Altered trace mineral milieu might play an aetiological role in the pathogenesis of polycystic ovary syndrome

Copper homeostasis and cuproptosis in gynecological disorders: Pathogenic insights and therapeutic implications

This review comprehensively explores the complex role of copper homeostasis in female reproductive system diseases. As an essential trace element, copper plays a crucial role in various biological functions. Its dysregulation is increasingly recognized as a pivotal factor in the pathogenesis of gynecological disorders. We investigate how copper impacts these diseases, focusing on aspects like oxidative stress, inflammatory responses, immune function, estrogen levels, and angiogenesis. The review highlights significant changes in copper levels in diseases such as cervical, ovarian, endometrial cancer, and endometriosis, underscoring their potential roles in disease mechanisms and therapeutic exploration. The recent discovery of 'cuproptosis,' a novel cell death mechanism induced by copper ions, offers a fresh molecular perspective in understanding these diseases. The review also examines genes associated with cuproptosis, particularly those related to drug resistance, suggesting new strategies to enhance traditional therapy effectiveness. Additionally, we critically evaluate current therapeutic approaches targeting copper homeostasis, including copper ionophores, chelators, and nanoparticles, emphasizing their emerging potential in gynecological disease treatment. This article aims to provide a comprehensive overview of copper's role in female reproductive health, setting the stage for future research to elucidate its mechanisms and develop targeted therapeutic strategies.

Minerals and the Menstrual Cycle: Impacts on Ovulation and Endometrial Health

The role of minerals in female fertility, particularly in relation to the menstrual cycle, presents a complex area of study that underscores the interplay between nutrition and reproductive health. This narrative review aims to elucidate the impacts of minerals on key aspects of the reproductive system: hormonal regulation, ovarian function and ovulation, endometrial health, and oxidative stress. Despite the attention given to specific micronutrients in relation to reproductive disorders, there is a noticeable absence of a comprehensive review focusing on the impact of minerals throughout the menstrual cycle on female fertility. This narrative review aims to address this gap by examining the influence of minerals on reproductive health. Each mineral's contribution is explored in detail to provide a clearer picture of its importance in supporting female fertility. This comprehensive analysis not only enhances our knowledge of reproductive health but also offers clinicians valuable insights into potential therapeutic strategies and the recommended intake of minerals to promote female reproductive well-being, considering the menstrual cycle. This review stands as the first to offer such a detailed examination of minerals in the context of the menstrual cycle, aiming to elevate the understanding of their critical role in female fertility and reproductive health.

Puerarin Ameliorated PCOS through Preventing Mitochondrial Dysfunction Dependent on the Maintenance of Intracellular Calcium Homeostasis

Polycystic ovarian syndrome (PCOS) is the major cause of infertility in reproductive women, but no universal drug is feasible. Although puerarin clinically treats cerebrovascular and cardiovascular diseases, its curative effect on PCOS remains elusive. The present study discovered that administration of puerarin restored estrous cycle of PCOS mice and diminished the number of cystic follicles with the concomitant recovery for circulating testosterone, LH and FSH levels, and LH/FSH ratio, indicating the therapeutic role of puerarin in PCOS. KEGG analysis of differential genes between PCOS and control revealed the enrichment in MAPK and calcium signaling pathway. Application of puerarin restricted the phosphorylation of ERK1/2 and JNK, whose activation neutralized the improvement of puerarin on the secretory function and apoptosis of ovarian granulosa cells (GCs). Meanwhile, puerarin alleviated the accumulation of cytosolic Ca2+ through restricting the opening of Ryr and Itpr channels, but this effectiveness was counteracted by the activatory ERK1/2 and JNK. Attenuation of cytosolic Ca2+ counteracted the antagonistic effects of ERK1/2 and JNK activation on puerarin's role in rescuing the calcineurin and Nfatc. Further analysis manifested that Mcu had been authenticated as a direct downstream target of Nfatc to mediate the amelioration of puerarin on mitochondrial Ca2+ uptake. Moreover, puerarin prevented the disorder of ATP content, mitochondrial membrane potential, and mitochondrial permeability transition pore opening through maintaining mitochondrial Ca2+ homeostasis. Collectively, puerarin might ameliorate the symptoms of PCOS mice through preventing mitochondrial dysfunction that is dependent on the maintenance of intracellular Ca2+ homeostasis after inactivation of ERK1/2 and JNK.

Investigation of the Association of Serum Trace Elements Concentrations and Serum Biochemical Parameters with the Risk of Polycystic Ovary Syndrome: a Case-Control Study

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrinological syndrome characterized by hyperandrogenism of ovarian origin and is often considered a predisposing factor for metabolic disorders. The objective of the study was to investigate serum levels of (a) trace elements (copper (Cu), zinc (Zn), magnesium (Mg), selenium (Se), iron (Fe), chromium (Cr), and manganese (Mn)); and (b) biochemical parameters (glucose, cholesterol, triglycerides, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), albumin, total protein, creatinine, and C-reactive protein (CRP) with risk of PCOS. Another objective was to explore the relationship between serum trace elements and biochemical variables. Serum trace elements were estimated by inductively coupled plasma mass spectrometry (ICP-MS) and biochemical parameters were estimated by colorimetric methods in 99 PCOS cases and 82 controls. Linear and non-linear associations of serum variables with PCOS risk were studied under logistic, probit, GAM, and BKMR model. Statistical analyses were performed using IBM SPSS 22.0 and R package version 4.2.1. All studied serum trace elements (except Zn) are significantly associated with PCOS. Combined effect analysis revealed Mg-Se and Fe-Cu association with PCOS risk. A significant association of cholesterol, HDL-C, LDL-C, CRP, and albumin was observed. Furthermore, linear regression analysis suggests an association between Mg-Cu and Mg-Fe-Mn with HDL-C; Fe and Cr-Cu with albumin; and Cu-Se with cholesterol and LDL-C both.

Copper in Gynecological Diseases

Copper (Cu) is an essential micronutrient for the correct development of eukaryotic organisms. This metal plays a key role in many cellular and physiological activities, including enzymatic activity, oxygen transport, and cell signaling. Although the redox activity of Cu is crucial for enzymatic reactions, this property also makes it potentially toxic when found at high levels. Due to this dual action of Cu, highly regulated mechanisms are necessary to prevent both the deficiency and the accumulation of this metal since its dyshomeostasis may favor the development of multiple diseases, such as Menkes' and Wilson's diseases, neurodegenerative diseases, diabetes mellitus, and cancer. As the relationship between Cu and cancer has been the most studied, we analyze how this metal can affect three fundamental processes for tumor progression: cell proliferation, angiogenesis, and metastasis. Gynecological diseases are characterized by high prevalence, morbidity, and mortality, depending on the case, and mainly include benign and malignant tumors. The cellular processes that promote their progression are affected by Cu, and the mechanisms that occur may be similar. We analyze the crosstalk between Cu deregulation and gynecological diseases, focusing on therapeutic strategies derived from this metal.

Comparison of Magnesium Status Using 24-h Urine Magnesium Content and Magnesium Fraction Excretion in PCOS with Non-PCOS Control Women: a Cross-sectional Study

Magnesium (Mg) is the second most frequent intracellular cation, having an important role in normal enzyme function and insulin secretion. Polycystic ovarian syndrome (PCOS) is the most prevalent endocrinopathy in women of reproductive age and often associated with insulin resistance. Two systematic reviews and meta-analyses have been conducted to compare mean serum Mg levels between PCOS and control groups. Both studies detected unexplained heterogeneity among input studies and the two conclusions contradict each other, while approximately 1% of total body Mg is present in extracellular fluid (ECF) and serum Mg level does not represent Mg status well. For the first time, we investigated magnesium renal fraction excretion (FEMg) and compared mean values between PCOS and non-PCOS control women. This study is a cross-sectional analysis conducted at an academic medical center. Forty-four women were included in the PCOS group based on the Rotterdam criteria and 50 non-PCOS women were included in the control group. Statistical analysis of the relationship between 24-h urinary Mg content and FEMg, and also physical and metabolic variables, was performed. Main outcome measurements are 24-h urinary Mg content and FEMg. Mean values of 24-h urinary Mg content and FEMg did not significantly differ between PCOS and control groups (P = 0.22 and P = 0.24, respectively). Also, serum Mg levels and Ca/Mg ratio were similar between the groups (P = 0.17 and P = 0.26, respectively). Our data suggested Mg status in the PCOS group was similar to the non-PCOS control group and both were not magnesium deficient. For further investigation, we recommend using FEMg for evaluating Mg status rather than serum Mg levels. Considering collection of background diet is helpful and desired for future studies.

