ADIPONECTIN TO LEPTIN RATIO AS A MARKER OF INSULIN RESISTANCE IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) IN RELATION TO BMI
Keywords:
PCOS, ALR, Adiponectin, LepinAbstract
Polycystic ovarian syndrome is commonly known endocrine disorder in women of reproductive age, PCOS has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type2 diabetes mellitus, adverse cardiovascular risk profiles) and psychological features (increased anxiety, depression). Insulin resistance (IR) is a defining characteristic of polycystic ovary syndrome,both lean and obese patients with PCOS have been found to be at risk for insulin resistance and type 2 diabetes mellitus. Meanwhile, leptin and adiponectin exert powerful effects on blood glucose homeostasis.
This study was aimed to evaluate the adiponectin to leptin ratio (ALR) as a marker of insulin resistance in women with polycystic ovary syndrome (PCOS) by examination the correlation of ALR with the glycemic indices and other studied parameters in patients with PCOS in comparison to their control groups with respect to BMI.
Fasting blood specimens from forty two women with polycystic ovary syndrome (PCOS) (22 non-obese with BMI <30 and 20 obese with BMI?30)whom are attending Kamal Al-Samarraee for Infertility and in vitro Fertilization Hospital in Baghdad/Iraq, besides forty seven apparently healthy women (27 non-obese with BMI <30 and 20 obese with BMI?30).For assessment of serum levels of glucose ( FSG) , insulin (FSI), adiponectin and leptin by ELISA kits .
QUIKI and HOMA-IR were significantly different in PCOS groups as compared to their control, the mean serum adiponectin levels were significantly decreased in obese PCOS women (20.14 ± 2.61ng/ml ) as compared with the control (33.77 ± 4.98ng/ml), furthermore, it was significantly lowered in non-obese PCOS in comparison to the control (31.91 ± 4.86ng/ml ,42.96 ± 3.96ng/ml respectively). Whereas, serum leptin levels were not significantly changed in PCOS groups as compared with the control.
Thus, ALR ratio could be considered as a good marker for early detection of IR in obese apparently healthy subjects and in non-obese PCOS , and to be more indicative for insulin sensitivity than considering W/H ratio which is related to adiponectin & leptin secretion.
Downloads
References
Scalzo K., and McKittrick M. Case problem: dietary recommendations to combat obesity, insulin resistance, and other concerns related to polycystic ovary syndrome. Journal of the American Dietetic Association. 2000; 100(8): 955-957.
TeedeH., Deeks A. and Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impact on health across the lifespan. BMC Med.2010 ;8:41.
Stein I.F. and Leventhal M.L.(1935). Amenorrhea associated with bilateral polycystic ovaries. Am J ObstetGynecol. 1935; 29:181–191.
Diamanti-Kandarakis E, Baillargeon JP, Iuorno MJ, Jakubowicz DJ, and Nestler JE. A modern medical quandary: polycystic ovary syndrome, insulin resistance, and oral contraceptive pills.Journal of Endocrinology and Metabolism . 2003; 88(5): 1927.
Ovalle F and Aziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and Sterility. 2002; 77(6): 1095-1105.
Fulghesu A.M.,Angioni S., Portoghese E. et al. Failure of the homeostatic model assessment calculation score for detecting metabolic deterioration in young patients with polycystic ovary syndrome .Fertility and Sterility.2006;86 (2) :398–404.
Diamanti-Kandarakis E. andDunaif A.Insulin resistance and the polycystic ovary syndrome revisited an update on mechanisms and implications. PEndocrine Reviews.2012;33(6) :981–1030.
Shaw L. J.,Merz C. N. B.,Azziz R. et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health—National Heart, Lung, and Blood Institute sponsored women’s ischemia syndrome evaluation. Journal of Clinical Endocrinology and Metabolism.2008; 93(4):1276–1284.
Unluer A. N., Findik R. B.,Sevinc N., andKarakaya J.Comparison of HbA1c levels in obese and non-obese polycystic ovarian patients .Clinical and Experimental Obstetrics and Gynecology.2013; 40(1):148–150.
Moran M. Arriaga G. Rodriguez and Moran S.Obesity differentially affects phenotypes of polycystic ovary syndrome. .International Journal of Endocrinology.2012;2012 :7.
Stefan N, Vozarova B, Funahashi T, Matsuzawa Y, Weyer C, Lindsay RS, Youngren JF, Havel PJ, Pratley RE, Bogardus C, Tataranni PA. Plasma adiponectin concentration is associated with skeletal muscle insulin receptor tyrosine phosphorylation, and low plasma concentration and low plasma concentration precedes a decrease in whole body insulin sensitivity in humans. Diabetes. 2002; 51: 1884–1888.
Mirza et al. Association between circulating adiponectin levels and polycystic ovarian syndrome. Journal of Ovarian Research.2014; 7:18.
Schwartz MW, Seeley RJ, Tschop MH, Woods SC, Morton GJ, Myers MG, et al. Cooperation between brain and islet in glucose homeostasis and diabetes. Nature 2013; 503(7474): 59–66.
