Metabolic response to selenium supplementation in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial

Effects of Selenium Administration on Blood Lipids: A Systematic Review and Dose-Response Meta-Analysis of Experimental Human Studies

CONTEXT

Overexposure to the essential trace element selenium has been associated with adverse metabolic and cardiovascular outcomes, hypertension, and diabetes. However, dose-response meta-analyses analyzing the effects of selenium administration on the lipid profile in experimental human studies are lacking.

OBJECTIVE

Through a restricted cubic spline regression meta-analysis, the dose-response relation between the dose of selenium administered or blood selenium concentrations at the end of the trials and changes over time in blood lipids, ie, total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and triglycerides was assessed.

DATA SOURCES

Searches were performed on PubMed, Web of Science, Embase, and the Cochrane Library from inception up to January 11, 2025 to identify randomized controlled trials (RCTs) investigating the impact of selenium supplementation on blood lipid profiles among adults.

DATA EXTRACTION

A total of 27 eligible RCTs that enrolled healthy individuals, pregnant individuals, and participants with specific health conditions were identified and the relevant data was extracted.

DATA ANALYSIS

Dose-response analysis indicated that selenium administration at and above 200 µg/day decreased HDL and LDL cholesterol and increased triglyceride levels. Blood selenium concentrations at the end of the trial above approximately 150 µg/L were positively associated with triglyceride and LDL cholesterol concentrations, and inversely associated with HDL cholesterol. Inorganic selenium supplementation showed stronger associations than organic selenium. At the lowest levels of baseline intake, selenium supplementation appeared instead to have beneficial effects on the lipid profile, with an overall indication of U-shaped curves, apart from HDL-cholesterol. The adverse effects of selenium were stronger in studies involving healthy participants as compared with unhealthy participants and pregnant females, in those having a longer duration of the intervention, particularly more than 3 months, and in European populations at selenium intake levels of above 300 µg/day.

CONCLUSIONS

In this dose-response meta-analysis of experimental human studies, an adverse effect of selenium administration on blood lipids at levels around or above the current upper level of intake was observed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022380432.

The effects of selenium supplementation on lipid profile in adults: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Dyslipidemia with a considerable progression rate is a primary risk factor for CVDs if left untreated. Dietary interventions have explored the health influences of selenium on lipid profiles in adults, yet the findings remain contentious. This study seeks to determine if selenium supplementation can positively modify the lipid profile (total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL), and high-density lipoprotein cholesterol (HDL-C) in adults.

METHODS

Using predefined keywords, we searched online databases, including Scopus, PubMed, Web of Science Core Collection, and Google Scholar, for relevant studies published from inception through July 2024. A random-effects meta-analysis was then employed to pool the weighted mean differences (WMD) and 95 % CI for outcomes assessed by a minimum of three studies.

RESULTS

Initially 1205 studies were obtained out of which 25 RCTs were decided to be included for further analyses. Selenium supplementation reduced VLDL (WMD: -1.53; 95 % CI: -2.86, -0.20), but did not change TG (WMD: 1.12; 95 % CI: -4.51, 6.74), TC (WMD: -2.25; 95 % CI: -6.80, 2.29), LDL-C (WMD: 1.60; 95 % CI: -4.26, 7.46), and HDL-C levels (WMD: 0.98; 95 % CI: - 0.02, 1.98).

CONCLUSION

Our study showed significantly reduced VLDL but limited effects were observed in other lipid indexes. More extensive RCTs are required globally to achieve a holistic comprehension of the connection between selenium and lipid profile.

Genetic Determinants of Selenium Availability, Selenium-Response, and Risk of Polycystic Ovary Syndrome

Selenium is a trace element and its deficiency has been associated with the risk of PCOS, a multifactorial syndrome that affects a large number of women worldwide. Several databases and literature were searched to find out genetic variants of the genes involved in selenium uptake, metabolism, and regulation which may be significantly associated with the risk of PCOS through Se-related pathways. Genes that require selenium for their biological actions to perform were also shortlisted. A total of eighteen significantly associated genes with forty-four variants were identified as candidate variants that could play a potential role in the modulation of PCOS risk among the study population. The genetic variant distribution data was available in-house and was obtained through a GWAS study of the North India population. In silico tools were applied to understand the functional impact of these variants. Three variants namely LDLR (rs2228671), TNF (rs1041981), and SAA2 (rs2468844) are strongly associated with PCOS risk and have a functional impact on encoded protein. Certain variants of Se uptake genes such as DIO1, GPX2, TXNRD1, DIO2 and GPX3 are also significantly associated with the risk of PCOS development. "C" allele of the Se transporter gene SELENOP (rs9686343) significantly increases PCOS risk. Other potential genes require selenium for their biological actions and are involved in the inflammatory, antioxidant response, and energy homeostasis signaling pathways. Thus, genetic variants of the population may affect the Se availability in the body. Also, deficiency of Se effects may get modulated due to underlying genetic polymorphism of Se-associated genes. This information may be helpful in dosage adjustment of Se supplementation for a population in order to get maximum benefits.

Mineral Metabolism and Polycystic Ovary Syndrome and Metabolic Risk Factors: A Mendelian Randomization Study

Observational investigations recommend that mineral supplements were associated with a higher risk of polycystic ovary syndrome (PCOS) and its risk factors (insulin resistance, hyperandrogenism, and obesity), but the relationship with risk of PCOS, hyperandrogenism, obesity, and insulin resistance was unclear. This study was to investigate the potential causal impact of genetically predicted levels of magnesium (Mg), calcium (Ca), selenium (Se), zinc (Zn), iron (Fe), and omega-3 (ω-3) on polycystic ovary syndrome (PCOS) and its associated risk factors. A two-sample Mendelian randomization (MR) analysis was conducted. The genetic variations obtained from GWAS of individuals with European ancestry were found to be associated with the genetically predicted levels of Ca, Mg, Zn, Se, Fe, or ω-3. The data obtained from the FinnGen Consortium and MAGIC were utilized for the outcome of GWAS. The study found that there was a correlation between genetically predicted higher levels of Se and a reduced risk of insulin resistance, with a decrease of 2.2% according to random-effect IVW (OR 0.978, 95% CI 0.960-0.996, p = 0.015). The association between genetically determined mineral levels and PCOS was found to be limited, with an odds ratio (OR) ranging from 0.875 (95% CI: 0.637-1.202, p value = 0.411) for Ca. Limited scientific proof was found for the efficacy of other genetically determined mineral levels on hyperandrogenism, obesity, and insulin resistance. These findings suggested a causal relationship between genetically predicted higher levels of Se and a reduced risk of insulin resistance. Nonetheless, there is limited evidence supporting a causal association between various genetically determined mineral levels and the risk factors associated with PCOS.

Association Between Selenium and Circulating Adipokine Levels in Patients with Polycystic Ovary Syndrome

There is increasing evidence that selenium (Se) and its major transport protein, selenoprotein-P (SePP), may be associated with polycystic ovary syndrome (PCOS). However, the association of serum Se and SePP levels with circulating adipokines in this population has not received sufficient attention. In the present study, we aimed to investigate the associations of serum Se and SePP with circulating adipokine levels in patients with PCOS. In this cross-sectional study, 115 patients aged 18-45 years with PCOS diagnosed according to the Rotterdam Consensus Criteria were recruited. The general characteristics of the participants were collected using a general questionnaire and anthropometric measurements were taken. Blood samples were obtained and serum levels of leptin, adiponectin, visfatin, resistin, and omentin-1, as well as markers of glucose metabolism, were measured. Serum levels of Se and SePP were inversely correlated with fasting blood glucose (FBS), serum insulin, and homeostatic model assessment for insulin resistance (HOMA-IR). In addition, serum levels of Se and SePP were positively correlated with serum levels of adiponectin and visfatin. Although there was no significant correlation between serum Se and serum omentin-1 levels, a significant positive correlation was found between serum SePP levels and this adipokine. The present study found that serum Se and SePP levels were positively correlated with serum adiponectin and visfatin levels. Further studies are needed to confirm these findings.

