10.3390/ijms22052734.
- Chernukha G.E., Blinova I.V. PCOS: cardiovascular risks and the impact of siofor therapy on them. Difficult Patient. 2008; 6(1): 18-22 (in Russian).
- Palomba S., Falbo A., Chiossi G., Orio F., Tolino A., Colao A. et al. Low-grade chronic inflammation in pregnant women with polycystic ovary syndrome: a prospective controlled clinical study. J. Clin. Endocrinol. Metab. 2014; 99(8): 2942-51. https://dx.doi.org/10.1210/jc.2014-1214.
- Mukherjee A.G., Wanjari U.R., Kannampuzha S., Murali R., Namachivayam A., Ganesan R. et al. The implication of mechanistic approaches and the role of the microbiome in polycystic ovary syndrome (PCOS): a review. Metabolites. 2023; 13: 129. https://dx.doi.org/10.3390/metabo13010129.
- Custodero C., Mankowski R.T., Lee S.A., Chen Z., Wu S., Manini T.M. et al. Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: A systematic review and meta-analysis. Ageing Res. Rev. 2018; 46: 42-59. https://dx.doi.org/10.1016/ j.arr.2018.05.004.
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