Heavy Metals and Essential Elements in Association with Oxidative Stress in Women with Polycystic Ovary Syndrome-A Systematic Review

Altered levels of heavy metals and essential elements have been associated with oxidative stress (OS) and metabolic and hormonal changes in women with polycystic ovary syndrome (PCOS). We aimed to summarize the knowledge on the association of heavy metals and essential elements with OS in PCOS. An electronic literature search using PubMed for studies published between January 2008 and April 2023 was conducted. We evaluated heavy metals and essential elements in relation to OS in PCOS in 15 articles. PCOS women had increased antimonium (Sb), cadmium (Cd), lead (Pb), mercury (Hg), arsenic (As), tellurium (Te), thallium (Tl) and osmium (Os) blood levels and decreased zinc (Zn) blood levels; the results of copper (Cu) blood levels were conflicting. Some studies showed a significant correlation between heavy metals (Sb, Cd, Pb, Hg, As, Te and Tl) and essential elements (Se, Zn, Cr, Ca, Mg and Cu) and markers of OS and chronic inflammation. Heavy metals (Sb, Cd, Pb and Hg) and essential elements (Zn, Cr, Se, Ca, Mg and Cu) were associated with metabolic and hormonal characteristics in PCOS. There might be a possible benefit from supplementation therapy in reducing OS and endocrinological problems related to PCOS. Our review confirmed an association between heavy metals and essential elements with OS in PCOS women. This systematic review is registered in PROSPERO under number CRD42023418453.

Effect of magnesium supplementation in improving hyperandrogenism, hirsutism, and sleep quality in women with polycystic ovary syndrome: A randomized, placebo-controlled clinical trial

Background and Aims

Polycystic ovary syndrome (PCOS) is one of the common endocrine disorders in women, which causes numerous symptoms in women. The relationship of many micronutrients with this syndrome has been investigated. This study was conducted to examine the effects of magnesium supplementation on hyperandrogenism, hirsutism, and sleep quality in women with PCOS.

Methods

In this parallel randomized clinical trial, 64 women with PCOS were randomly assigned to the magnesium group (n = 32) or placebo group (n = 32) for 10 weeks. Patients in the magnesium group received one 250 mg magnesium oxide tablet, per day. Hyperandrogenism, hirsutism, and sleep quality were measured at the beginning and end of the study. This randomized clinical trial was registered at https://www.IRCT.ir (IRCT20130903014551N8).

Results

Magnesium supplementation had no significant effect on hyperandrogenism (p = 0.51 for dehydroepiandrosterone sulfates, p = 0.27 for testosterone), hirsutism (p = 0.23), and sleep quality (p = 0.85) compared with placebo.

Conclusions

The present study showed that a single dose of magnesium supplementation elicited no beneficial effects on the mentioned symptoms in polycystic women. It is possible that the positive effects of magnesium observed in the former studies were due to the synergistic effects of other vitamins or minerals. More studies are needed in this area.

Effect of vitamin E supplementation on cardiometabolic risk factors, inflammatory and oxidative markers and hormonal functions in PCOS (polycystic ovary syndrome): a systematic review and meta-analysis

Polycystic ovary syndrome (PCOS) is a common endocrinopathy among reproductive-age women. Various therapeutical approaches are currently used to manage or control symptoms associated with PCOS. This systematic review intended to assess the effects of Vit E supplementation on cardiometabolic risk factors, inflammatory and oxidative markers, and hormonal functions in PCOS women based on the clinical trial's results. The databases including PubMed, Scopus, Cochrane, Web of Science, and Embase were used to find all relevant studies. The authors reviewed all relevant clinical trials via systematic evaluation of abstracts and titles. Searches were conducted on August 1, 2020. After the initial search and reading of the article's title and abstract, 353 articles were reviewed; finally, 12 articles met the inclusion criteria. Vitamin E supplementation improves lipid profile, decreases insulin and HOMA-IR levels. Furthermore, while Vitamin E supplementation decreases LH and testosterone concentrations, it increases FSH and progestrone concentrations. The following meta-analysis showed that vitamin E supplementation made statistically significant improvements in triglyceride (TG) and low-density lipoproteins (LDL) levels, meanwhile, pooled mean difference for waist circumference (WC) and HOMA-IR were also statistically significant. Supplementary regimens containing vitamin E can positively affect metabolic and hormonal parameters in women with PCOS.

Effects of Melatonin and/or Magnesium Supplementation on Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial

Magnesium and melatonin are known to exert multiple beneficial effects including anti-inflammatory and antioxidant actions. This study was designed to determine the effects of magnesium and/or melatonin supplementation on metabolic profiles in women with polycystic ovary syndrome (PCOS). This randomized double-blind, placebo-controlled trial was conducted among 84 subjects with PCOS aged 18-40 years old. Patients were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, or placebo for 8 weeks. Fasting blood samples were taken at baseline and after the intervention to quantify related variables. After the 8-week intervention, an insignificant marginal difference was seen in waist circumference (WC) between groups (P = 0.085). Magnesium-melatonin co-supplementation resulted in more reductions in hirsutism compared with other groups (P < 0.001). Serum levels of tumor necrosis factor-α (TNF-α) declined significantly in the melatonin and co-supplementation groups compared to baseline (P < 0.05). Also, magnesium plus melatonin was associated with a more increase in total antioxidant capacity (TAC) levels, as compared to the other treatment groups (P = 0.001). Overall, we found a favorable effect of co-supplementation of magnesium and melatonin for 8 weeks in women with PCOS on hirsutism, serum TNF-α, and TAC levels. Furthermore, melatonin independently contributed to decreased serum values of TNF-α.Clinical trial registration number http://www.irct.ir : IRCT20191130045556N1, January 2020.

Clinical evidence of the effects of carnitine supplementation on body weight, glycemic control and serum lipids in women with polycystic ovary syndrome: a systematic review and meta-analysis

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Several clinical trials have investigated the influence of carnitine on metabolic variables in PCOS, but have yielded conflicting results. This study aimed to summarize the clinical evidence of the effects of carnitine on weight management, glycemic and serum lipids controls in women with PCOS by conducting a meta-analysis of randomized control trials (RCTs). PubMed, Embase, Web of Sciences, Scopus, and the CENTRAL database were searched from inception to March 2021 for eligible articles. Study selection and assessment of quality were conducted independently by two investigators. Effect sizes for each outcome were reported with the weighted mean differences (WMDs) and 95% confidence intervals (CIs). The statistical heterogeneity of the included clinical trials was tested using the I² statistic. Six studies with 672 PCOS participants were included for meta-analysis. Our results revealed that carnitine supplements significantly decreased total cholesterol, low-density lipoprotein-cholesterol, triglycerides, body weight, body mass index, hip circumference, and waist circumference (All p < .05). In addition, carnitine intervention also improved the levels of high-density lipoprotein cholesterol. However, no significant changes were seen in glucose homeostasis parameters. These results were stable after sensitivity analysis, and no significant publication biases were detected. Based on current evidence, carnitine supplementation in women with PCOS had beneficial effects on weight loss and lipid profiles. Further large-scale, well-designed RCTs are required to confirm these results.

Levels of Trace Elements in Erythrocytes as Endocrine Disruptors in Obese and Nonobese Women with Polycystic Ovary Syndrome

Introduction: Polycystic ovary syndrome (PCOS) is one of the most commonly recognized endocrinopathies in women. The literature lacks clear data that allow any meaningful conclusions to be drawn about the influence of trace elements in erythrocytes on the biochemical parameters of PCOS. Materials and methods: This study was conducted among 47 women meeting the Rotterdam criteria for the diagnosis of polycystic ovary syndrome. The research groups included women with PCOS with different BMI values (body mass index): obese women with PCOS (PCOS with BMI ≥ 30, mean BMI index 35.4 ± 4.4 kg/m²), nonobese PCOS women (PCOS with BMI < 30, mean BMI index 25.2 ± 2.8 kg/m²), and healthy control group (CG) with a mean BMI of 23.57 ± 0.9 kg/m². The contents of trace elements in erythrocytes were determined with an inductively coupled plasma atomic emission spectrometer. Results: The only trace element showing significant differences in concentration between the studied groups was nickel (Ni). The level of nickel in the obese women with PCOS (BMI ≥ 30) was significantly higher than in nonobese women (BMI < 30). The content of other trace elements in erythrocytes did not differ significantly between the studied groups. Several significant correlations were found within each of the studied PCOS groups: in the group of obese women, the content of zinc (Zn) in erythrocytes positively correlated with prolactin, the content of magnesium (Mg) positively correlated with testosterone, and the content of manganese (Mn) negatively correlated with thyroid-stimulating hormone. In the group of nonobese women, Zn content correlated positively with testosterone, Ni with luteinizing hormone (LH) and estradiol, and Mg negatively correlated with estradiol. Conclusions: The relationship between the level of trace elements and the level of hormones suggests that, in obese women with PCOS, nickel may play a role in inhibiting the processes of folliculogenesis and ovulation. Research on trace elements and their relationship to ovulatory cycles and the development of PCOS may contribute to reducing the consequences of PCOS and, therefore, should be extended.

Alterations in manganese level in the biological samples of young obese Saudi women

OBJECTIVES

This study aims to evaluate the changes in serum manganese levels in the nails of women with obesity.