Glutathione peroxidase (GPX1) - Selenocysteine metabolism preserves the follicular fluid's (FF) redox homeostasis via IGF-1- NMD cascade in follicular ovarian cysts (FOCs)

Follicular ovarian cysts (FOCs) are characterized by follicles in the ovaries that are >20 mm in diameter and persist for >10 days without the corpus luteum, leading to anovulation, dysregulation of folliculogenesis and subfertility in humans and livestock species. Despite their clinical significance, the precise impact of FOCs on oocyte reserve, maturation, and quality still needs to be explored. While FOCs are observed in both human and livestock populations, they are notably prevalent in livestock species. Consequently, livestock species serve as valuable models for investigating the molecular intricacies of FOCs. Thus, in this study, using goat FOCs, we performed integrated proteomic, metabolomic and functional analyses to demonstrate that oocyte maturation is hampered due to increased reactive oxygen species (ROS) in FOCs follicular fluid (FF) via downregulation of glutathione peroxidase (GPX1), a critical antioxidant seleno enzyme required to negate oxidative stress. Notably, GPX1 reduction was positively correlated with the FF's decline of free selenium and selenocysteine metabolic enzymes, O-phosphoryl-tRNA (Sec) selenium transferase (SEPSECS) and selenocysteine lyase (SCLY) levels. Adding GPX1, selenocysteine, or selenium to the culture media rescued the oocyte maturation abnormalities caused by FOCs FF by down-regulating the ROS. Additionally, we demonstrate that substituting GPX1 regulator, Insulin-like growth factor-I (IGF-1) in the in vitro maturation media improved the oocyte maturation in the cystic FF by down-regulating the ROS activity via suppressing Non-sense-mediated decay (NMD) of GPX1. In contrast, inhibition of IGF-1R and the target of rapamycin complex 1 (mTORC1) hampered the oocyte maturation via NMD up-regulation. These findings imply that the GPX1 regulation via selenocysteine metabolism and the IGF-1-mediated NMD may be critical for the redox homeostasis of FF. We propose that GPX1 enhancers hold promise as therapeutics for enhancing the competence of FOCs oocytes. However, further in vivo studies are necessary to validate these findings observed in vitro.

Effect of Selenium and Zinc Supplementation on Reproductive Organs Following Postnatal Protein Malnutrition

Protein diets are required for the normal development of the reproductive system and their inadequacy or deficiency might have hazardous functional complications during maturational and developmental stages. The study was carried out to evaluate the effect of selenium (Se) and zinc (Zn) supplementation on the male and female reproductive organs of rats with postnatal protein malnutrition. Male and female weanling rats were randomly assigned to six groups respectively. The adequate protein diet rats were fed with 16% casein diet while the protein malnourished diet (PMD) rats were fed with 5% casein diet. After the 8th week of feeding, Se (sodium selenite; Na2SeO3) and Zn (zinc sulfate; ZnSO4·7H2O) were supplemented for 3 weeks. The growth curve of body weights, lipid profile, testosterone and progesterone level, Na+-K+-ATPase activity, oxidative stress, and antioxidant status were evaluated. The results showed that PMD reduced the body weights of male and female rats. It also reduced the activities of catalase and glutathione peroxidase in the testes, but reductions in superoxide dismutase and glutathione-S-transferase activities, glutathione, vitamins C and E, testosterone, and progesterone levels were observed in both the testes and ovaries. Furthermore, PMD increased the nitric oxide level in both organs and altered the plasma lipid profiles in both sexes. Se and Zn supplementation, however, restored almost all the alterations observed in all the parameters analyzed. In conclusion, Se and Zn supplementation protects the male and female reproductive organs of rats against postnatal protein malnutrition.

Efficacy of antioxidant supplementation in improving endocrine, hormonal, inflammatory, and metabolic statuses of PCOS: a meta-analysis and systematic review

Background and aim: A large number of recent studies have reported on the use of antioxidants in patients with polycystic ovary syndrome (PCOS). This study aimed to evaluate the antioxidant effects on PCOS. Methods: We searched PubMed, Embase, Web of Science, and The Cochrane Library to identify randomized controlled trials investigating the use of antioxidants in treating PCOS. Statistical analysis was performed using Review Manager 5.4. Stata17.0 software was used to conduct sensitivity analyses. Results: This meta-analysis included 49 articles and 62 studies. The sample comprised 1657 patients with PCOS from the antioxidant group and 1619 with PCOS from the placebo group. The meta-analysis revealed that the fasting blood glucose levels [standardized mean difference (SMD): -0.31, 95% confidence interval (CI): -0.39 to -0.22, P < 0.00001], the homeostatic model assessment of insulin resistance (SMD: -0.68, 95% CI: -0.87 to -0.50], P < 0.00001), and insulin levels (SMD: -0.68, 95% CI: -0.79 to -0.58, P < 0.00001) were significantly lower in patients with PCOS taking antioxidants than those in the placebo group. Further, total cholesterol levels (SMD: -0.38, 95% CI: -0.56 to -0.20, P < 0.001), low-density lipoprotein cholesterol levels (SMD: -0.24, 95% CI: -0.37 to -0.10, P = 0.0008), and very low-density lipoprotein levels (SMD: -0.53, 95% CI: -0.65 to -0.41, P < 0.00001) were lower in patients with PCOS taking antioxidant supplements compared with the placebo group. Total testosterone (TT) level (SMD: -0.78, 95% CI: -1.15 to -0.42, P < 0.0001), dehydroepiandrosterone level (SMD: -0.42, 95% CI: -0.58 to -0.25, P < 0.00001), and mean standard deviation modified Ferriman-Gallway (MF-G scores) (SMD: -0.63, 95% CI: -0.98 to -0.28, P = 0.0004) were lower in patients taking antioxidant supplements. C-reactive protein (CRP) levels (SMD: -0.48, 95% CI: -0.63 to -0.34, P < 0.000001), body mass index [mean difference (MD): -0.27, 95% CI: -0.50 to -0.03, P = 0.03], weight (MD: -0.73, 95% CI: -1.35 to -0.11, P = 0.02), and diastolic blood pressure (MD: -3.78, 95% CI: -6.30 to -1.26, P = 0.003) were significantly lower. Moreover, the levels of sex hormone-binding protein (SMD: 0.23, 95% CI: 0.07-0.38, P = 0.004), high-density lipoprotein cholesterol (SMD: 0.11, 95% CI: 0.01-0.20, P = 0.03), total antioxidant capacity (SMD: 0.59, 95% CI: 0.31-0.87, P < 0.0001), and quantitative insulin sensitivity index (SMD: 0.01, 95% CI: 0.01-0.02, P < 0.00001) were higher in patients with PCOS who took antioxidant supplements compared with the placebo group. Antioxidant supplements did not affect other analyzed parameters in these patients, including follicle-stimulating hormone, free androgen index, nitric oxide, glutathione, malondialdehyde, and diastolic blood pressure. Conclusions: Antioxidants are beneficial in treating PCOS. Our study might provide a new treatment strategy for patients with clinical PCOS. We hope that more high-quality studies evaluating the effects of antioxidants on patients with PCOS will be conducted in the future. Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023448088.

Expert consensus on the role of supplementation in obstetrics and gynecology using modified delphi method

PURPOSE

To reach a consensus among obstetrics and gynecology experts on the effects of micronutrient supplementation on fertility and pregnancy to aid clinicians in decision-making and create a unified approach to managing micronutrient deficiencies in women, by performing a modified Delphi study.

METHODS

A three-round modified Delphi process was conducted among a Delphi panel of 38 Egyptian experts to define recommendations regarding the role of supplementation on fertility and pregnancy in women of reproductive age. A literature review was performed and supporting evidence was graded to help guide the recommendations based on available evidence.

RESULTS

A total of 62 statements were developed for discussion and voting. Out of the 62 statements, 60 statements reached expert consensus. Statements were divided into two domains. The first domain discussed the role of supplementation in fertility: optimizing natural fertility, polycystic ovary syndrome (PCOS), in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), unexplained infertility, and endometriosis, whereas the second domain was concerned with the role of supplementation in pregnancy during the prenatal, antenatal, and postnatal periods.

