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Ganie MA, Rashid A, Baba MS, Zargar MA, Wani IA, Nisar S, Wani IA, Douhath S, Sriwastawa M, Geer MI, Asrar MM, Kutum R, Hassan S, Khan S, Rafi W, Bhat DA, Showkat W, Sahar T, Choh NA, Khurshid R, Mudassar S, Shah ZA, Shabir I, Sofi SA, Gupta N, Hafeez I, Sreenivas V. Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set. Clin Endocrinol (Oxf) 2023; 99:566-578. [PMID: 37656656 DOI: 10.1111/cen.14964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. DESIGN Prospective observational study. PATIENTS AND MEASUREMENTS In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. CONCLUSION The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Aafia Rashid
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mohammad Salem Baba
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mohd Afzal Zargar
- Department of Life Sciences, Central University of Kashmir, Ganderbal, India
| | - Imtiyaz Ahmad Wani
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Sobia Nisar
- Department of Medicine, Government Medical College, Srinagar, India
| | - Ishfaq Ahmad Wani
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Syed Douhath
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mukesh Sriwastawa
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, USA
| | - Mohd Ishaq Geer
- Department of Pharmacology, University of Kashmir, Srinagar, India
| | - Mir Mohd Asrar
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rintu Kutum
- Department of Computer Science, Ashoka University, Sonepath, India
- Department of Computer Science, Trivedi School of Biosciences, Ashoka University, Sonepath, India
| | - Saqib Hassan
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology (Deemed University), Chennai, India
| | - Shahid Khan
- Department of Lab Medicine, AIIMS New Delhi, New Delhi, India
| | - Wajid Rafi
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Dil Afroz Bhat
- Department of Clinical Biochemistry, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Wasia Showkat
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Tajali Sahar
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Naseer Ahmad Choh
- Department of Radiodiagnosis and Imaging, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rabia Khurshid
- Department of Obstetrics and Gynecology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Syed Mudassar
- Department of Clinical Biochemistry, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Zafar Amin Shah
- Department of Immunology and Molecular Medicine, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Iram Shabir
- Department of Biochemistry, Iowa State University, Ames, Iowa, USA
| | - Sanjeed Ahmad Sofi
- Department of Radiodiagnosis and Imaging, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Nandita Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Imran Hafeez
- Department of Cardiology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Vishnubatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Rozati R, Wani IA, Shukla A, Arora T, Rashid H. Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study. JMIR Public Health Surveill 2023; 9:e43199. [PMID: 37672315 PMCID: PMC10512112 DOI: 10.2196/43199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. OBJECTIVE This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. METHODS We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research-PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. RESULTS Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. CONCLUSIONS Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23437.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Meghalaya, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Chatisgarh, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Roya Rozati
- Department of Obstetrics & Gynaecology, Maternal Health & Research Trust, Hyderabad, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Nair A, Rozati R, Shukla A, Rashid R, Shah IA, Rashid H, Wani IA, Arora T, Kulkarni B. Normative range of various serum hormonal parameters among Indian women of reproductive age: ICMR-PCOS task force study outcome. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 15:100226. [PMID: 37614351 PMCID: PMC10442974 DOI: 10.1016/j.lansea.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 08/25/2023]
Abstract
Background The hormonal profile varies considerably with age, gender, ethnicity, diet or physiological state of an individual. Limited population-specific studies have studied the variations in hormonal parameters among apparently healthy women. We aimed to analyse the biological reference interval for various hormonal parameters in the reproductive-aged healthy Indian women. Methods Out of 3877 participants that were clinically evaluated, 1441 subjects were subjected to laboratory investigations. All participants underwent a detailed clinical, biochemical and hormonal profiling. The hormone analysis was carried out at a single centre using a uniform methodology. Among the participants evaluated for biochemical and hormonal parameters, subjects that presented any abnormal profile or had incomplete investigations (n = 593) were excluded for further analysis. Findings The mean age (±SD) of the subjects retained in the final analysis (n = 848) was 29.9 (±6.3) years. In the present study, the biological reference interval (2.5th-97.5th centile) observed were: serum T4: μg/dL (5.23-12.31), TSH: μg/mL (0.52-4.16) and serum prolactin: ng/mL (5.13-37.35), LH: mIU/mL (2.75-20.68), FSH: mIU/mL 2.59-15.12), serum total testosterone: ng/mL (0.06-0.68), fasting insulin: mIU/mL (1.92-39.72), morning cortisol: μg/dL (4.71-19.64), DHEAS:μg/dL (50.61-342.6) and SHBG: nmol/L (21.37-117.54). Unlike T4, TSH, LH, and E2, the biological reference interval for prolactin, FSH, testosterone, C-peptide insulin and DHEAS varied when the subjects were stratified by age (p < 0.05). The comparative analysis showed marginal differences in the normative ranges for the hormones analysed among different populations. Interpretation Our first large composite data on hormonal measures will benefit future endeavours to define biological reference intervals in reproductive-aged Indian women. Funding The study was financially supported by the grant-in-aid from ICMR vide file No:5/7/13337/2015-RBMH.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