METHODS

A cross-sectional study was conducted between 2018 and 2019 at Imam Abdulrahman Bin Faisal University, KSA. It was conducted in a convenience sample of 30 women with obesity and 40 without obesity. We obtained biological samples of nails from the participants and analysed these samples using a plasma atomic emission spectrometer to estimate the levels of manganese. A standard questionnaire containing items related to demographic features, such as address, age, education, and marital status, was used. In addition, the data on the usual consumption of water, milk, and soft drinks during a day or week, eating habits, and other health information were included in the questionnaire.

RESULTS

The results of this study show that manganese levels are significantly lower (p < 0.001) in the group with obesity at 0.34 ± 0.06 mg/kg than in the group without obesity at 0.62 ± 0.02 mg/kg. Regular sports activity in a week and consumption of fruit, vegetables, fish, meat, and water are significant predictors of the levels of manganese in the body.

CONCLUSION

The study demonstrates a significant difference in the levels of manganese in the nails of obese participants compared to non-obese participants. Further studies are needed to determine whether Saudi women are at risk for manganese deficiency.

Explore the potential molecular mechanism of polycystic ovarian syndrome by protein-protein interaction network analysis

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders prevailing in reproductive age women, present in 3-15% population of women worldwide. Although there are many studies on PCOS, its underlying mechanism remains to be determined. The present study was to construct protein-protein interaction networks based on the potential disease-causing genes for PCOS and characterize the underlying molecular mechanisms of PCOS using the networks. PCOS-associated genes were extracted from DisGeNet and the protein-protein interaction networks (PPIN) of PCOS were constructed using the String Database. Then we utilized MCODE algorithm to analyse the hub-gene modules from the PPIN. Finally, the major biological functions and signaling pathways involved in the hub modules were explored by functional enrichment analysis. A total of 522 candidate genes associated to PCOS were extracted from DisGeNET database. The PPIN constructed using the genes we have collected above included 488 genes and 2767 interaction relationships. Moreover, seven major gene modules were obtained after analyzing the PPIN with the use of MCODE plug-in. The major modules generated were enriched in certain biological functions such as cancer and cell proliferation and apoptosis, regulation of lipid and glucose metabolism, cell cycle and so on. The integrated analysis performed in the current study revealed that these hub modules and their related genes are closely associated to the pathogenesis of PCOS, which may probably provide novel insights for the treatment of PCOS and the study of its latent pathogenic mechanism. The relationship between several of the key genes including ALB, TOP2A, PTGER3, NPB and BRD2 in the modules and PCOS has not been investigated previously and it remains to be verified by further research of large sample, multi-center and multi-ethnic.

DNA methylation of AMHRII and INSR gene is associated with the pathogenesis of Polycystic Ovary Syndrome (PCOS)

BACKGROUND:

Polycystic ovary syndrome (PCOS) is a common gynecologic endocrinopathy, characterized by menstrual disorders, ovulation disorders, polycystic ovary, hyperandrogen syndrome and insulin resistance. At present, the etiology and exact pathogenesis of PCOS are still unclear. Anti-Müllerian hormone is a local regulator secreted by ovarian granulosa cells, and participates in regulating the occurrence and development of PCOS. Insulin resistance is another important pathophysiological feature of PCOS. Although the expression of anti-müllerian hormone receptor (AMHR) and insulin receptor (INSR) in PCOS have been previously reported, the DNA methylation of the genes have not been well characterized.

OBJECTIVE:

To study AMHR II/INSR and its role in gene methylation in Ovarian and endometrial pathology of PCOS subjects.

METHODS:

We recruited seventy-five women with PCOS as cases and twenty healthy women as controls, using immunohistochemical method, study localization, distribution and expression of MHRII/INSR in ovary and endometrium and then discover the correlation of AMHRII/INSR gene methylation.

RESULTS:

Different clinical features in PCOS group AMHRII gene methylation level and insulin resistance relations have significant differences (r= 0.532, P= 0.000); INSR gene methylation level and insulin resistance relations have significant differences (r= 0.281, P= 0.03).

CONCLUSIONS:

The analysis of DNA methylation suggested that methylation of AMHRII and INSR genes was associated with basic clinical characteristics and insulin resistance of PCOS. These results provide evidence for AMHRII and INSR genes, and their methylation levels are intimately associated with the pathogenesis of PCOS.

The effect of follicular fluid selenium concentration on oocyte maturation in women with polycystic ovary syndrome undergoing in vitro fertilization/Intracytoplasmic sperm injection: A cross-sectional study

BACKGROUND

A high level of free radicals and oxidative substances in women with polycystic ovary syndrome (PCOS) can affect the ovaries through oxidative stress. Antioxidants such as selenium, a vital trace element in human health, can improve the prognosis of PCOS by reducing oxidative stress.

OBJECTIVE

This study was performed due to the lack of comprehensive information about selenium concentration in follicular fluid and its effect on the oocyte count and quality in infertile women with PCOS.

MATERIALS AND METHODS

In this cross-sectional study, 78 women with PCOS referred to Umm-al-Banin Infertility Clinic Center, Ganjavian Hospital, Dezful, Iran for in-vitro fertilization from March to November 2019 were enrolled. After ovarian stimulation with the antagonist protocol, the oocytes were retrieved under transvaginal ultrasound in in-vitro fertilization/intracytoplasmic sperm injection cycles, and selenium concentrations were measured in the follicular fluid using an atomic absorption method by spectrophotometer device. Oocyte count and morphology were evaluated using inverted optical microscopy.

RESULTS

There were no significant differences between follicular fluid selenium concentrations in terms of the total number of oocytes and immature oocytes in the metaphase I and germinal vesicle stages. However, a significantly reduced number of metaphase II oocytes was observed at selenium levels < 40 μg/dL (p = 0.001).

CONCLUSION

Based on our results, low levels of follicular selenium concentration in infertile women with PCOS can reduce the quality and potency of oocyte maturation.

The Content of Minerals in the PCOS Group and the Correlation with the Parameters of Metabolism

Polycystic ovary syndrome (PCOS) is a common disease in women of childbearing age. It is characterized by excessive androgen production, ovulation disorders, and developing metabolic syndrome. The aim of the study was to check whether selected minerals were related to the pathophysiological mechanisms of PCOS. The concentrations of minerals were determined using an inductively coupled atomic plasma-emission spectrometer (ICP-AES Jobin Yvon JY-24). Blood samples from PCOS and control women were collected, processed, and digested with a microwave system in women with PCOS with and without insulin resistance and in the control group. It was found: zinc (Zn)-10.14 ± 2.11, 9.89 ± 1.44 and 10.30 ± 1.67; nickel (Ni) 0.001 ± 0.0009, 0.001 ± 0.0006 and 0.002 ± 0.00001; iron (Fe) 868.0 ± 155.8, 835.3 ± 156.4 and 833.0 ± 94.6; manganese (Mn) 0.017 ± 0.006, 0.017 ± 0.008 and 0.020 ± 0.009; copper (Cu) 0.714 ± 0.129, 0.713 ± 0.114 and 0.761 ± 0.146; magnesium (Mg) 48.4 ± 8.3, 50.0 ± 8.4 and 45.3 ± 10.7; sodium (Na) 374.3 ± 84.3, 396.3 ± 66.6 and 367.9 ± 88.9; potassium (K) 2541.8 ± 330.9, 2409.6 ± 347.1 and 2336.9 ± 211.4 (µg/g). Some micronutrient deficiencies may have a negative effect on the lipid profile in PCOS patients (Ni, Na). Further studies are needed to better understand dependencies.

Serum Copper Level and Polycystic Ovarian Syndrome: A Meta-Analysis

INTRODUCTION

The association of serum copper with polycystic ovarian syndrome (PCOS) has been studied for years, but no definite conclusion is drawn. Therefore, we conducted a meta-analysis to investigate serum copper concentrations in PCOS subjects compared with healthy controls.

METHODS

Electronic search was performed in PubMed, Google Scholar, and Scopus up to June 30, 2020, without any restriction. Standardized mean differences (SMDs) with corresponding 95% CIs in serum copper levels were employed with random-effects model. I2 was applied to evaluate heterogeneity among studies.

RESULTS

Nine studies, measuring plasma copper levels in 1,168 PCOS patients and 1,106 controls, were included. Pooled effect size suggested serum copper level was significantly higher in women with PCOS (SMD = 0.51 μg/mL, 95% CI = [0.30, 0.72], p < 0.0001). The overall heterogeneity was not connected with subgroups of the country, but derived from the opposite result of 1 study.

CONCLUSION

Our research generally indicated circulating copper level in PCOS sufferers was significantly higher than normal controls. Large-scale studies are still needed to elucidate the clear relation between copper status and etiology of PCOS.

Potential environmental toxicant exposure, metabolizing gene variants and risk of PCOS-A systematic review

Exposure of environmental toxicants such as potentially toxic metals and pesticides have largely been attributed to produce adverse effects on general women's health and to be more precise on the reproductive system. In order to explore exposure of toxicants and metabolizing gene variants as risk factor for polycystic ovarian syndrome (PCOS), literature search was carried out using the databases PubMed, Central Cochrane Library, Google Scholar, Science Direct with appropriate keywords upto 6 December 2020. While most of the studies indicate higher serum Cu concentration and lower concentration of Mn as risk factor, studies also report presence of higher pesticide concentration in PCOS women. Genes such as MTHFR, CYPs participate in the metabolism of toxicants and may show different response due to underlying genetic variants. Thus, toxicant exposure are to some extent responsible for the pathogenesis of syndrome through oxidative stress and endocrine disruption, but the susceptibility may vary due to the underlying genetic polymorphism of the exposed population.