CONCLUSION

In this work, a modified Delphi methodology was implemented to reach a consensus on the use of micronutrient supplementation in women of reproductive age. These recommendations can help clinicians in their practice, guide future research, and identify gaps in the market for the pharmaceutical industry. This clinical guidance can be extrapolated to similar communities.

In Vitro Assessment of the Bioaccessibility of Zn, Ca, Mg, and Se from Various Types of Nuts

The bioaccessibility of zinc (Zn), calcium (Ca), magnesium (Mg), and selenium (Se) from various nuts (Brazil nuts, walnuts, peanuts, almonds, cashews, pecans, hazelnuts, macadamia nuts, and pistachios) was assessed using a simulated two-phase model of enzymatic digestion in vitro. The levels of Zn, Mg, and Ca were determined by atomic absorption spectrometry, and Se was measured by inductively coupled plasma-mass spectrometry. All tested nuts were good sources of Mg, and most, except macadamia nuts, were also good sources of Zn (the standard portion covers over 15% of NRV-R (UE) 1924/2006). Brazil nuts had the highest Se content. Almonds and Brazil nuts were rich in Ca. Se demonstrated the highest bioaccessibility from nuts (27.7% to 70.65%), whereas Ca exhibited the lowest bioaccessibility (below 9%). Pistachios had the highest Zn bioavailability, while cashews excelled in Mg bioaccessibility. Macadamia and pistachios were top for Ca bioaccessibility, and Brazil nuts for Se. Bioaccessibility is positively correlated with fat (for Zn: r = 0.23), carbohydrates (for Mg: 0.44; for Ca: 0.35), and sugar content (for Zn: r = 0.36; for Mg: 0.46; for Ca: 0.40).

Comparison of nutritional supplements in improving glycolipid metabolism and endocrine function in polycystic ovary syndrome: a systematic review and network meta-analysis

Objective

To explore the comparative effectiveness of nutritional supplements in improving glycolipid metabolism and endocrine function in patients with polycystic ovary syndrome (PCOS).

Method

Randomized controlled clinical trials on the effects of nutritional supplements in PCOS patients were searched in PubMed, Embase, Cochrane Library, and Web of Science from their establishments to March 15, 2023. Then, literature screening, data extraction, and network meta-analysis were performed. This study was registered at PROSPERO (registration number CRD 42023441257).

Result

Forty-one articles involving 2,362 patients were included in this study. The network meta-analysis showed that carnitine, inositol, and probiotics reduced body weight and body mass index (BMI) compared to placebo, and carnitine outperformed the other supplements (SUCRAs: 96.04%, 97.73%, respectively). Omega-3 lowered fasting blood glucose (FBG) (SUCRAs: 93.53%), and chromium reduced fasting insulin (FINS) (SUCRAs: 72.90%); both were superior to placebo in improving insulin resistance index (HOMA-IR), and chromium was more effective than Omega-3 (SUCRAs: 79.99%). Selenium was potent in raising the quantitative insulin sensitivity index (QUICKI) (SUCRAs: 87.92%). Coenzyme Q10 was the most effective in reducing triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels (SUCRAs: 87.71%, 98.78%, and 98.70%, respectively). Chromium and probiotics decreased TG levels, while chromium and vitamin D decreased TC levels. No significant differences were observed in high-density lipoprotein cholesterol (HDL-C), total testosterone (TT), sex-hormone binding globulin (SHBG), and C-reactive protein (CRP) between nutritional supplements and placebo.

Conclusion

Carnitine was relatively effective in reducing body mass, while chromium, Omega-3, and selenium were beneficial for improving glucose metabolism. Meanwhile, coenzyme Q10 was more efficacious for improving lipid metabolism. However, publication bias may exist, and more high-quality clinical randomized controlled trials are needed.

Co-supplementation of Vitamin K2 and Selenium Synergistically Improves Metabolic Status and Reduces Cardiovascular Risk Markers in Dyslipidemic Rabbits

This work investigated the impact of vitamin K2 and selenium co-supplementation on metabolic profile and indicators of cardiovascular health in dyslipidemic rabbits. Fifty adult male rabbits were equally allocated into 5 groups: Control group, Dyslipidemic group: received 0.5% cholesterol in diet for 12 weeks, groups 3, 4 and 5 dyslipidemic rabbits daily treated with vitamin K2 (10 mg/kg bw) or/and selenium (1 mg/kg bw) for 8 weeks. Co-supplementation of vitamin K2 and selenium significantly decreased body weight gain and blood pressure elevation in dyslipidemic rabbits compared to un-treated ones. Consuming vitamin K2 plus selenium also markedly lowered serum lipids encompassing cholesterol, triglycerides and LDL and elevated HDL relative to placebo. Additionally, such co-supplementation reduced fasting glucose and insulin, enhancing insulin sensitivity with respect to placebo. Regarding cardiovascular risk markers, dyslipidemic rabbits received vitamin K2 concurrently with selenium displayed lower levels of atherogenic index (LDL/HDL), serum C-reactive protein, heart fatty acid-binding protein and asymmetric dimethylarginine as well as aortic ox-LDL, lipid peroxidation and calcium but higher levels of serum nitric oxide and aortic total antioxidants than un-treated ones. Concomitant administration of vitamin K2 and selenium improved metabolic profile, markers of cardiovascular health and atherosclerosis in dyslipidemic rabbits.

Selenium supplementation effect on glycemic control: A GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials

Results from different studies on the effects of selenium supplementation on glycemic control are still debated. To fill this knowledge gap, we investigated the overall effects of selenium supplementation on some glycemic parameters such as fasting blood sugar (FBS), hemoglobinA1c (HbA1c), fasting insulin, quantitative insulin sensitivity check index (QUICKI), and homeostatic model assessment of insulin resistance (HOMA-IR). A comprehensive literature search was conducted from inception to April 2023 on Scopus, Web of Science, PubMed, Google Scholar, and Cochrane databases. All randomized controlled trials (RCTs) which reported an effect of selenium supplementation on glycemic parameters were included. A random-effects model was used to estimate the weighted mean difference (WMD) and 95% CI for each outcome. Between-studies heterogeneity was assessed by the I2 and Cochran's Q test. 20 trials were included in the meta-analysis. Pooled analysis showed that selenium intake significantly reduced fasting insulin (WMD: -3.02 µIu/mL, 95% CI; -5.13, -0.90, P = 0.005) and increased QUICKI levels (WMD: 0.01, 95% CI: 0.01, 0.02, P = 0.005). However, selenium supplementation did not change FBS (WMD: -1.32 mg/dL, 95% CI; -4.02, 1.37, P = 0.332), HbA1c (WMD = 0.05%, 95% CI: -0.19, 0.28, p = 0.701), and HOMA-IR (WMD: -0.82, 95% CI; -2.14, 0.50, P = 0.223). Moreover, we found that there is a non-linear association between selenium supplementation dosage and FBS (P-nonlinearity = 0.008). In conclusion, our study findings indicate some benefits of selenium on fasting insulin, and QUICKI compared with placebo, but elicits no effect on HbA1c, HOMA-IR, and FBS. Further well-designed RCTs with larger samples are necessary to ascertain the effects of selenium supplementation on glycemic control.

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 Selenium Supplementation on Biochemical Markers of Women with Polycystic Ovarian Syndrome: A Systematic Review

Polycystic ovary syndrome (PCOS) is a widespread endocrine disorder among fertile women and may be induced by nutritional deficiencies. In this study, we assess the impact of selenium supplementation (SS) on biochemical markers in women with PCOS. To gather relevant literature, we searched the Web of Science, Cochrane Library, Scopus, Embase, and MEDLINE databases from inception up to July 24, 2022. Subsequently, we included all published full-text randomized clinical trials examining the effects of SS versus placebo on biochemical changes in women with PCOS. Review Manager 5.3 was used to collect and analyze data and assess the risk of bias. Seven articles, comprising 413 women, were ultimately involved in the study. According to the results, SS could increase the level of quantitative insulin sensitivity check index [standardized mean difference (SMD)=0.34, 95% confidence interval (CI)=0.04∼0.65], total antioxidant capacity (SMD=0.89 mmol/L, 95% CI=0.52∼1.26), and glutathione (SMD=1.00 μmol/L, 95% CI=0.22∼1.78). Conversely, SS could decrease triglyceride, cholesterol, fasting plasma glucose, insulin, and the homeostasis model of assessment-insulin resistance levels compared with the placebo. Furthermore, there were no significant differences regarding sex hormone-binding globulin level, testosterone level, malondialdehyde, and body mass index between the two groups. In addition, the results suggest that SS improves biochemical markers in women with PCOS and thus is recommended for treating biochemical disorders among these women in addition to standard treatment.

