Leptin and adiponectin blood levels in women with premature ovarian failure and age- and weight-matched women with normal menstrual cycles

Metabolic Changes in Patients with Premature Ovarian Insufficiency: Adipose Tissue Focus-A Narrative Review

Background: Estrogen plays a crucial role in adipose tissue homeostasis, influencing fat distribution, lipid metabolism, and insulin sensitivity. Through estrogen receptor (ER) activation, particularly ERα, estradiol (E2) regulates adipogenesis, inhibits adipocyte hypertrophy, and promotes insulin signaling. It enhances lipid oxidation, reduces lipogenesis, and suppresses pro-inflammatory cytokine production, thereby maintaining metabolic health. Primary ovarian insufficiency (POI), characterized by estrogen deficiency before the age of 40, disrupts this regulatory network, leading to adverse metabolic effects. Objetives: This review examines the effects of estrogen on adipose tissue, lipid metabolism, and carbohydrate metabolism, with a particular focus on clinical evidence in women with POI. Methods: A narrative review of the metabolic alterations associated with POI, emphasizing the molecular, biochemical, and metabolic mechanisms underlying estrogen deficiency, with a special focus on adipose tissue. Results: Women with POI exhibit increased visceral fat accumulation, reduced lean mass, and alterations in adipokine secretion, resembling the metabolic phenotype of postmenopausal women. The decline in estrogen levels contributes to central adiposity, impaired lipid metabolism, and insulin resistance, exacerbating the risk of type 2 diabetes (T2D) and cardiovascular disease (CVD). The loss of estrogenic regulation leads to enhanced lipolysis in visceral fat, raising free fatty acid flux to the liver, promoting hepatic steatosis, and worsening insulin resistance. Studies indicate that POI patients have significantly higher total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides compared to age-matched controls, reinforcing their heightened CVD risk. Reduced sex hormone-binding globulin (SHBG) levels increase free androgen availability, aggravating central fat deposition. These metabolic disturbances can potentially accelerate atherosclerosis and vascular aging, increasing morbidity and mortality in POI patients. Conclusions: Understanding the role of estrogen in adipose tissue and its disruption in POI highlights the importance of early intervention. Although the available evidence is limited and largely extrapolated from menopause studies, strategies such as hormone replacement therapy, lifestyle modifications, and lipid profile optimization are essential to mitigate metabolic consequences and improve long-term health outcomes in women with POI.

Estrogen: a master regulator of bioenergetic systems in the brain and body

Estrogen is a fundamental regulator of the metabolic system of the female brain and body. Within the brain, estrogen regulates glucose transport, aerobic glycolysis, and mitochondrial function to generate ATP. In the body, estrogen protects against adiposity, insulin resistance, and type II diabetes, and regulates energy intake and expenditure. During menopause, decline in circulating estrogen is coincident with decline in brain bioenergetics and shift towards a metabolically compromised phenotype. Compensatory bioenergetic adaptations, or lack thereof, to estrogen loss could determine risk of late-onset Alzheimer's disease. Estrogen coordinates brain and body metabolism, such that peripheral metabolic state can indicate bioenergetic status of the brain. By generating biomarker profiles that encompass peripheral metabolic changes occurring with menopause, individual risk profiles for decreased brain bioenergetics and cognitive decline can be created. Biomarker profiles could identify women at risk while also serving as indicators of efficacy of hormone therapy or other preventative interventions.

Adiponectin gene polymorphisms may not be associated with idiopathic premature ovarian failure

Premature ovarian failure (POF) is a syndrome characterized by loss of ovarian function before the age of 40 years. Adiponectin, a protein secreted by adipose tissue, exerts beneficial effects on glucose and lipid metabolism. Transcription of adiponectin and its receptor gene is correlated with follicular development. POF, as a type of pathological ovarian aging, is associated with an increase in fat mass and body weight, in which adiponectin may be involved. The present study aimed to investigate the relationship between adiponectin gene polymorphisms and idiopathic POF in Chinese women. We examined DNA samples of the variant SmaI (rs2241766) and BsmI (rs1501299) loci of the adiponectin gene in 120 POF patients and 104 controls. Polymerase chain reaction and restriction fragment length polymorphism were used to assess these genotype variants. Our results showed that the genotype distributions of the SmaI and BsmI polymorphisms did not significantly differ between the patients with idiopathic POF and the controls. Moreover, no significant difference was found between the controls and POF patients in the haplotype analysis. This suggests that the SmaI and BsmI polymorphisms of adiponectin gene might not be responsible for idiopathic POF, at least, in the Chinese population. More researches are required to determine whether these findings can be extrapolated to other populations.

Leptin levels in children and adults with classic galactosaemia

Among the long-term complications of Classic Galactosaemia (Gal) is premature ovarian insufficiency (POI) in female patients with subtle abnormalities of reproductive function also reported in male patients. Leptin is a circulating hormone which reflects body energy stores and which affects the neuroendocrine reproductive axis and pubertal development.We measured serum leptin in 28 children (10 girls, 18 boys; mean age 7.6 years, range 0.5-17.9 years) and in 22 adults (10 females, 12 males; mean age 23.9 years, range 18-37 years) with Gal on a strict galactose-restricted diet in comparison with control data.Leptin levels (expressed as SDS for gender and pubertal stage) were lower in Gal children than controls (mean leptin-SDS = -0.71 for girls, p < 0.05, -0.97 for boys compared with SDS = 0 for controls, p < 0.05). In an age-related analysis, leptin levels did not correlate with age in children with Gal for both sexes as it did for matched controls.As expected, females had higher leptin levels than males in either group. In adults with Gal, leptin concentrations were within normal limits for both sexes when adjusted for gender and BMI. There was a linear relationship between log-leptin and BMI in children with Gal and in controls. For Gal women, log-leptin was also associated with BMI. However, for Gal men, and hence for the entire group of adult Gal patients, this association between log-leptin and BMI was not detectable. Our findings suggest that leptin dysregulation may play a role in fertility issues in individuals with Gal from an early age.