Metabolic and hormonal effects of melatonin and/or magnesium supplementation in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial

BACKGROUND

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. This study was designed to investigate the effects of melatonin and/or magnesium supplementation on metabolic profile and levels of sex hormones in PCOS women.

METHODS

In an 8-week randomized double-blind placebo-controlled trial, 84 subjects with PCOS aged 18-40 years were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, and placebo. Fasting blood samples were obtained at the beginning and end of the study.

RESULTS

After intervention, the mean Pittsburg Sleep Quality Index score decreased significantly in both co-supplementation and melatonin groups (P < 0.001). Magnesium supplementation in combination with melatonin resulted in a significant greater decrease in testosterone concentrations compared with the placebo (P < 0.05). Co-supplementation of magnesium-melatonin had significantly reduced serum insulin levels (geometric means difference: - 1.11 (mIU/mL) (percent change: - 15.99)), homeostasis model of assessment-insulin resistance (HOMA-IR) (- 0.28 (- 18.66)), serum cholesterol (mean difference: - 16.08 (mg/dl) [95% CI - 24.24, - 7.92]), low-density lipoprotein cholesterol (LDL-C) - 18.96 (mg/dl) [- 28.73, - 9.20]) and testosterone levels (- 0.09 (ng/ml) (- 25.00)), as compared to the baseline values (P < 0.05). An increase in serum high-density lipoprotein cholesterol (HDL-C) levels was also observed following the administration of the melatonin alone (2.76 (mg/dl) [0.57, 4.95]) or in combination with magnesium (2.19 (mg/dl) [0.61, 3.77]) (P < 0.05).

CONCLUSIONS

Co-supplementation with magnesium and melatonin had beneficial effects on sleep quality and total testosterone. Additionally, melatonin supplementation alone was found to be associated with a significant reduction in PSQI score. Moreover, combined melatonin and magnesium supplementation was more effective in improving serum levels of cholesterol, LDL-C, HDL-C and insulin, and HOMA-IR.

TRIAL REGISTRATION

Iranian Registry of Clinical Trial. http://www.irct.ir : IRCT20191130045556N1, January 2020.

Nutrition in Gynecological Diseases: Current Perspectives

Diet and nutrition are fundamental in maintaining the general health of populations, including women’s health. Health status can be affected by nutrient deficiency and vice versa. Gene–nutrient interactions are important contributors to health management and disease prevention. Nutrition can alter gene expression, as well as the susceptibility to diseases, including cancer, through several mechanisms. Gynecological diseases in general are diseases involving the female reproductive system and include benign and malignant tumors, infections, and endocrine diseases. Benign diseases such as uterine fibroids and endometriosis are common, with a negative impact on women’s quality of life, while malignant tumors are among the most common cause of death in the recent years. In this comprehensive review article, a bibliographic search was performed for retrieving information about nutrients and how their deficiencies can be associated with gynecological diseases, namely polycystic ovary syndrome, infertility, uterine fibroids, endometriosis, dysmenorrhea, and infections, as well as cervical, endometrial, and ovarian cancers. Moreover, we discussed the potential beneficial impact of promising natural compounds and dietary supplements on alleviating these significant diseases.

Associations Between Serum Magnesium Concentrations and Polycystic Ovary Syndrome Status: a Systematic Review and Meta-analysis

Magnesium (Mg) is the second most frequent intracellular cation in humans with a critical role in insulin metabolism and glucoregulation. Women with polycystic ovary syndrome (PCOS) often present with insulin resistance and impaired glucoregulatory status; however, their Mg status remains unclear. Therefore, we aimed to conduct a systematic review and meta-analysis to evaluate serum Mg concentration in women with PCOS and compare it with that of controls without PCOS. Online databases of PubMed, Scopus, Cochrane Library, and ISI Web of Science were searched for studies evaluating the relationship between Mg concentrations and PCOS status until October 2019. Pooled weighted mean differences (WMDs) of serum Mg levels were calculated using random effects models. A total of eight studies (10 arms; n = 2026 women) were included. Pooled effect sizes, expressed as WMD and 95% CI, revealed decreased serum Mg concentrations in women with PCOS compared with controls (- 0.09 (- 0.17, - 0.02) mmol/L; P = 0.01). However, significant heterogeneity was detected across the studies (I ² = 98.0%, P < 0.001). Despite the classification of studies based on baseline BMI classes, we did not detect the potential source of the observed heterogeneity. Subgroup analysis showed that overweight and obese women (BMI ≥ 25 kg/m², 0.07 mmol/L (- 0.14, - 0.01); P = 0.02) with PCOS had lower magnesium concentrations than normal women (BMI < 25 kg/m², - 0.11 (- 0.25, 0.04) mmol/L; P = 0.14) compared with the control group. Serum Mg concentrations appear to be declined in overweight or obese women with PCOS, which may warrant screening and management of Mg status in this clinical population. High-quality studies are needed to elucidate the relationship between Mg concentrations and the development of PCOS.

Associations of Serum Magnesium With Insulin Resistance and Testosterone in Women With Polycystic Ovary Syndrome

OBJECTIVE

This article aimed to investigate whether serum magnesium is associated with insulin resistance index and testosterone level in women with polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

Overall 1000 women with PCOS were enrolled in a randomized controlled trial and a cross-sectional analysis of the association of serum magnesium with glucose metabolism markers and testosterone was performed. Serum magnesium, glucose metabolism markers and testosterone were measured. Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR) and quantitative insulin-sensitivity check index (QUICKI). Multivariable linear regression and logistic regression models were used to estimate the association between serum magnesium, insulin resistance and testosterone.

RESULTS

In comparative analyses, women with higher quartile of serum magnesium had significantly lower fasting glucose, HOMA-IR and testosterone. Multiple linear regression showed serum magnesium was independently negatively associated with insulin, glucose, HOMA-IR, testosterone and positively associated with QUICKI (P for trend <0.05) after adjusting confounding covariates. Logistic regression showed serum magnesium in quartile 1 and 2 were independently associated with insulin resistance status (Quartile 1: OR: 2.15, 95%CI: 1.35-3.40, P = 0.001; Quartile 2: OR: 1.90, 95%CI: 1.20-3.02, P = 0.006), while quartile 1 was marginally associated with hyperandrogenemia status (Quartile 1: OR: 1.45, 95%CI: 0.99-2.11, P = 0.055) after adjusting confounding covariates.

CONCLUSION

The current findings suggest that lower serum magnesium was associated with aggravated insulin resistance and higher testosterone levels among women with PCOS.

The Role of Zinc in Selected Female Reproductive System Disorders

Zinc is an essential microelement that plays many important functions in the body. It is crucial for the regulation of cell growth, hormone release, immunological response and reproduction. This review focuses on its importance in the reproductive system of women of reproductive and postmenopausal ages, not including its well described role in pregnancy. Only recently, attention has been drawn to the potential role of zinc in polycystic ovary syndrome (PCOS), dysmenorrhea, or endometriosis. This review is mainly based on 36 randomized, controlled studies on reproductive, pre- and post-menopausal populations of women and on research trying to explain the potential impact of zinc and its supplementation in the etiology of selected female reproductive system disorders. In women with PCOS, zinc supplementation has a positive effect on many parameters, especially those related to insulin resistance and lipid balance. In primary dysmenorrhea, zinc supplementation before and during each menstrual cycle seems to be an important factor reducing the intensity of menstrual pain. On the other hand, little is known of the role of zinc in endometriosis and in postmenopausal women. Therefore, further studies explaining the potential impact of zinc and its supplementation on female reproductive system would be highly advisable and valuable.