Effects of selenium supplementation on Polycystic Ovarian Syndrome: a systematic review and meta-analysis on randomized clinical trials

BACKGROUND

This study provides a systematic review and meta-analysis of randomized controlled trials, which examined the effect of the selenium supplementation on polycystic ovary syndrome (PCOS).

METHODS

Confirmed studies related to selenium supplementation and PCOS were searched from the databases of EMBASE, PubMed and Web of Science. Data were reported as weighted mean difference (WMD) or standard mean difference (SMD) and associated 95% confidence intervals (CIs). Analysis was performed with Stata version 12.0.

RESULTS

A total of 389 cases (selenium group n = 195, control group n = 194) were included in this studies. This meta-analysis showed that selenium supplementation has a positive effect on TAC, and supplementation of selenium does not significantly improve the level of BMI, Weight, LDL, HDL, Triglycerides, Total Testosterone, HOMA-IR, NO, GSH, MDA and FPG.

CONCLUSION

Although selenium can improve TAC in PCOS patients, it has no significant effect on BMI, Total Testosterone, et al. In terms of the results of this meta-analysis, it is not recommended for patients with PCOS to use selenium as a regular trace element supplement. Based on the improving effect of selenium on TAC, supplementation of selenium may have a positive effect on improving follicle quality for some PCOS patients who have poor follicle quality caused by oxidative stress or who want to undergo IVF.

EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch‐Ernst K, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Peláez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Aggett P, Crous Bou M, Cubadda F, Ciccolallo L, de Sesmaisons Lecarré A, Fabiani L, Titz A, Naska A. Scientific opinion on the tolerable upper intake level for selenium

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the tolerable upper intake level (UL) for selenium. Systematic reviews of the literature were conducted to identify evidence regarding excess selenium intake and clinical effects and potential biomarkers of effect, risk of chronic diseases and impaired neuropsychological development in humans. Alopecia, as an early observable feature and a well-established adverse effect of excess selenium exposure, is selected as the critical endpoint on which to base a UL for selenium. A lowest-observed-adverse-effect-level (LOAEL) of 330 μg/day is identified from a large randomised controlled trial in humans (the Selenium and Vitamin E Cancer Prevention Trial (SELECT)), to which an uncertainty factor of 1.3 is applied. A UL of 255 μg/day is established for adult men and women (including pregnant and lactating women). ULs for children are derived from the UL for adults using allometric scaling (body weight0.75). Based on available intake data, adult consumers are unlikely to exceed the UL, except for regular users of food supplements containing high daily doses of selenium or regular consumers of Brazil nuts. No risk has been reported with the current levels of selenium intake in European countries from food (excluding food supplements) in toddlers and children, and selenium intake arising from the natural content of foods does not raise reasons for concern. Selenium-containing supplements in toddlers and children should be used with caution, based on individual needs.

Correlations of selenium and selenoprotein P with asymmetric dimethylarginine and lipid profile in patients with polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is associated with an increased risk of cardiovascular diseases (CVD). Accumulating evidence has suggested that selenium (Se) is of importance for optimal function of the cardiovascular system. This study aimed to investigate the associations of selenium and selenoprotein P (SePP) with asymmetric dimethylarginine (ADMA) and lipid profile in women with PCOS.

METHODS

In this cross-sectional study, 125 females aged 18-45 years diagnosed with PCOS were recruited. An interviewer-administered questionnaire was applied to gather the relevant demographic characteristics, detailed clinical information, and lifestyle habits of participants. Fasting blood samples were obtained to measure biochemical parameters. Serum concentrations of total testosterone, sex hormone-binding globulin (SHBG), ADMA, and lipid profiles as well as anthropometric measurements were assessed across tertiles of serum Se and SePP concentrations.

RESULTS

There was a positive correlation between serum Se and SePP concentrations (r = 0.434, p < 0.001). Serum Se level was inversely correlated with ADMA (r = -0.21, p = 0.025) and TG (r = -0.17, p = 0.041) concentrations. There were also inverse correlations between SePP and ADMA (r = -0.34, p < 0.001), TG (r = -0.21, p = 0.019), and oxidized low density lipoprotein (ox-LDL) (r = -0.25, p = 0.007) levels. No significant relationship was found between serum Se and SePP concentrations with total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein-A1 (Apo-A1), apolipoprotein-B (Apo-B100), total testosterone, SHBG, and free androgen index as well as anthropometric parameters (All p > 0.05).

CONCLUSION

The present study found that Se and SePP levels were inversely correlated with ADMA and TG concentrations as well as ox-LDL levels.

An overview on effects of micronutrients and macronutrients interventions in management of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the common endocrinopathies among women. Changing dietary behaviors for PCOS management has been an important research focus during the last decades. This review has discussed current evidence and clinical trial studies relating to the impact of macronutrients and micronutrients in the management of different clinical feature of PCOS. The possible relationship between the quality and quantity of micronutrients and macronutrients and PCOS as well as the necessity to manage PCOS as a complex condition highlights the importance of diet-related interventions. The growing number of clinical trials related to the effect of micronutrients (zinc, chromium, selenium, vitamin D, inositol, and vitamin E) and macronutrients interventions (manipulation of fat, carbohydrate, protein, and MedDiet, Calorie restriction, Low Glycemic Diet) have been demonstrated to be practical approaches for managing clinical and biochemical features of PCOS, however the potential benefit of micronutrient and macronutrient approaches could be different from one by one, particularly in different phenotypes of PCOS. To achieve optimum outcomes, providing information regarding safety and the best dose selection of micronutrients and macronutrients is necessary. Hence, to better understand the approaches' risk/benefit in women with PCOS, future trials with a large sample size are recommended.

Antioxidant supplements relieve insulin resistance but do not improve lipid metabolism in women with polycystic ovary syndrome: a meta-analysis of randomized clinical trials

Objective: The effect of antioxidant supplements on glucose metabolism and lipid profiles in polycystic ovary syndrome (PCOS) remains controversial. This systematic review and meta-analysis aimed to evaluate whether antioxidant supplements improve glucose metabolism and lipid profiles in women with PCOS to provide optimal nutritional supplement advice in clinical practice. Methods: The search was conducted across multiple medical databases from inception to January 1, 2022 and performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A random effects model was used to calculate the overall effects. Results: Eighteen trials (1113 participants) were included. Antioxidant supplements significantly improved insulin resistance (95% CI, -0.62, -0.30; p < 0.00001; I² =48%), fasting insulin (95% CI, -0.80, -0.44; p < 0.00001; I² = 48%), and fasting plasma glucose (95% CI, -0.54, -0.21; p < 0.00001; I² = 38%) in patients with PCOS. However, antioxidant supplements were found to not improve most indices of lipid profiles in PCOS except triglyceride. Conclusions: Antioxidant supplements are an effective intervention for relieving insulin resistance but do not significantly improve lipid metabolism in women with PCOS.

The effects of selenium supplementation on blood lipids and blood pressure in adults: A systematic review and dose-response meta-analysis of randomized control trials

BACKGROUND

Previous studies evaluating the effects of selenium supplementation on lipid profile and blood pressure (BP) offer contradictory findings. This systematic review and meta-analysis assessed the effects of selenium supplementation on these lipid profile and BP.

METHODS

In order to identify interrelated clinical trials, we performed a comprehensive literature search in the online databases, including PubMed, Scopus, Embase, and ISI web of science, up to December 2021.