Leptin, fat mass, and bone mineral density in healthy pre- and postmenopausal women

The purpose was to examine relationships between age, fat mass, and bone mineral density (BMD) with resting leptin levels in premenopausal and postmenopausal women. Young (aged 18-30 yr, n=30) and estrogen-deficient postmenopausal (aged 55-75 yr, n=43) women were recruited. Total body and segmental fat mass and bone-free lean body mass (BFLBM) and total body, lumbar spine, and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Serum-resting, fasted leptin levels were measured by Immunoradiometric Assay (IRMA), and leptin-to-fat mass ratios were calculated. Young and older women had similar amounts of BFLBM, but older women had greater (p<0.05) amounts of fat mass and 35% higher leptin levels. Age differences in leptin concentrations were no longer significant after controlling for fat mass. Older women had significantly (p<0.05) lower hip BMD values. Age was negatively related (r=-0.29, p<0.05) to leptin:trunk fat ratio. Increases in fat mass, not menopause per se, contributes to higher leptin levels in older women. Relationships between leptin and BMD may be age dependent.

Early menopause association with employment, smoking, divorced marital status and low leptin levels

AIMS

The aims of this study were (1) to investigate the determining risk factors related to early menopause and (2) to compare the relationships between demographic characteristics and hormonal status and leptin levels in subjects with early (no surgical) and natural menopause.

STUDY DESIGN

The prospective study was conducted on 500 women with early and 2700 women with natural menopause. Detailed information was collected about their employment status, past and present smoking habits, coffee and alcohol use, educational level and other factors relevant to health. Thirty participants with early menopause and 30 participants with natural menopause were evaluated for hormone and leptin levels.

RESULTS

Employment status (OR: 1.94), current smoking (OR: 1.80) and divorced marital status (OR: 1.79) were found to be significant risk factors for early menopause. Mean levels of leptin in natural and early menopause were measured 11.40 ± 4.1 ng/ml and 8.01 ± 3.9 ng/ml, respectively (p = 0001). Leptin levels in the early (r = 0.765, p = 0.001) and natural (r = 0.750, p = 0.001) menopause subjects correlated positively with oestradiol (E2) levels.

CONCLUSION

This study shows that early onset of menopause is correlated with smoking, employment status, divorced marital status and lower leptin levels.

Adipokine concentrations in nonobese women: a study of reproductive aging, body mass index, and menstrual cycle effects

OBJECTIVE

To explore the influence of reproductive aging, body mass index (BMI), and the menstrual cycle on adiponectin (AD) and leptin concentrations.

DESIGN

Cross-sectional comparison in age- and BMI-matched nonobese volunteers with regular cycles (CO, n = 19) or in early postmenopause (EPM, n = 19), aged 40-52 years, and a young cycling group (CY, n = 21), aged 20-30 years.

MEASURES

Sex steroids, fasting AD, leptin, insulin, glucose, AD/leptin (A/L) ratio, and insulin resistance (IR) by homeostasis model assessment (HOMA-IR). In ovulatory women, AD, estradiol (E(2)), and progesterone were assessed weekly across the same menstrual cycle.

RESULTS

Insulin, glucose, HOMA-IR, A/L ratio, and leptin values were similar across the three study groups. AD differed, with the highest concentrations in the EPM group (CY: 13.0 +/- 0.9 microg/ml vs. CO: 14.0 +/- 1.1 microg/ml vs. EPM: 17.7 +/- 1.5 microg/ml; p = .05). Values among cycling women were similar. When the cycling groups were combined into a premenopausal (PRE) group and compared to EPM women by BMI (> or

CONCLUSION

Nonobese, midlife women experience minimal adverse effects from reproductive aging on insulin sensitivity and adipokine secretion. The menstrual cycle is not a key mediator of AD. Early menopause has differential, BMI-dependent effects on adipokine secretion.

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Key Words

• menopause
• menstrual cycle
• adipokines

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MESH Headings

• Adipokines/blood
• Adult
• Aging/blood
• Body Mass Index
• Female
• Humans
• Insulin Resistance
• Middle Aged
• Reproduction

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Grants

• P30 NR010677 NINR NIH HHS
• P30NR010677 NINR NIH HHS
• R01 AG015083 NIA NIH HHS
• R01-AG15083-04 NIA NIH HHS
• 5-M01-00042 PHS HHS

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Affiliation(s)

Patricia A. Rouen McAuley School of Nursing, University of Detroit Mercy, 4001 W. McNichols Road., Detroit, MI 48221, , Phone: (313) 993-1739 Fax: (313) 993-1271
Jane L. Lukacs School of Nursing, University of Michigan, Ann Arbor, MI
Nancy E. Reame School of Nursing, Columbia University, New York, NY

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