Clinical and Metabolic Responses to Magnesium Supplementation in Women with Polycystic Ovary Syndrome

We hypothesized that magnesium supplementation might help improve metabolic profiles and clinical symptoms of polycystic ovary syndrome (PCOS) through its role in insulin action. The present study aimed to investigate the effect of magnesium supplementation on metabolic profiles and levels of sex hormones in women with PCOS. In this parallel randomized, double-blind, placebo-controlled clinical trial, 60 women with PCOS aged 20-45 years were recruited. After stratification for body mass index (BMI), age, and types of medications, participants were randomly assigned to consume magnesium supplements (containing 250 mg magnesium oxide) or placebo for 8 weeks. To assess biochemical indicators, a venous blood sample was taken after an overnight fasting. The mean age of study participants was 26.4 years. We found that magnesium supplementation for 8 weeks among women with PCOS had favorable effects on BMI compared with the placebo group (changes from baseline in intervention group: - 0.31 ± 0.07 vs. 0.07 ± 0.09 kg/m² in control group). In addition, the supplementation lead to preventing the increase in waist circumference in intervention group compared with the control group (0.02 vs. 1.15 cm). No significant effects on glycemic variables and lipid profile were seen following the magnesium supplementation. A significant increase in serum LH levels in intervention group and a decrease in placebo group were observed (P = 0.01). Although we found a significant decrease in serum testosterone levels in intervention and placebo groups, comparing the changes between the two groups, a marginally significant difference in serum testosterone levels was found (51.65 vs. 47.80 in intervention, 43.41 vs. 39.46 in placebo, P = 0.08). A significant increase in serum dehydroepiandrogens (DHEA) (136.32 vs. 172.37 intervention, 102.74 vs. 120.15 placebo, P = 0.01) was seen in two groups. Magnesium supplementation had no significant effects on FSH, 17OH-progesteron, sex hormone-binding globulin (SHBG), and free androgen index (FAI) levels. We found evidence indicating that magnesium supplementation did not influence serum lipid profiles and glycemic indicators among women with PCOS. Magnesium supplementation resulted in reduced BMI and testosterone levels as well as increased DHEA concentrations in women with PCOS. Also, magnesium supplementation may increase serum LH levels. ClinicalTrials.gov IRCT registration no. NCT02178150.

Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India

Polycystic ovary syndrome (PCOS) is a common endocrine disorder predominantly affecting women of reproductive age. Clinical manifestations are diverse including hyperandrogenism, anovulation, infertility and increased risk of metabolic diseases besides psychosocial dysfunction. This review provides information on the problem of PCOS in India, its pathophysiology, genetics and an overview of current management options to instigate further research in this field. Prevalence of PCOS in India ranges from 3.7 to 22.5 per cent depending on the population studied and the criteria used for diagnosis. Abnormalities in leptin-adiponectin (adipocyte biology), oxidative stress and autoimmunity are among the mechanisms studied regarding pathogenesis of PCOS. Many candidate gene studies have shown associations with PCOS in various studies. Studies have consistently demonstrated the relationship between the well-known manifestation of hyperandrogenism among Indian PCOS women and the metabolic morbidities including insulin resistance, glucose intolerance and cardiovascular risk. Management of individual components of PCOS can be achieved by medications or surgical methods, though further clarification regarding pathogenesis of PCOS is needed to sharpen our therapeutic armamentarium.

Status of Serum Copper, Magnesium, and Total Antioxidant Capacity in Patients with Polycystic Ovary Syndrome

This study evaluates serum copper and magnesium and total antioxidant capacity levels in PCOS patients. In this regard, the probable association of copper and magnesium with total antioxidant capacity (TAC) was investigated. In total, 150 women (60 PCOS patients and 90 healthy subjects) participated in this case-control study. PCOS was diagnosed according to the Rotterdam criteria (2003). Serum Cu, Mg, Ca, TAC, insulin levels, and insulin resistance indices were determined. Insulin was measured using ELISA methods. Serum Cu and Mg levels were measured by an atomic absorption spectrophotometer and the Xylidyl Blue method respectively. The correlations between the parameters were analyzed using the Spearman correlation test. Serum Cu level was significantly higher while TAC was significantly lower in the PCOS patients than those in the controls (p = 0.019 and p = 0.002 respectively). No significant difference was detected between the two groups in terms of serum Mg and Ca levels and Ca/Mg ratio. In insulin-resistant PCOS subjects, there was a negative correlation between Mg levels and homeostatic model assessment for insulin resistance (r = - 0.449, p = 0.006) but a positive correlation between Mg levels and quantitative insulin sensitivity check index (r = 0.480, p = 0.003). A negative correlation also existed between Mg levels and TAC in non-insulin-resistant PCOS patients (r = - 0.407, p = 0.04). According to the results, copper and magnesium seem to contribute to oxidative stress and insulin resistance in PCOS patients. Therefore, to prevent long-term metabolic complications in PCOS women, it is recommended that these elements be routinely monitored. Also, significantly lower levels of serum TAC in PCOS patients than in normal women may suggest increased oxidative stress in such patients.

The Impact of Maternal Overweight on Hair Essential Trace Element and Mineral Content in Pregnant Women and Their Children

The aim of the present study was to investigate hair essential trace elements and mineral levels in 105 pregnant normal-weight (control) and 55 overweight and obese women in the third trimester of pregnancy, as well as in their children at the age of 9 months. The hair essential trace elements and mineral levels were assessed using inductively coupled plasma mass-spectrometry. Overweight pregnant women had significantly reduced Cr (- 24%; p = 0.047) and Zn (- 13%; p = 0.008) content, as well as elevated hair Na and K levels as compared to the controls. Children from overweight and obese mothers had lower hair Mo (- 18%; p = 0.017), Se (- 8%; p = 0.043), and V (- 24%; p = 0.028) levels, as well as elevated Sr content (19%; p = 0.025). Correlation analysis revealed a significant relationship between maternal and child hair levels of Co (r = 0.170; p = 0.038), Cu (r = 0.513; p < 0.001), Mn (r = 0.240; p = 0.003), and Na (r = 0.181; p = 0.027) in the whole sample. Pre-pregnancy maternal body mass index (BMI) positively correlated with maternal hair K (r = 0.336; p < 0.001) and Na (r = 0.212; p = 0.008) and negatively correlated with V (r = - 0.204; p = 0.011) and Zn (r = - 0.162; p = 0.045) levels. The results indicate that impaired trace element and mineral metabolism may play a role in the link between maternal obesity, complications of pregnancy and child's postnatal development. Hypothetically, dietary improvement may be used as a tool to reduce these risks. However, further experimental and clinical studies are required to investigate the relationship between obesity and trace element metabolism in pregnancy.

Serum Trace Elements in Patients With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Polycystic ovary syndrome (PCOS) is reported to be associated with certain trace elements. However, previous data are inconsistent and potentially biased due to small sample sizes. The potential utility of trace element levels for screening of PCOS remains to be established. The aim of this meta-analysis was to investigate the potential relationships between PCOS and serum levels of zinc (Zn), copper (Cu), magnesium (Mg), iron (Fe) and ferritin. We carried out a literature search of PubMed, EMBASE, and Web of Science for relevant cross-sectional/case-control studies published prior to October 2019. Random-effect models were used to estimate the overall standard mean differences (SMDs) between PCOS and healthy control subjects. The screening value of potential microelement biomarkers for PCOS was assessed using the receiver operating characteristic (ROC) curve. Twenty-one studies featuring 2,173 women with PCOS and 1,897 healthy women were selected for analysis. Our results showed that Cu and ferritin levels were significantly higher in women with PCOS than healthy controls, with SMDs of 0.52 [95% confidence interval (CI): 0.38-0.67, I² = 47.6%] and 1.05 (95% CI: 0.25-1.86, I² = 97.0%), respectively. The serum ferritin concentration was distinguished as a potential biomarker for PCOS based on the high area under ROC curve value of 0.71 (95% CI: 0.57-0.86). Although we did not identify a statistical association between serum Zn concentration and PCOS overall, the concentration of Zn in PCOS women with insulin resistance (IR) was lower than that in healthy women (SMD = -0.89, 95% CI: -1.73 to -0.06). Furthermore, the concentrations of Mg (SMD = 0.31, 95% CI: -0.32-0.94, I² = 95.4%) and Fe (SMD = -0.59, 95% CI: -1.29-0.12, I² = 97.2%) were not statistically significant between the PCOS and control groups. We generated hypothetical pathways for associations among serum Cu, ferritin and PCOS. The serum concentrations of both Cu and ferritin were significantly higher in women with PCOS, and ferritin was identified as a potential early indicator for PCOS screening. Further studies are essential to determine the specific underlying mechanisms.

Insulin Resistance and Serum Magnesium Concentrations among Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) affects ∼1 in 10 women worldwide. Hypomagnesemia may worsen insulin resistance (IR) due to the role magnesium (Mg) plays in glucose metabolism. This review explores the relation between serum Mg and IR among women with PCOS. A review of primary research focusing on both serum Mg and women with PCOS was conducted from 2011 to 2019. Studies reviewed included human subjects, written in the English language, and limited to community-dwelling women aged ≥18 y. A total of 7 articles were reviewed. The findings from 4 epidemiological analytic studies evaluating serum Mg status suggest there may be a relation between serum Mg concentrations and IR among women with PCOS. However, among the 3 experimental trials, Mg supplementation inconsistently impacted IR among women with PCOS. Women with PCOS are more likely to underconsume Mg-rich foods and have a greater likelihood of lower serum Mg concentrations. Although it remains unclear if dietary Mg and/or supplementation should be a nutritional strategy for all women with PCOS, current research indicates an association between adequate Mg status and improved IR. Further research evaluating dietary interventions and supplementation is warranted.