RESULTS

The analysis of the data established that selenium supplementation did not significantly affect TG level (WMD: -0.84 mg/dL; 95 % CI: -4.74, 3.05, p = 0.671), LDL-C (WMD: 0.86 mg/dL; 95 % CI: -1.21, 2.95, p = 0.416), and HDL-C (WMD: 0.3 mg/dL; 95 % CI: -0.66, 1.27, p = 0.535). however, there was a significant reduction in TC levels following selenium supplementation (WMD: -2.11 mg/dL; 95 % CI: -4.09, -0.13, p = 0.037). After subgroup analysis, when the baseline levels of LDL-C were < 130 mg/dL, selenium supplementation elicited a significant increase in LDL-C levels (WMD: 2.89 mg/dL; 95 % CI: 0.26, 5.51, p = 0.031). For BP, selenium supplementation significantly increased SBP (WMD: 2.02 mmHg; 95 % CI: 0.50, 3.55, p = 0.009), while it had no significant effect on DBP (WMD: 0.39 mmHg; 95 % CI: (-0.89, 1.68, p = 0.551)).

CONCLUSION

Although our findings suggest selenium may have possible therapeutic effects in improving TC and VLDL, because of its negative effects on LDL and BP, selenium supplementation for cardiovascular protection should be recommended with caution.

Selenium supplementation for polycystic ovary syndrome: a meta-analysis of randomized controlled trials

Introduction: The efficacy of selenium supplementation was elusive for polycystic ovary syndrome. This meta-analysis aimed to explore the efficacy of selenium supplementation for polycystic ovary syndrome. Methods: PubMed, EMbase, Web of science, EBSCO, Cochrane library database, CNKI, Chongqing VIP database and Wanfang databases have been searched through July 2022 and we included randomized controlled trials (RCTs) reporting the effect of selenium supplementation versus placebo in patients with polycystic ovary syndrome. Results: Five RCTs were included in the meta-analysis. Compared with placebo group for polycystic ovary syndrome, selenium supplementation was associated with significantly reduced total testosterone (SMD=-0.42; 95% CI=-0.78 to -0.06; p = 0.02) and cholesterol (SMD=-0.71; 95% CI=-1.41 to -0.02; p = 0.04), but revealed no remarkable influence on SHBG (SMD=-0.52; 95% CI=-1.29 to 0.25; p = 0.19), triglyceride (SMD=-1.45; 95% CI=-3.62 to 0.73; p = 0.19), LDL (SMD=-0.17; 95% CI=-0.72 to 0.37; p = 0.53), FPG (SMD=-0.95; 95% CI=-3.72 to 1.82; p = 0.50) or HOMA-IR (SMD=-0.51; 95% CI=-3.79 to 2.77; p = 0.76). Conclusions: Selenium supplementation may be able to improve the metabolic response for polycystic ovary syndrome, and this finding should be interpreted with caution.

Effects of antioxidant intervention in patients with polycystic ovarian syndrome: A systematic review and meta-analysis

BACKGROUND

The role of antioxidant intervention in polycystic ovary syndrome (PCOS) patients has been increasingly investigated in recent years. In order to further clarify whether antioxidant therapy is beneficial for PCOS patients and the emphasis of its effects, this study provides a systematic review and meta-analysis of randomized controlled trials examining the effect of antioxidant intervention on PCOS.

METHODS

Enrolled study designs related to antioxidant interventions and PCOS, published from 1999 to 2020, were searched from EMBASE, PubMed, and Web of Science databases to sort out proven studies on antioxidant interventions and PCOS. Data were reported as weighted mean difference (WMD) or standard mean difference with associated confidence intervals of 95%. The analysis was conducted using Stata version 16.0.

RESULTS

Twenty-three studies were included in total. Antioxidant intervention had a positive impact on homeostasis model assessment of insulin resistance (WMD = -0.37, P = .011) and Triglycerides (WMD = -25.51, P < .001). And antioxidant intervention did not improve testosterone levels significantly (WMD = -0.20, P = .2611). Subgroup analysis showed that except for the D-chiro-inosito subgroup, no difference in body mass index was observed between the intervention group and the control group.

CONCLUSIONS

This meta-analysis demonstrates the efficacy of antioxidant intervention in patients with PCOS, demonstrating that antioxidant intervention has a significant effect on insulin resistance and lipid metabolism improvement. However, antioxidant intervention therapy has no discernible impact on testosterone levels or body mass index. Omega-3 may be a more effective antioxidant intervention for PCOS. In addition, this meta-analysis provides important reference opinions and treatment recommendations for PCOS.

The Impact of Mineral Supplementation on Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is an endocrinopathy that is common among women of reproductive age. It is a heterogeneous disorder with an unknown etiology. Different strategies have been proposed for the treatment of PCOS. Recent studies recommend supplementation with specific minerals for treating various PCOS phenotypes. We searched PubMed, Google Scholar, and SCOPUS databases by using search terms combining PCOS with the supplementation of magnesium, zinc, selenium, or chromium. This review presents a narrative concerning the association between PCOS and magnesium, zinc, selenium, and chromium supplementation. We review findings from various randomized controlled trials and meta-analyses conducted in women of childbearing age with PCOS. Recent reports highlight the beneficial effect of minerals on the clinical and metabolic symptoms of PCOS. Further studies are required to establish the appropriate dosage level of these minerals for ameliorating the pathologies associated with PCOS because of the potential health risks linked with higher doses.

Impact of Low Frequency Electro-acupuncture on Glucose and Lipid Metabolism in Unmarried PCOS Women: A Randomized Controlled Trial

OBJECTIVE

To explore the effect of electro-acupuncture (EA) on glucose and lipid metabolism in unmarried patients with polycystic ovary syndrome (PCOS).

METHODS

Fifty-four PCOS patients were equally randomized into true acupuncture group and sham acupuncture group (control) for totally 16 weeks of treatment by random method with a computerized randomization program. Patients in true acupuncture group accepted traditional acupuncture methods with EA and two sets of acupoint groups were used alternatively. The first set consisted of Zhongji (CV 3), Qihai (CV 6), Guilai (ST 29), Sanyinjiao (SP 6), Yinlingquan (SP 9), Hegu (LI4) and Baihui (GV 20), and the second set consisted of Tianshu (ST 25), ST 29, CV 3, CV 6, SP 6, Taichong (LR 3), Neiguan (PC) 6 and GV 20. Patients in the sham acupuncture group accepted shallow acupuncture methods through EA without electricity at 4 non-meridian points in each shoulder and upper arm. Outcome measures included body mass index (BMI), waist-hip-ratio (WHR), oral glucose tolerance test (OGTT), insulin release test, glucose and lipid metabolism indicators such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), adiponectin, leptin, visfatin, resistin, and interleukin (IL-6).

RESULTS

Twenty-six subjects in the true acupuncture group and 20 subjects in the sham group completed the clinical trial. After 16 weeks of treatment, no significant difference in the outcome measures were observed between the two groups (P>0.05). However, as compared with baseline data, a reduction in weight, BMI, hipline, WHR, fasting glucose, homeostatic model assessment of insulin sensitivity, visfatin and HDL-C, and an increase in resistin and IL-6 were observed in the true acupuncture group (P<0.05). In addition, a reduction in visfatin and an increase in TC were also observed in the sham group (P<0.05).

CONCLUSIONS

Acupuncture may have a beneficial effect in the treatment of PCOS by improving glucose and lipid metabolism. Moreover, the sham acupuncture may be not completely ineffective. Sham acupuncture may improve some of the aspects of the glucose and lipid metabolism of PCOS patients through a placebo effect. (Registration Nos. ChiCTR-TRC-12002529 and NCT01812161).

Food Chemistry of Selenium and Controversial Roles of Selenium in Affecting Blood Cholesterol Concentrations

Hypercholesterolemia, one of the major risk factors of cardiovascular diseases, is a worldwide public health problem. Nutraceuticals and phytochemicals are attracting attention as a result of their cholesterol-lowering ability and minimal side effects. Among them, selenium (Se) is on the list. The amount of Se in foods varies by region. Se-enriched fertilizers and feeds can raise the Se content in plants and animals, while some processing methods decrease food Se content. This review summarizes recent studies on (1) the content distribution of Se in foods and factors influencing Se-enriched foods, (2) the bioavailability and metabolism of Se, and (3) the role of Se in affecting blood cholesterol and cholesterol metabolism. Although the hypocholesterolemic effect of Se is equivocal, its cholesterol-lowering activity may be more remarkable when the Se supplementation is 200 μg/day or the baseline blood total cholesterol is above 200 mg/dL in humans with low Se status.