Caro JF, Sinha MK, Kolaczynski JW, Zhang PL, Considine RV. Leptin: the tale of an obesity gene. Diabetes. 1996;45:1455–62.
Carmina E, Bucchieri S, Mansueto P,Rini G, Ferin M & Lobo RA Circulating levels of adipose products and differences in fat distribution in the ovulatory and anovulatory phenotypes of polycystic ovary syndrome. Fertility and Sterility .2009; 91: 1332–1335.
Yildizhan R, Ilhan GA, Yildizhan B, Kolusari A, Adali E &Bugdayci G. Serum retinol-binding protein 4, leptin, and plasma asymmetric dimethylarginine levels in obese and nonobese young women with polycystic ovary syndrome. Fertility and Sterility. 2011; 96: 246–250.
Weyer C., Funahashi T., TanakaS., et al .Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J ClinEndocrinolMetab. 2001; 86: 1930–1935.
Poretsky L, Cataldo NA,Rosenwaks Z &GiudiceLC . The insulin-related ovarian regulatory system in health and disease. Endocrine Reviews. 1999;20: 535-582.
Monti V, Carlson JJ, Hunt SC, Adams TD.Relationship of ghrelin and leptin hormones with body mass index and waist circumference in a random sample of adults.J Am Diet Assoc. 2006;106(6):822-8.
Yen SSC and Jaffe RB (eds.), Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management, 3rd ed. Copyright Elsevier/Saunders; 1991, pp: 936–981.
Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. FertilSteril; 81: 19-25.
Trinder P. Determination of blood glucose using 4-amino phenazone as oxygen acceptor. J ClinPathol. 1969; 22: 246.
Starr J. I, MakoM. E., JuhnD. and RubensteinA. H. (1978). Measurement of serum material: cross-reactivity of porcine and human pro insulin in the insulin radioimmunoassay.J. Lab. Clin. Med. 1978; 91(4) 691-692.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985 ;28(7):412-9.
Yokohama H, Emoto M and Fujiwara S, et al :Quantitative insulin sensitivity check index and the reciprocal index of homeostasis model assessment are useful indices of insulin resistance in type 2 diabetic patients with wide range of fasting plasma glucose.J ClinEndocrinolMetab. 2004 ;89:1481-1484.
Pajvani U.B., et al. Structure-function studies of the adipocyte-secreted hormone Acrp30/adiponectin. Implications fpr metabolic regulation and bioactivity. J Biol Chem. 2003;278(11):9073-85.
Sinha MK, Opentanova I, Ohannesian JP, et al. Evidence of free and bound leptin in human circulation. J Clin Invest.1996;98:1277-1282.
Carmina E, Lobo RA. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. FertilSteril. 2004; 82: 661-665.
Gavrila A, Peng CK, Chan JL, Mietus JE, Goldberger AL &Mantzoros CS Diurnal and ultradian dynamics of serum adiponectin in healthy men: comparison with leptin, circulating soluble leptin receptor, and cortisol patterns. Journal of Clinical Endocrinology and Metabolism. 2003; 88: 2838–2843.
Escobar-Morreale HF. Adiponectin and resistin in PCOS: a clinical, biochemical and molecular genetic study. Human Reproduction.2006; 21: 2257–2265.
Pietilainen KH, Kannisto K, Korsheninnikova E, Rissanen A, Kaprio J, Ehrenborg E, Hamsten A &Yki-Jarvinen H.Acquired obesity increases CD68 and tumor necrosis factor-α and decreases adiponectin gene expression in adipose tissue: a study in monozygotic twins. Journal of Clinical Endocrinology and Metabolism. 2006; 91: 2776–2781.
Ryo M., et al. Adiponectin as a biomarker of the metabolic syndrome. Circ. J.2004; 68:975–981.
Yamamoto Y., Hirose H., Saito I., Nishikai K., and Saruta T. 2004. Adiponectin, an adipocyte derived protein, predicts future insulin-resistance: two-year follow-up study in Japanese population. J. Clin. Endocrinol. Metab.2004; 89:87–90.
Trevaskis JL, Gawronska-Kozak B, Sutton GM, et al. 2007 Role of adiponectin and inflammation in insulin resistance of Mc3r and Mc4r knockout mice. Obesity (Silver Spring).2007; 15: 2664-2672.
Blumer RM, van der Crabben SN, Stegenga ME, et al. Hyperglycemia prevents the suppressive effect of hyperinsulinemia on plasma adiponectin levels in healthy humans. Am J PhysiolEndocrinolMetab.2008;295: E613-617.
Yildizhan R, Ilhan GA, Yildizhan B, Kolusari A, Adali E &Bugdayci G. Serum retinol-binding protein 4, leptin, and plasma asymmetric dimethylarginine levels in obese and nonobese young women with polycystic ovary syndrome. Fertility and Sterility. 2011; 96 :246–250.
Published
How to Cite
Issue
Section
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
.