The Effects of Magnesium and Vitamin E Co-Supplementation on Hormonal Status and Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome

Synergistic approach of magnesium and vitamin E may benefit clinical symptoms of patients with polycystic ovary syndrome (PCOS) through improving their metabolic profiles and reducing oxidative stress and inflammation. This study was designed to determine the effects of magnesium and vitamin E co-supplementation on hormonal status and biomarkers of inflammation and oxidative stress in women with PCOS. This randomized, double-blind, placebo-controlled trial was conducted among 60 women with PCOS, aged 18-40 years old. Participants were randomly divided into two groups to take 250 mg/day magnesium plus 400 mg/day vitamin E supplements or placebo (n = 30 each group) for 12 weeks. Fasting blood samples were taken at baseline and after the 12-week intervention to quantify related variables. Magnesium and vitamin E co-supplementation resulted in a significant reduction in hirsutism (β - 0.37; 95% CI, - 0.70, - 0.05; P = 0.02) and serum high-sensitivity C-reactive protein (hs-CRP) (β - 0.67 mg/L; 95% CI, - 1.20, - 0.14; P = 0.01), and a significant increase in plasma nitric oxide (NO) (β 3.40 μmol/L; 95% CI, 1.46, 5.35; P = 0.001) and total antioxidant capacity (TAC) levels (β 66.32 mmol/L; 95% CI, 43.80, 88.84; P < 0.001). Overall, magnesium and vitamin E co-supplementation for 12 weeks may benefit women with PCOS on hirsutism, serum hs-CRP, plasma NO, and TAC levels. Clinical trial registration number http://www.irct.ir : IRCT2017082733941N8.

Carnitine and chromium co-supplementation affects mental health, hormonal, inflammatory, genetic, and oxidative stress parameters in women with polycystic ovary syndrome

OBJECTIVE

The aim of this study was to evaluate the effect of the co-administration of carnitine and chromium on mental health, hormonal, inflammatory and genetic parameters in women with PCOS.

METHODS

This randomized, double-blinded, placebo-controlled clinical trial was conducted on 54 subjects, aged 18-40 years old. Subjects were randomly allocated to take either 1000 mg/d carnitine plus 200 µg/d chromium as chromium picolinate (n = 26) or placebo (n = 27) for 12 weeks.

RESULTS

Carnitine and chromium co-supplementation, compared with the placebo, significantly improved beck depression inventory (β - 0.84; 95% CI, -1.51, -0.17; p = 0.01), general health questionnaire scores (β - 1.13; 95% CI, -2.13, -0.14; p = 0.02) and depression anxiety and stress scale scores (β - 0.96; 95% CI, -0.78, -0.14; p = 0.02). Participants who received carnitine plus chromium supplements had significantly lower total testosterone (β - 0.15 ng/mL; 95% CI, -0.24, -0.06; p = 0.002), hirsutism (β - 0.48; 95% CI, -0.91, -0.06; p = 0.02), high-sensitivity C-reactive protein (hs-CRP) (β - 1.02 mg/L; 95% CI, -1.79, -0.25; p = 0.01), and malondialdehyde (MDA) levels (β - 0.38 µmol/L; 95% CI, -0.56, -0.20; p < 0.001), and higher total antioxidant capacity (TAC) levels (β 107.18 mmol/L; 95% CI, 44.24, 170.12; p = 0.001) compared with the placebo. Moreover, carnitine and chromium co-supplementation upregulated gene expression of interleukin-6 (IL-6) (p = 0.02) and tumor necrosis factor alpha (TNF-α) (p = 0.02) compared with the placebo.

CONCLUSION

Overall, the co-administration of carnitine and chromium for 12 weeks to women with PCOS had beneficial effects on mental health parameters, serum total testosterone, mF-G scores, hs-CRP, TAC and MDA levels, and gene expression of IL-6 and TNF-α.

Zinc status and polycystic ovarian syndrome: A systematic review and meta-analysis

Several studies have investigated serum zinc levels in patients with polycystic ovarian syndrome (PCOS), but the results of these studies remain inconclusive. Therefore, to derive a more precise estimation, we conducted a meta-analysis to investigate serum zinc concentrations in women with PCOS in comparison with healthy subjects. Electronic search was performed in PubMed, Scopus, and Google scholar up to April; 4, 2018 without any restriction. Eligible studies that evaluated the levels of zinc status in subjects with PCOS were included. Weighted mean differences (WMDs) with corresponding 95% CIs in serum zinc levels were initially estimated using a random-effects model. Eight studies, measuring circulating zinc levels in 552 PCOS and 464 control subjects, were included. Pooled effect size suggested that serum zinc levels in women with PCOS were not statistically different than their controls (WMD = -4.43 mg/dL; 95% CI = [-10.30, 1.44]; P = 0.139). Exclusion of one study revealed that women with PCOS significantly have lower serum zinc levels compared to healthy controls (WMD: -6.60 mg/dL; 95% CI = [-12.43, -0.76], P = 0.027). Our study indicated that circulating zinc levels in women with PCOS were significantly lower than those in healthy controls when detailed analysis is conducted. Large scale studies are needed to elucidate clear relation between zinc status and etiology of PCOS.

The Effect of Magnesium and Vitamin E Co-Supplementation on Glycemic Control and Markers of Cardio-Metabolic Risk in Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial

Data on the effects of magnesium and vitamin E co-supplementation on glycemic control and markers of cardio-metabolic risk of patients with polycystic ovary syndrome (PCOS) were collected. This investigation was conducted to evaluate the effects of magnesium and vitamin E co-supplementation on glycemic control and markers of cardio-metabolic risk in women with PCOS. This randomized, double-blind, placebo-controlled trial was carried out on 60 women with PCOS, aged 18-40 years old. Participants were randomly divided into two groups to receive 250 mg/day magnesium plus 400 mg/day vitamin E supplements or placebo (n=30 each group) for 12 weeks. Fasting blood samples were taken at baseline and after the 12-week intervention to quantify related variables. After the 12-week intervention, compared with the placebo, magnesium and vitamin E co-supplementation led to a significant reduction in serum insulin levels (-1.1±3.0 vs. +1.6±3.7 μIU/ml, p=0.003) and homeostatic model of assessment for insulin resistance (-0.2±0.7 vs. +0.4±0.9, p=0.002), and a significant increase in the quantitative insulin sensitivity check index (+0.01±0.01 vs. -0.009±0.02, p=0.003). Furthermore, magnesium plus vitamin E supplementation significantly decreased serum triglycerides (-15.0±24.4 vs. +6.7±22.2 mg/dl, p=0.001) and VLDL-cholesterol concentrations (-3.0±4.9 vs. +0.6±2.4 mg/dl, P=0.01) compared with the placebo. A trend toward a greater decrease in total cholesterol levels was observed in magnesium plus vitamin E group compared to placebo group (-7.0±32.6 vs. +8.1±26.6 mg/dl, p=0.05). In conclusion, magnesium and vitamin E co-supplementation for 12 weeks to PCOS women had beneficial effects on parameters of insulin metabolism and few markers of cardio-metabolic risk.

The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review

Polycystic ovary syndrome (PCOS) is complex heterogeneous disorder that has several aspects in terms of pathology such as metabolic, endocrine, reproductive, and psychological. However, the etiology of PCOS remains poorly understood. Several studies suggest that insulin resistance and hyperandrogenism play a central role in the progression of PCOS pathophysiology. Therefore, common treatment strategies of PCOS are based on lifestyle modification, which include exercise, diet, and nutrient supplementation therapy. Recent studies have recommended some nutrients such as vitamins, minerals, and vitamin-like nutrients for the therapy of PCOS because each has at least one functional property in PCOS-induced pathways. Therefore, it is claimed that the cause of PCOS could be vitamin or mineral deficiency. This review aims to provide a critical literature survey on nutritional supplementation for the treatment of PCOS-associated endocrine and metabolic dysfunctions and discuss the role of nutrients in the management of PCOS in view of the clinical trials and experimental studies.

Meta-analysis of the effects of probiotic supplementation on glycemia, lipidic profiles, weight loss and C-reactive protein in women with polycystic ovarian syndrome

INTRODUCTION

Several studies have been designed to investigate the beneficial effects of probiotic supplementation on metabolic parameters and inflammation status in women with polycystic ovarian syndrome (PCOS), but results have been inconsistent. Herein, we perform a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of probiotic supplementation on glycemia control, lipidic profiles, weight loss and C-reactive protein (CRP) in women with PCOS.

EVIDENCE ACQUISITION

MELINE, EMBASE, and Cochrane Library were searched for RCTs that investigated the effects of probiotic in women with PCOS. Two investigators independently performed the screening, data extraction, and methodological quality assessment. Data were pooled as mean differences (MDs) with 95% confidence intervals (CIs). The statistical heterogeneity was assessed with the I2 test. Sensitivity analyses were performed by the leave-one-out approach.

EVIDENCE SYNTHESIS

From the literature search, 26 publications were screened and 6 RCTs involving 406 PCOS participants (aged 25-28.5 years) with follow-up period between 8-12 weeks were included. The pooled results showed that probiotic supplement significantly affected the levels of fasting blood insulin (FBI), quantitative insulin sensitivity check index (QUICKI), triglycerides (TG), and very low density lipoprotein-cholesterol (VLDL-C). However, no significant changes were found in other markers, including fasting plasma glucose, homeostatic model assessment-insulin resistance, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, body weight, CRP, and dehydroepiandrosterone sulfate levels. The pooled result was robust after the sensitivity analysis.