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.

Comparison of dietary micronutrient intake in PCOS patients with and without metabolic syndrome

BACKGROUND

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. It is one of the risk factors of metabolic syndrome (MetS). These two syndromes have an inflammatory etiologic foundation along with oxidative stress. The present study aimed to compare the dietary intake of antioxidant micronutrients in PCOS women with and without MetS.

MATERIALS AND METHODS

Overall, 42 participants eligible for this nested case control study were selected by the convenience sampling method. The case group included 14 PCOS patients with MetS and the control group included 28 PCOS patients without MetS. The dietary intake assessment of selenium, chromium, zinc, carotenoids, vitamin D and vitamin E was carried out by a 147-item Food Frequency Questionnaire (FFQ). PCOS and MetS were diagnosed using the Rotterdam criteria and NCEP ATP III, respectively. Statistical analysis was performed using SPSS16 software, T-test and Mann Whitney. Significant P-value was considered 0.05.

RESULTS

Dietary intake of antioxidant micronutrients (selenium, zinc, chromium, carotenoids and vitamin E) was significantly lower in the PCOS women with MetS than in the control group (P < 0.05).

CONCLUSION

Since the PCOS patients without MetS had more intake of the aforementioned micronutrients than those with MetS, it is assumed that the dietary intake of these nutrients could probably have a protective effect on MetS.

Effects of salubrinal on ER stress in an experimental model of polycystic ovary syndrome

This study aimed to investigate the role of endoplasmic reticulum (ER) stress in polycystic ovary syndrome (PCOS) and the effect of salubrinal (SAL) on this role. Animals were divided into four groups as control, PCOS, PCOS+SAL and SAL. Weights and serum testosterone levels were increased in the PCOS group while serum LH and ATF4 expressions were decreased. Morphometrically, number of follicles with a diameter between 150 and 300 µm were declined and number of follicles larger than 300 µm as well as the percentage of cystic follicles (CFs) were increased. Immunoreactivities of GRP78 and p-eIF2α were decreased, whereas oxidative stress (OS) dependent PAR expression was increased. Ultrastructurally, the PCOS group had no ER enlargement which was observed in the control group, while there were mitochondrial damage in granulosa cells (GCs). Elevated OS levels did not induce but rather decreased ER stress in GCs, and SAL injection in the PCOS model was ineffective on searched parameters. Since ER stress plays roles in certain physiological processes, we suggest that inhibitors of ER stress may not be always useful for reproductive tissues.

Effects of Selenium Supplementation on Asymmetric Dimethylarginine and Cardiometabolic Risk Factors in Patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is characterized by various reproductive and cardiometabolic disorders. Asymmetric dimethylarginine (ADMA) is associated with cardiovascular, metabolic, and hormonal status. Selenium, a micronutrient with antioxidant properties, could affect multiple physiological pathways. This study aimed to investigate the effect of selenium supplementation on ADMA, cardiometabolic risk factors, and hormonal status in women with PCOS. In this randomized, double-blind, placebo-controlled clinical trial, 66 women with PCOS, aged 18-45 years, were randomly assigned to receive either 200 μg/day selenium or placebo, for 12 weeks. Circulating concentrations of ADMA, testosterone, sex hormone-binding globulin (SHBG), lipid profiles, and glycemic parameters were assessed at baseline and following supplementation. ADMA concentration decreased significantly compared to baseline values (85.14 ± 75 to 56.4 ± 38.64 ng/l, p = 0.02) in the selenium group. This change was marginally significant compared with the placebo group (28.74 ± 68.63 vs. - 1.77 ± 52.88 ng/l, p = 0.056). Serum testosterone levels declined significantly in the intervention compared to the placebo group (0.01 ± 0.17 vs. - 0.08 ± 0.18 ng/ml, p = 0.038). Pre- to post-Apo-B100/Apo-A1 ratio declined considerably in the intervention group (0.72 ± 0.16 to 0.65 ± 0.16, p = 0.003). No further differences were observed in SHBG, lipid profiles, Apo-A1, Apo-B100, Apo-B100/Apo-A1 ratio, and glycemic control between the two groups at the end of the study. Selenium supplementation for 12 weeks had beneficial effects on reduction of circulating ADMA and total testosterone levels in women with PCOS. No significant improvements were seen in other cardiometabolic risk factors. The effects of selenium supplementation on hormonal, reproductive, and cardiometabolic disorders, considering the potential mediating role of ADMA, should be further investigated.

The Effects of Selenium Supplementation on Clinical Symptoms and Gene Expression Related to Inflammation and Vascular Endothelial Growth Factor in Infertile Women Candidate for In Vitro Fertilization

This study was performed to determine the effects of selenium supplementation on clinical symptoms and gene expression related to inflammatory markers in infertile women with polycystic ovary syndrome (PCOS) who were candidate for in vitro fertilization (IVF). Thirty-six women candidate for IVF were recruited in this randomized double-blinded, placebo-controlled trial. They (n = 18/group) were randomly assigned into intervention groups to take either 200 μg/day of selenium or placebo for 8 weeks. RT-PCR findings indicated that selenium supplementation downregulated gene expression of interleukin-1 (IL-1) (P < 0.004) and tumor necrosis factor alpha (TNF-α) (P = 0.02) in lymphocytes of patients with PCOS compared with the placebo. In addition, selenium supplementation upregulated gene expression of vascular endothelial growth factor (VEGF) (P = 0.001) in lymphocytes of patients with PCOS compared with the placebo. Selenium supplementation had no significant effect on clinical symptoms and gene expression of IL-8 (P = 0.10) and transforming growth factor beta (TGF-β) (P = 0.63). Overall, our findings documented that selenium supplementation for 8 weeks to infertile women candidate for IVF improved IL-1, TNF-α, and VEGF gene expression, though selenium had no effect on clinical symptoms and, IL-8 and TGF-β gene expression. Clinical trial registration number: http://www.irct.ir: IRCT20170513033941N23.

Effect of selenium supplementation on glycemic indices: a meta-analysis of randomized controlled trials

PURPOSE

The association between selenium supplementation and glycemic indices seems to be a controversial issue. This systematic review and meta-analysis was conducted to evaluate the effect of selenium supplementation on glycemic indices.

METHODS

We systematically searched PubMed/MEDLINE, ISI/WOS, and Scopus (from their commencements up to Jan 2016) for relevant studies examining the association between intake of selenium and glycemic indices. The data were extracted from relevant qualified studies and estimated using the random-effect or pooled model and standardized mean difference (SMD) with 95% confidence interval (CI).

RESULTS

Twelve articles published between 2004 and 2016 were included. In all the studies, the participants were randomly assigned to an intervention group (n = 757) or a control group(n = 684). All the studies were double blind, placebo controlled trials. Selenium supplementation resulted in a significant decrease in homeostasis model of assessment-estimated β-cell function (HOMA-B) (SMD: -0.63; 95%CI: -0.89 to -0.38) and a significant increase in quantitative insulin sensitivity check index (QUICKI) (SMD: by 0.74; 95%CI: 0.49 to 0.1) as compared with the controls. There were no statistically significant improvements in glycemic indices, such as fasting plasma glucose (FPG), insulin, homeostasis model of assessment-estimated insulin resistance (HOMA-IR), Hemoglobin A1c (HbA1c) and adiponectin.

CONCLUSION

This meta-analysis indicated that selenium supplementation significantly decreased HOMA-B and increased QUICKI score. There was no statistically significant improvement in FPG, insulin, HOMA-IR, HbA1c and adiponectin indices following selenium supplementation.

Efficacy of a Persian Herbal Remedy and Electroacupuncture on Metabolic Profiles and Anthropometric Parameters in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

Background:

The most prevalent endocrine disorder in women of reproductive age is polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate the efficaciousness of a Persian herbal remedy, as well as electroacupuncture and the combination of them on metabolic profiles and anthropometric parameters in these patients.

Materials and Methods:

Eighty overweight women with PCOS were randomly divided into four groups. All of them received metformin 1000 mg and the second group received 5 g of herbal medicine per day (main components: Foeniculum vulgare, Urtica dioica, and Daucus carota), the third group were subjected to 20 electroacupuncture sessions, and the fourth group received both therapies.