- Multidisciplinary Research Unit, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology Metabolism, Institute of Postgraduate Medical Education Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Abilash Nair
- Department of Endocrinology, Government Medical College, Thiruvananthapuram, India
| | - Roya Rozati
- Department of Obstetrics and Gynaecology, Maternal Health, Research Trust, Hyderabad, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Rabiya Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Idrees A. Shah
- Multidisciplinary Research Unit, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
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Hasan G, Shaikh S, Joshi B, Ganie MA, Shukla A, Vadhan H, Parab R, Sanap P, Mashal I. Addressing Challenges During Community based Screening of Women for Polycystic Ovary Syndrome (PCOS): A Research Experience from Maharashtra, India before and During COVID Pandemic. Indian J Community Med 2023; 48:167-171. [PMID: 37082412 PMCID: PMC10112744 DOI: 10.4103/ijcm.ijcm_181_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction A multicentric community-based screening to determine prevalence of Polycystic Ovary Syndrome was undertaken in India. This article aims to describe the challenges faced at one site and strategies adopted to mitigate them. Material and Methods Eligible women were enrolled at household-level and investigated for Polycystic Ovary Syndrome diagnosis as per Rotterdam criteria. Challenges faced were documented and alternate strategies were adopted. Results Challenges ranged from identifying women as per the polling booth list, enrolling them, and getting them investigated. COVID-19 pandemic added to the challenges. Involving health system workforce, gaining community support, flexible timings, and alternate strategies for investigation including COVID-19 appropriate safety measures helped mitigate some of the challenges. Conclusion Unforeseen challenges may crop up in community-based studies, like the ones faced during the COVID-19 pandemic. Planning, strategizing, using technology to keep communications on, and finding out of the box and amicable solutions for bottlenecks may help mitigate challenges.
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Affiliation(s)
- Gazala Hasan
- Senior Research Fellow, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Sharmeen Shaikh
- Junior Medical Officer, ICMR, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Beena Joshi
- Scientist F, Department of Operational Research, ICMR - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Mohd A. Ganie
- Department of Endocrinology and Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Amlin Shukla
- Scientist D, Division of Reproductive Biology, Maternal & Child Health, Indian Council of Medical Research, New Delhi, India
| | - Himali Vadhan
- Field Officer, ICMR, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Rita Parab
- Data Entry Operator, ICMR, PCOS Taskforce Study, Mumbai, Maharashtra, India
| | - Pravin Sanap
- Technician A, Department of Operational Research, ICMR - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Iranna Mashal
- Technician 2, Department of Operational Research, ICMR - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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Alexandre-Santos B, Martins FFTR, da Silva Gonçalves L, de Oliveira Guimarães C, Carla-Ruggiero F, Magliano DC. Potential role of endoplasmic reticulum stress in the pathophysiology of polycystic ovary syndrome. Horm Mol Biol Clin Investig 2022; 44:105-112. [PMID: 36018673 DOI: 10.1515/hmbci-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/07/2022] [Indexed: 11/15/2022]
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects million women worldwide, presenting a complex pathophysiology that has not been fully elucidated yet. Recently, it has been suggested that PCOS triggers the endoplasmic reticulum (ER) stress, thus being associated with unfolded protein response (UPR) activation. Indeed, the UPR response has been associated with several pathological conditions, including in the reproductive system. Several studies demonstrated that ovarian UPR markers are upregulated in PCOS, being associated with worst ovarian outcomes, and this was ameliorated by ER stress inhibition. In this review, we aim to summarize the main findings from previous studies covering this topic, in an attempt to clarify the potential role of ER stress and the UPR response in the pathophysiology of PCOS.
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Affiliation(s)
- Beatriz Alexandre-Santos
- Histology and Embryology League, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil.,Research Center on Morphology and Metabolism, Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | | | - Larissa da Silva Gonçalves
- Histology and Embryology League, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | | | - Fernanda Carla-Ruggiero
- Histology and Embryology League, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | - D'Angelo Carlo Magliano
- Histology and Embryology League, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil.,Research Center on Morphology and Metabolism, Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
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