CONCLUSIONS

Our finding provides evidence that daily probiotic consumption has beneficial effects on decreasing FBI, TG, and VLDL-C, and increasing the QUICKI score in PCOS patients.

The Influences of Chromium Supplementation on Glycemic Control, Markers of Cardio-Metabolic Risk, and Oxidative Stress in Infertile Polycystic ovary Syndrome Women Candidate for In vitro Fertilization: a Randomized, Double-Blind, Placebo-Controlled Trial

This study was carried out to investigate the effects of chromium intake on glycemic control, markers of cardio-metabolic risk, and oxidative stress in infertile polycystic ovary syndrome (PCOS) women candidate for in vitro fertilization (IVF). This randomized double-blind, placebo-controlled trial was done among 40 subjects with infertile PCOS candidate for IVF, aged 18-40 years old. Individuals were randomly allocated into two groups to take either 200 μg/day of chromium (n = 20) or placebo (n = 20) for 8 weeks. Biochemical parameters were assessed at baseline and at end-of-trial. Compared with the placebo, taking chromium supplements led to significant reductions in fasting plasma glucose (- 2.3 ± 5.7 vs. + 0.9 ± 3.1 mg/dL, P = 0.03), insulin levels (- 1.4 ± 2.1 vs. + 0.4 ± 1.7 μIU/mL, P = 0.004), homeostatic model of assessment for insulin resistance (- 0.3 ± 0.5 vs. + 0.1 ± 0.4, P = 0.005), and a significant increase in quantitative insulin sensitivity check index (+ 0.004 ± 0.008 vs. - 0.001 ± 0.008, P = 0.03). In addition, chromium supplementation significantly decreased serum triglycerides (- 19.2 ± 33.8 vs. + 8.3 ± 21.7 mg/dL, P = 0.004), VLDL- (- 3.8 ± 6.8 vs. + 1.7 ± 4.3 mg/dL, P = 0.004) and total cholesterol concentrations (- 15.3 ± 26.2 vs. - 0.6 ± 15.9 mg/dL, P = 0.03) compared with the placebo. Additionally, taking chromium supplements was associated with a significant increase in plasma total antioxidant capacity (+ 153.9 ± 46.1 vs. - 7.8 ± 43.9 mmol/L, P < 0.001) and a significant reduction in malondialdehyde values (-0.3 ± 0.3 vs. + 0.1 ± 0.2 μmol/L, P = 0.001) compared with the placebo. Overall, our study supported that chromium administration for 8 weeks to infertile PCOS women candidate for IVF had beneficial impacts on glycemic control, few variables of cardio-metabolic risk, and oxidative stress.

Dietary minerals, reproductive hormone levels and sporadic anovulation: associations in healthy women with regular menstrual cycles

Although minerals are linked to several reproductive outcomes, it is unknown whether dietary minerals are associated with ovulatory function. We hypothesised that low intakes of minerals would be associated with an increased risk of anovulation. We investigated associations between dietary mineral intake and both reproductive hormones and anovulation in healthy women in the BioCycle Study, which prospectively followed up 259 regularly menstruating women aged 18-44 years who were not taking mineral supplements for two menstrual cycles. Intakes of ten selected minerals were assessed through 24-h dietary recalls at up to four times per cycle in each participant. Oestradiol, progesterone, luteinising hormone (LH), follicle-stimulating hormone (FSH), sex-hormone-binding globulin and testosterone were measured in serum up to eight times per cycle. We used weighted linear mixed models to evaluate associations between minerals and hormones and generalised linear models for risk of anovulation. Compared with Na intake ≥1500 mg, Na intake <1500 mg was associated with higher levels of FSH (21·3 %; 95 % CI 7·5, 36·9) and LH (36·8 %; 95 % CI 16·5, 60·5) and lower levels of progesterone (-36·9 %; 95 % CI -56·5, -8·5). Na intake <1500 mg (risk ratio (RR) 2·70; 95 % CI 1·00, 7·31) and Mn intake <1·8 mg (RR 2·00; 95 % CI 1·02, 3·94) were associated with an increased risk of anovulation, compared with higher intakes, respectively. Other measured dietary minerals were not associated with ovulatory function. As essential minerals are mostly obtained via diet, our results comparing insufficient levels with sufficient levels highlight the need for future research on dietary nutrients and their associations with ovulatory cycles.

Chromium supplementation does not improve weight loss or metabolic and hormonal variables in patients with polycystic ovary syndrome: A systematic review

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, and recently, chromium was discussed as an adjuvant way to manage it. Herein, a systematic review was conducted which centered on the effects of chromium on ovarian physiology with a focus on body mass index, as well as hormonal and metabolic dysfunctions in women suffering from PCOS. This review was performed using the guidelines from Preferred Reporting Items for Systematic Reviews. Clinical trials investigating chromium in women with PCOS with outcome measures related to metabolic and hormonal status were included. The search was conducted using PubMed, Scopus, and Google Scholar databases for clinical trials in the English language from the inception of the resources until May 2017 with the terms: chromium, chromium picolinate, CrP, polycystic ovary syndrome, PCOS, and sclerocystic ovary syndrome. The search resulted in 89 articles, and after inclusion and exclusion criteria were applied, 6 articles were selected for analysis. Two studies that evaluated the effect of chromium on body weight or body mass index reported no effect. Another study reported the beneficial effect of chromium on weight reduction. It seems that the effect of chromium in the reduction of blood glucose is insignificant, and results are inconsistent in relation to dyslipidemia. With regard to the effects of chromium on concentrations of sex hormones, a longer duration of treatment is needed to produce significant changes. The articles reviewed demonstrated that chromium supplementation has limited effects on weight reduction, glucose control, lipid profile, and hormonal disturbance of women with PCOS; however, more studies are needed due to the clinical changes observed in patients with PCOS after chromium supplementation.

PCOS and pregnancy: a review of available therapies to improve the outcome of pregnancy in women with polycystic ovary syndrome

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a common cause of female infertility affecting multiple aspects of a women's health.

AREAS COVERED

The aim of this review is to summarize the existing evidence on the treatment of PCOS patients and to examine the actual available therapies to overcome the problem of infertility and improve the outcome of pregnancy. We analyse different treatment strategies such as lifestyle modification, bariatric surgery, insulin sensitizing agents, inositol, clomiphene citrate (CC), aromatase inhibitors, gonadotrophins, laparoscopic ovarian drilling, and assisted reproductive techniques (ART).

EXPERT COMMENTARY

Lifestyle modification is the best initial management for obese PCOS patients seeking pregnancy and insulin sensitizing agents seem to have an important role in treating insulin resistance. Up to now, CC maintains a central role in the induction of ovulation and it has been confirmed as the first-line treatment; the use of gonadotrophins is considered the second-line in CC resistant patients; laparoscopic ovarian drilling is an alternative to gonadotrophins in patients who need laparoscopy for another reason. However, in anovulatory patients, ART represents the only possible alternative to obtain pregnancy. Larger and well-designed studies are needed to clarify the best way to improve the outcome of pregnancy in PCOS women.

Magnesium-Zinc-Calcium-Vitamin D Co-supplementation Improves Hormonal Profiles, Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial

Data on the effects of magnesium-zinc-calcium-vitamin D co-supplementation on hormonal profiles, biomarkers of inflammation, and oxidative stress among women with polycystic ovary syndrome (PCOS) are scarce. The objective of this study was to assess the effects of magnesium-zinc-calcium-vitamin D co-supplementation on hormonal profiles, biomarkers of inflammation, and oxidative stress in women with PCOS. Sixty PCOS women were randomized into two groups and treated with 100 mg magnesium, 4 mg zinc, 400 mg calcium plus 200 IU vitamin D supplements (n = 30), or placebo (n = 30) twice a day for 12 weeks. Hormonal profiles, biomarkers of inflammation, and oxidative stress were assessed at baseline and at end-of-treatment. After the 12-week intervention, compared with the placebo, magnesium-zinc-calcium-vitamin D co-supplementation resulted in significant reductions in hirsutism (-2.4 ± 1.2 vs. -0.1 ± 0.4, P < 0.001), serum high sensitivity C-reactive protein (-0.7 ± 0.8 vs. +0.2 ± 1.8 mg/L, P < 0.001), and plasma malondialdehyde (-0.4 ± 0.3 vs. +0.2 ± 1.0 μmol/L, P = 0.01), and a significant increase in plasma total antioxidant capacity concentrations (+46.6 ± 66.5 vs. -7.7 ± 130.1 mmol/L, P = 0.04). We failed to find any significant effect of magnesium-zinc-calcium-vitamin D co-supplementation on free androgen index, and other biomarkers of inflammation and oxidative stress. Overall, magnesium-zinc-calcium-vitamin D co-supplementation for 12 weeks among PCOS women had beneficial effects on hormonal profiles, biomarkers of inflammation, and oxidative stress.