Results:

After 12 weeks, the body fat and body mass index decreased the most in the herbal medicine+electroacupuncture group, and waist to hip ratio decreased the most in the electroacupuncture group. A significant decrease was also observed in fasting insulin, homeostasis model assessment of insulin resistance. A significant increase was seen in the quantitative insulin sensitivity check index in all intervention groups, but there was no noteworthy difference in these parameters in the control group. Total cholesterol and low-density lipoprotein cholesterol decreased significantly in the electroacupuncture groups and herbal medicine+electroacupuncture. Also, a significant decrease was observed in triglycerides, aspartate aminotransferase, and alanine aminotransferase in the herbal medicine groups and herbal medicine+electroacupuncture.

Conclusion:

It is advisable to use this herbal remedy and electroacupuncture for better treatment of metabolic complications and overweight problems in these patients.

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.

The effects of probiotic and selenium co-supplementation on mental health parameters and metabolic profiles in type 2 diabetic patients with coronary heart disease: A randomized, double-blind, placebo-controlled trial

BACKGROUND AND AIMS

The objective of this investigation was to assess the effects of probiotic and selenium co-supplementation on indicators of mental health and metabolic profiles in diabetic people with coronary heart disease (CHD).

METHODS

This randomized, double-blind, placebo-controlled trial was conducted among 54 diabetic people with CHD. Patients were randomly allocated into two groups to receive either 200 μg/day selenium plus 8 × 10⁹ CFU/day probiotic (n = 27) or placebo (n = 27) for 12 weeks.

RESULTS

Probiotic and selenium co-supplementation significantly decreased Beck Depression Inventory index (β -1.46; 95% CI, -2.61, -0.31; P = 0.01) and Beck Anxiety Inventory index (β -1.23; 95% CI, -2.33, -0.12; P = 0.02) compared with the placebo. Consuming probiotic plus selenium lowered fasting plasma glucose (β -10.80 mg/dL; 95% CI, -17.68, -3.92; P = 0.003), serum insulin levels (β -3.42 μIU/mL; 95% CI, -4.93, -1.90; P < 0.001), insulin resistance (β -0.96; 95% CI, -1.45, -0.47; P < 0.001), and enhanced insulin sensitivity (β 0.01; 95% CI, 0.007, 0.01; P < 0.001) compared with the placebo. Additionally, co-supplementation reduced triglycerides (β -34.45 mg/dL; 95% CI, -56.18, -12.72; P = 0.003), VLDL- (β -6.89 mg/dL; 95% CI, -11.23, -2.54; P = 0.003), total cholesterol (β -18.13 mg/dL; 95% CI, -23.42, -2.83; P = 0.02) and high sensitivity C-reactive protein (β -1043.28 ng/mL; 95% CI, -1929.67, -156.89; P = 0.02), and increased nitric oxide (β 7.86 μmol/L; 95% CI, 5.63, 10.09; P < 0.001), total antioxidant capacity (β 119.30 mmol/L; 95% CI, 63.04, 175.57; P < 0.001) and total glutathione (β 154.16 μmol/L; 95% CI, 82.57, 225.74; P < 0.001) compared with the placebo.

CONCLUSIONS

Probiotic and selenium co-supplementation to diabetic people with CHD improved indicators of mental health and metabolic profiles. Registered under Clinical Trials.gov Identifier no. http://www.irct.ir: IRCT20170513033941N28.

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.

Protective effects of Chinese Fenggang zinc selenium tea on metabolic syndrome in high-sucrose-high-fat diet-induced obese rats

The protective effect of zinc selenium tea against metabolic syndrome (MetS) was tested by using a high-sucrose-high-fat diet (HSHFD)-induced MetS model. Fifty Sprague–Dawley rats were randomly divided into five groups: normal diet (C-group), HSHFD (CH-group), HSHFD + green tea (0.24 g/kg/day) (TH-group), HSHFD + low-dose zinc selenium organic tea (0.24 g/kg/day) (ZTHL-group), and HSHFD + high-dose zinc selenium organic tea (1.20 g/kg/day) (ZTHH-group). After 8 weeks, compared to both the C-group and CH-group, the hepatosomatic index (HI) was significantly reduced in the ZTHL-group (p < 0.05). Fasting blood glucose (FBG) levels were highest in the TH-group, followed by the CH-group, then the ZTHL-group, then the ZTHH-group, and finally the C-group. Compared with the CH-group, the serum total cholesterol (TC) and low density lipid-cholesterol (LDL-C) concentrations were significantly lower in the ZTHH-group (p < 0.05). Significant decreases in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bile acids (TBA), alkaline phosphatase (ALP), and direct bilirubin (DBIL) levels were observed in ZTHL-group versus the CH-group (p < 0.05). Serum alpha-L-fucosidase (AFU) levels in the ZTHH-group were lower than in the CH-group (P < 0.01). Histopathological examination of the liver and fat biopsies illustrates that the liver cells showed a decrease in the extent of necrosis and dropsy in the ZTHL-group and ZTHH-group versus the CH-group. Zinc selenium tea showed a protection effect against hepatic damage.

The effects of vitamin D and evening primrose oil co-supplementation on lipid profiles and biomarkers of oxidative stress in vitamin D-deficient women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial

PURPOSE OF THE STUDY

There was inconsistent evidence about the benefit of vitamin D plus evening primrose oil (EPO) supplement intake on lipid profiles and reduced oxidative stress among women with polycystic ovary syndrome (PCOS). The current study was performed to evaluate the effects of vitamin D plus EPO supplementation on lipid profiles and biomarkers of oxidative stress in vitamin D-deficient women with PCOS.

MATERIALS AND METHODS

This randomized, double-blind, placebo-controlled trial was performed among 60 vitamin D-deficient women with PCOS. Participants were randomly assigned into two groups to receive either 1000 IU vitamin D3 plus 1000 mg EPO (n = 30) or placebo (n = 30) for 12 weeks. Metabolic profiles were quantified at baseline and after the 12-week intervention.

RESULTS

Compared with the placebo group, women in vitamin D and EPO co-supplementation group had significant increases in serum 25-hydroxyvitamin D (25(OH)D) (+10.7 ± 8.4 vs. -0.5 ± 1.6 ng/mL, p < 0.001) and plasma total glutathione (GSH) (+62.7 ± 58.0 vs. -0.7 ± 122.7 µmol/L, p = 0.01), while there were significant decreases in triglycerides (-7.3 ± 23.8 vs. +6.9 ± 26.3 mg/dL, p = 0.03), very low-density lipoprotein (VLDL) cholesterol levels (-1.5 ± 4.7 vs. +1.4 ± 5.3 mg/dL, p = 0.03), total/high-density lipoprotein cholesterol ratio (-0.3 ± 0.4 vs. -0.02 ± 0.4, p = 0.02), and malondialdehyde (MDA) concentration (-0.4 ± 0.4 vs. +0.5 ± 1.8 µmol/L, p = 0.008).

CONCLUSION

Overall, vitamin D and EPO co-supplementation for 12 weeks among vitamin D-deficient women with PCOS significantly improved triglycerides, VLDL cholesterol, GSH, and MDA levels.

Selenium status parameters in patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. To date, no systematic study of interactions between selenium status parameters (SSPs: serum selenium concentration, plasma glutathione peroxidase, GPX3, plasma selenoprotein P, SELENOP), sex hormones, thyroid function parameters, and other laboratory parameters in patients with PCOS has been undertaken. Therefore we aimed to compare such parameters in women with PCOS and in the control groups, and to investigate the multidimensional interactions between various parameters in PCOS patients and in controls. The subjects were diagnosed either with PCOS (n=28, 25.4±5.2 y) or with PCOS+Hashimoto disease (n=13, 27.3±5.6 y). Female patients having normal menses were recruited into the first control group (n=70, 26.8±7.3 y) or to the second control group comprising women only with Hashimoto disease (n=10, 26.2±6.9 y). No apparent differences in SSPs between control subjects and patients with PCOS, also complicated with Hashimoto disease, were identified, though such differences were noticeable for total testosterone (tT), sex hormone binding globulin, free androgen index, dehydroepiandrosterone sulfate (DHEAS), and insulin profile. The correlation between tT and DHEAS was found the strongest. The other group of mutually highly and positively correlated parameters consisted of GPX3, follicle stimulating hormone, free triiodothyronine and free thyroxine. All the latter parameters correlated negatively with vitamin D3. SSPs took part in interactions with thyroid hormones, sex hormones and some other parameters, but only for GPX3 such interactions were statistically significant. The significance of these findings remains open for further investigation, particularly in patients with PCOS and/or Hashimoto disease.

The effect of selenium supplementation on coronary heart disease: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Selenium is a crucial mineral with antioxidant and immune functions, and selenium deficiency may increase the risk of coronary heart disease (CHD). However, the effect of selenium supplementation on CHD is still controversial according to numerous randomized controlled trials (RCTs). The aim of our meta-analysis study was to investigate the impact of selenium on CHD.

METHODS

PUBMED, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials databases were systematically searched to identify RCTs evaluating the effect of selenium supplementation on CHD mortality, blood lipid profile (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol), serum C-reactive protein (CRP), and the level of glutathione peroxidase (GSH-PX) from inception until September 20, 2016. Odds ratio of CHD mortality and the associated 95% confidence intervals (CIs) were calculated using the fixed effect model. Weighted mean difference or standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated to determine the lipid profile, serum CRP, and GSH-PX using fixed effect or random effect models depending on the observed heterogeneity.

RESULTS

A total of 16 eligible RCTs with 43998 participants were included. Significant effects were observed for serum CRP (SMD=-0.48; 95% CI, -0.96 to 0; p=0.049) and GSH-PX (SMD=0.5; 95% CI, 0.36-0.64; p<0.001) after selenium supplementation. However, selenium supplementation was not statistically associated with CHD mortality and an aberrant lipid profile.

CONCLUSION

Selenium supplementation decreased serum CRP and increased the GSH-PX level, suggesting a positive effect on reducing oxidative stress and inflammation in CHD. However, selenium supplementation is not sufficient to reduce mortality and to improve the lipid status.

Effect of Two Different Doses of Vitamin D Supplementation on Metabolic Profiles of Insulin-Resistant Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial

The current study was conducted to evaluate the effects of 2 different doses of vitamin D supplementation on metabolic profiles of insulin-resistant patients with polycystic ovary syndrome (PCOS). This randomized double-blind, placebo-controlled trial was performed on 90 insulin-resistant patients with PCOS according to the Rotterdam criteria aged 18-40 years old. Participants were randomly allocated into 3 groups to receive either 4 000 IU of vitamin D (n=30) or 1 000 IU of vitamin D (n=30) or placebo (n=30) per day for 12 weeks. Vitamin D supplementation (4 000 IU), compared with vitamin D (1 000 IU) and placebo, led to reduced fasting plasma glucose (-4.3±8.6 vs. -4.7±7.1 and +0.1±6.7 mg/dl, respectively, p=0.02), serum insulin concentrations (-2.7±2.7 vs. -1.4±4.2 and -0.1±4.1 μIU/ml, respectively, p=0.02), and HOMA-IR (-0.6±0.6 vs. -0.4±1.0 and -0.1±0.9, respectively, p=0.02). In addition, we found significant decreases in mean change of serum triglycerides (-10.3±7.3 vs. -3.6±14.5 and +6.9±23.8 mg/dl, respectively, p=0.001), VLDL- (-2.0±1.5 vs. -0.7±2.9 and +1.4±4.8 mg/dl, respectively, p=0.001), total- (-14.0±9.5 vs. -6.2±24.0 and +7.1±29.7 mg/dl, respectively, p=0.002), LDL- (-10.8±8.3 vs. -5.7±21.9 and +6.8±28.2 mg/dl, respectively, p=0.005), and total-/HDL-cholesterol ratio (-0.2±0.3 vs. -0.1±0.6 and +0.2±0.7 mg/dl, respectively, p=0.003) in the high-dose vitamin D group compared with low-dose vitamin D and placebo groups. Overall, vitamin D supplementation at a dosage of 4 000 IU/day for 12 weeks in insulin-resistant patients with PCOS had beneficial effects of glucose metabolism and lipid profiles compared with 1 000 IU/day of vitamin D and placebo groups.

Clinical and Metabolic Response to Selenium Supplementation in Pregnant Women at Risk for Intrauterine Growth Restriction: Randomized, Double-Blind, Placebo-Controlled Trial

Data on the effects of selenium supplementation on clinical signs and metabolic profiles in women at risk for intrauterine growth restriction (IUGR) are scarce. This study was designed to assess the effects of selenium supplementation on clinical signs and metabolic status in pregnant women at risk for IUGR. This randomized double-blind placebo-controlled clinical trial was performed among 60 women at risk for IUGR according to abnormal uterine artery Doppler waveform. Participants were randomly assigned to intake either 100 μg selenium supplements as tablet (n = 30) or placebo (n = 30) for 10 weeks between 17 and 27 weeks of gestation. After 10 weeks of selenium administration, a higher percentage of women in the selenium group had pulsatility index (PI) of <1.45) (P = 0.002) than of those in the placebo group. In addition, changes in plasma levels of total antioxidant capacity (TAC) (P < 0.001), glutathione (GSH) (P = 0.008), and high-sensitivity C-reactive protein (hs-CRP) (P = 0.004) in the selenium group were significant compared with the placebo group. Additionally, selenium supplementation significantly decreased serum insulin (P = 0.02), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (P = 0.02), and homeostatic model assessment for B-cell function (HOMA-B) (P = 0.02) and significantly increased quantitative insulin sensitivity check index (QUICKI) (P = 0.04) and HDL-C levels (P = 0.02) compared with the placebo. We did not find any significant effect of selenium administration on malondialdehyde (MDA), nitric oxide (NO), fasting plasma glucose (FPG), and other lipid profiles. Overall, selenium supplementation in pregnant women at risk for IUGR resulted in improved PI, TAC, GSH, hs-CRP, and markers of insulin metabolism and HDL-C levels, but it did not affect MDA, NO, FPG, and other lipid profiles.Clinical trial registration number http://www.irct.ir : IRCT201601045623N64.

The Effects of Vitamin D Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial

Data on the effects of vitamin D supplementation on metabolic status of patients with polycystic ovary syndrome (PCOS) are scarce. The current study was conducted to evaluate the effects of vitamin D supplementation on metabolic status of patients with PCOS. This randomized double-blind, placebo-controlled trial was performed on 70 vitamin D-deficient (serum concentrations<20 ng/ml) women with phenotype B-PCOS according to the Rotterdam criteria aged 18-40 years old. Participants were randomly allocated into 2 groups to take either 50 000 IU vitamin D (n=35) or placebo (n=35) every 2 weeks for 12 weeks. Metabolic, endocrine, inflammation, and oxidative stress biomarkers were quantified at the beginning of the study and after 12-week intervention. After the 12-week intervention, compared to the placebo, vitamin D supplementation significantly decreased fasting plasma glucose (FPG) (-3.1±7.3 vs. +0.5±6.3 mg/dl, p=0.02), insulin (-1.4±3.6 vs. +2.6±7.0 μIU/ml, p=0.004), homeostasis model of assessment-estimated insulin resistance (-0.3±0.8 vs. +0.6±1.6, p=0.003), homeostasis model of assessment-estimated B cell function (-4.9±13.4 vs. +9.9±26.9, p=0.005), and increased quantitative insulin sensitivity check index (+0.01±0.01 vs. -0.02±0.05, p=0.007). Supplementation with vitamin D also led to significant reductions in serum high-sensitivity C-reactive protein (hs-CRP) (-0.7±1.4 vs. +0.5±2.1 μg/mL, p=0.009) and plasma malondialdehyde (MDA) levels (-0.1±0.5 vs. +0.9±2.1 μmol/l, p=0.01) compared to the placebo. Overall, vitamin D supplementation for 12 weeks in vitamin D-deficient women with phenotype B-PCOS had beneficial effects on glucose homeostasis parameters, hs-CRP, and MDA.