Serum Level of Zinc and Copper in Sudanese Women with Polycystic Ovarian Syndrome

The study aimed to evaluate the serum level of zinc and copper in women with polycystic ovarian syndrome (PCOS). A case-control study was conducted at Saad Abualila infertility center (Khartoum, Sudan). The cases were women who had a PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history data were gathered using questionnaires. Zinc and copper levels were measured using atomic absorption spectrophotometer. While there was no difference in zinc and copper levels between the two groups (50 women in each arm), mean (SD) of body mass index (BMI) was significantly higher in women with PCOS compared to the controls [28.4 (4.2) vs. 25.6 (5.7) kg/m²; P = 0.006], respectively. There were no significant differences in the level of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, prolactin, testosterone, cholesterol, triglycerides and low-density lipoprotein (LDL) between the cases and the controls. In linear regression analyses, none of the investigated factors were associated with PCOS. Zinc and copper were not associated with PCOS in this setting.

Nutritional management in women with polycystic ovary syndrome: A review study

Polycystic ovary syndrome (PCOS) is endocrine disorder in women of reproductive age, which leads to reproductive, hormonal and metabolic abnormalities. Due to the presence of insulin resistance, PCOS increases the risk of chronic diseases like type 2 diabetes, hypertension, lipid disorders, cardiovascular diseases and malignancies such as breast and endometrial cancer. The actual cause of this syndrome is unknown but environmental factors such as dietary habits play an important role in prevention and treatment and lifestyle modifications are the most important therapeutic strategies in these patients. The approach of the diet therapy in these patients must be to reach specific goals such as improving insulin resistance, metabolic and reproductive functions that will be possible through the design of low-calorie diet to achieve weight loss or maintaining a healthy weight, limit the intake of simple sugars and refined carbohydrates and intake foods with a low glycemic index, reduction of saturated and trans fatty acids and attention to possible deficiencies such as vitamin D, chromium and omega-3. Given the prevalence of overweight and obesity and insulin resistance, a relatively low reduction in weight, about 5%, can improve problems such as insulin resistance, high levels of androgens, reproductive system dysfunctions and fertility in these women.

Chromium supplementation in women with polycystic ovary syndrome: Systematic review and meta-analysis

AIM

Increasing evidence has suggested that chromium supplementation may improve the clinical symptoms of polycystic ovary syndrome (PCOS), yet the results have been inconsistent. To derive a more precise estimation of the efficacy of chromium, a meta-analysis was performed.

METHODS

Studies published in PubMed, EMBASE and the Cochrane Library up to April 2017 were retrieved. Standardized mean differences (SMD) with 95%CI were calculated for net changes using random-effects or fixed-effects models.

RESULTS

A total of six randomized clinical trials (RCT) with 351 PCOS women were ultimately collected in this meta-analysis. All included RCT were of moderate-high quality. On pooled analysis, insulin resistance was significantly decreased (SMD, -0.84; 95%CI: -1.30 to -0.38; P = 0.0004), while the total testosterone (SMD, 0.36; 95%CI: 0.07-0.65; P = 0.02) and free testosterone (SMD, 0.80; 95%CI: 0.48-1.12; P < 0.00001) were markedly increased in chromium-treated PCOS patients compared with control groups. No significant difference was found in other indexes of insulin metabolism (body mass index, fasting insulin, fasting blood sugar and quantitative insulin sensitivity check index), hormone status (luteinizing hormone, follicle-stimulating hormone and prolactin) and lipid profiles (cholesterol and triglycerides) between the two groups.

CONCLUSION

Supplementation with chromium may not have significant benefits for women with PCOS. More RCT with low heterogeneity, however, are required to corroborate the present findings.

Chromium supplementation and polycystic ovary syndrome: A systematic review and meta-analysis

INTRODUCTION

polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Some vitamins and mineral can play role in improvement of PCOS. Chromium (Cr) is an essential element in glucose and insulin homeostasis. However, findings are not consistent regarding PCOS improvement. Therefore, the purpose of this paper was to assess the effect of Cr supplementation in PCOS that have not yet fully been elucidated.

METHODS

We searched ISI Web of Science, MEDLINE (1966 to June 2016), Google Scholar databases and Proquest and identified eligible papers and extracted the following terms: total testosterone, DHEAS, insulin sensitivity, fasting glucose, fasting insulin, OGTT 1h glucose, OGTT 2h glucose (mg/dL), LH (mIU/mL), FSH, DHEAS, ferriman-Galwey score (FG score). We calculated overall effect size with random effects model, between-study heterogeneity with I square (I²) statistic. Publication bias was assessed using Begg's test regression.

RESULT

Totally, 7 RCTs were selected. Results indicated that Cr supplementation had a beneficial effect on BMI with effect size: -2.37 (kg/m²), 95% CI: -2.99, -1.76, p=0.001 and free testosterone concentration with effect size=-0.52 (pg/mL), 95% CI: -0.83, -0.23, p=0.001. Cr reduced fasting insulin in subgroup of studies with >10 participants with effect size: -0.86mIU/ml, 95% CI: -0.67, -0.17; p=0.001. Cr supplementation had no beneficial effects on reducing total testosterone, FG score, DHEA, FSH and LH.

CONCLUSION

This systematic review and meta-analysis shows that using Cr picolinate supplementation has beneficial effects on decreasing BMI, fasting insulin and free testosterone in PCOS patients.

The Effects of Calcium, Vitamins D and K co-Supplementation on Markers of Insulin Metabolism and Lipid Profiles in Vitamin D-Deficient Women with Polycystic Ovary Syndrome

Data on the effects of calcium, vitamins D and K co-supplementation on markers of insulin metabolism and lipid profiles among vitamin D-deficient women with polycystic ovary syndrome (PCOS) are scarce. This study was done to determine the effects of calcium, vitamins D and K co-supplementation on markers of insulin metabolism and lipid profiles in vitamin D-deficient women with PCOS. This randomized double-blind, placebo-controlled trial was conducted among 55 vitamin D-deficient women diagnosed with PCOS aged 18-40 years old. Subjects were randomly assigned into 2 groups to intake either 500 mg calcium, 200 IU vitamin D and 90 µg vitamin K supplements (n=28) or placebo (n=27) twice a day for 8 weeks. After the 8-week intervention, compared with the placebo, joint calcium, vitamins D and K supplementation resulted in significant decreases in serum insulin concentrations (-1.9±3.5 vs. +1.8±6.6 µIU/mL, P=0.01), homeostasis model of assessment-estimated insulin resistance (-0.4±0.7 vs. +0.4±1.4, P=0.01), homeostasis model of assessment-estimated b cell function (-7.9±14.7 vs. +7.0±30.3, P=0.02) and a significant increase in quantitative insulin sensitivity check index (+0.01±0.01 vs. -0.008±0.03, P=0.01). In addition, significant decreases in serum triglycerides (-23.4±71.3 vs. +9.9±39.5 mg/dL, P=0.03) and VLDL-cholesterol levels (-4.7±14.3 vs. +2.0±7.9 mg/dL, P=0.03) was observed following supplementation with combined calcium, vitamins D and K compared with the placebo. Overall, calcium, vitamins D and K co-supplementation for 8 weeks among vitamin D-deficient women with PCOS had beneficial effects on markers of insulin metabolism, serum triglycerides and VLDL-cholesterol levels.

Expression Patterns and Correlations with Metabolic Markers of Zinc Transporters ZIP14 and ZNT1 in Obesity and Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is associated with infertility, increased androgen levels, and insulin resistance. In adipose tissue, zinc facilitates insulin signaling. Circulating zinc levels are altered in obesity, diabetes, and PCOS; and zinc supplementation can ameliorate metabolic disturbances in PCOS. In adipose tissue, expression of zinc influx transporter ZIP14 varies with body mass index (BMI), clinical markers of metabolic syndrome, and peroxisome proliferator-activated receptor gamma (PPARG). In this study, we investigated expression levels of ZIP14 and PPARG in subcutaneous adipose tissue of 36 PCOS women (17 lean and 19 obese women) compared with 23 healthy controls (7 lean and 16 obese women). Further, expression levels of zinc transporter ZIP9, a recently identified androgen receptor, and zinc efflux transporter ZNT1 were investigated, alongside lipid profile and markers of glucose metabolism [insulin degrading enzyme, retinol-binding protein 4 (RBP4), and glucose transporter 4 (GLUT4)]. We find that ZIP14 expression is reduced in obesity and positively correlates with PPARG expression, which is downregulated with increasing BMI. ZNT1 is upregulated in obesity, and both ZIP14 and ZNT1 expression significantly correlates with clinical markers of altered glucose metabolism. In addition, RBP4 and GLUT4 associate with obesity, but an association with PCOS as such was present only for PPARG and RBP4. ZIP14 and ZNT1 does not relate to clinical androgen status and ZIP9 is unaffected by all parameters investigated. In conclusion, our findings support the existence of a zinc dyshomeostasis in adipose tissue in metabolic disturbances including PCOS-related obesity.