THE ROLE OF ENERGY BALANCE IN THE DEVELOPMENT OF POLYCYSTIC OVARY SYNDROME
Keywords:polycystic ovary syndrome, energy balance, calorimetry
Objective. The aim of our study was to evaluate energy parameters in adolescents by the method of indirect calorimetry and to determine their association with PCOS.
Methods. 50 adolescents (age - 13-19 years) with different body mass with PCOS were studied in a cross-sectional study. 50 adolescents with the same body mass and age without PCOS made up the control group. Participants of both groups were interviewed using a specially designed questionnaire to obtain data on food intake, eating habits, sleep and physical activity. Energy indicators were determined by the method of indirect calorimetry with REEVUE Metacheck (KORRTM, USA) device. Resting Metabolic Rate (RMR) was determined by the ratio of oxygen percentage values in inhaled and exhaled air fractions during 10 minutes. Anthropometric parameters were assessed by calculating body mass index taking into account age and gender (percentile tables, WHO, 2002).
Results. The RMR in the main study group (1758.5±363.7 kcal), as well as in the study subgroups of low body (1603.6±274.0 kcal), normal (1724.2±356.9 kcal) and overweight patients (2088.0±327.2 kcal) was significantly increased compared to the control subgroups. If we compare the RMR rates between the subgroups, it is clear that in the study subgroup of excess body mass and PCOS was significantly increased compared to the study patients with normal and low mass and PCOS (p<0.001), while the rate of the study subgroup of normal mass was not significantly different from the rate of patients with low mass and PCOS (p=0.254). In the study group, a total of 9 (18%) patients had a decreased indicator compared to the indicator calculated by mathematical formulas, which was considered an energy deficient condition. In the subgroups divided by body mass, this condition was distributed as follows: low mass - 6 (33.3%), normal mass - 3 (15.0%). Such a situation was not observed in people with excess body weight.
According to the data obtained from the survey, in terms of behavioral disorders and unbalanced diet, compared to the control group, the study group had a significantly higher chance of: protein-lack and carbohydrate-rich food, breakfast skipping, intermittent sleep, sleep duration (<8 hours) and a sedentary lifestyle.
Conclusion. Based on the results of the research, it can be concluded that energy imbalance is most likely one of the important pathogenic factors in the development of excess body mass and PCOS. In order to turn this assumption into evidence, large-scale randomized clinical trials are needed.
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The Prevalence and Features of the Polycystic Ovary Syndrome in an Unselected Population. J Clin Endocrinol Metab 2004, 89(6):2745–2749.
Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the Polycystic Ovary Syndrome in Unselected Black and White Women of the Southeastern United States: A Prospective Study. J Clin Endocrinol Metab 1998, 83(9):3078–3082.
Asunción M, Calvo RM, San Millán JL, Sancho J, Avila S, Escobar-Morreale HF. A Prospective Study of the Prevalence of the Polycystic Ovary Syndrome in Unselected Caucasian Women from Spain. J Clin Endocrinol Metab 2000, 85(7):2434–2438.
Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG et al. A Survey of the Polycystic Ovary Syndrome in the Greek Island of Lesbos: Hormonal and Metabolic Profile. J Clin Endocrinol Metab 1999, 84(7):4006–4011.
AgaIbáñez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E et al. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr 2017, 88(6):371-395.
Wolf WM, Wattick RA, Kinkade ON, Olfert MD. Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity. Int J Environ Res Public Health. 2018, 15(11):2589.
Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, Ben-Ami Shor D, Tzur D, Afek A, Shamiss A, Haklai Z, Kark JD. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. N Engl J Med 2016, 374(25):2430-40.
Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2014, 20(5):748-58.
Ding DC, Chen W, Wang JH, Lin SZ. Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer: A population-based cohort study in Taiwan. Medicine (Baltimore) 2018, 97(39):e12608.
Li L, Feng Q, Ye M, He Y, Yao A, Shi K. Metabolic effect of obesity on polycystic ovary syndrome in adolescents: a meta-analysis. J Obstet Gynaecol 2017 37(8):1036-1047.
Ovesen P, Moller J, Ingerslev HJ, Jørgensen JO, Mengel A, Schmitz O et al. Normal basal and insulin-stimulated fuel metabolism in lean women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1993, 77(6):1636-40.
Engmann L, Jin S, Sun F, Legro RS, Polotsky AJ, Hansen KR et al. Reproductive Medicine Network. Racial and ethnic differences in the polycystic ovary syndrome metabolic phenotype. Am J Obstet Gynecol 2017, 216(5):493.e1-493.e13.
Apter D, Bützow T, Laughlin GA, Yen SS. Metabolic features of polycystic ovary syndrome are found in adolescent girls with hyperandrogenism. J Clin Endocrinol Metab 1995, 80(10):2966-73.
Xu T, Zhu G, Han S. Prevalence of Suboptimal Health Status and the Relationships between Suboptimal Health Status and Lifestyle Factors among Chinese Adults Using a Multi-Level Generalized Estimating Equation Model. Int J Environ Res Public Health 2020;17(3):763.
Wu S, Xuan Z, Li F, Xiao W, Fu X, Jiang P, Chen J, Xiang L, Liu Y, Nie X, Luo R, Sun X, Kwan H, Zhao X. Work-Recreation Balance, Health-Promoting Lifestyles and Suboptimal Health Status in Southern China: A Cross-Sectional Study. Int J Environ Res Public Health. 2016 Mar 19;13(3):339. doi: 10.3390/ijerph13030339. PMID: 27007383; PMCID: PMC4809002.
Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev. 2013;14(2):95–109.
Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2010;16(4):347–363.
Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223–1236.
Dunaif A, Scott D, Finegood D, Quintana B, Whitcomb R. The insulin-sensitizing agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab. 1996;81(9):3299–3306.
Hall KD, Heymsfield SB, Kemnitz JW, Klein S, Schoeller DA, Speakman JR. Energy balance and its components: implications for body weight regulation. Am J Clin Nutr. 2012;95(4):989–994
Heymsfield SB, Darby PC, Muhlheim LS, Gallagher D, Wolper C, Allison DB. The calorie: myth, measurement, and reality. Am J Clin Nutr. 1995;62(5 Suppl):1034S–1041S.
Rosenbaum M, Ravussin E, Matthews DE, Gilker C, Ferraro R, Heymsfield SB, Hirsch J, Leibel RL. A comparative study of different means of assessing long-term energy expenditure in humans. Am J Physiol. 1996;270(3 Pt 2):R496–R504.
Schoeller DA. Measurement of energy expenditure in free-living humans by using doubly labeled water. J Nutr. 1988;118(11):1278–1289.
Robinson S, Chan SP, Spacey S, Anyaoku V, Johnston DG, Franks S. Postprandial thermogenesis is reduced in polycystic ovary syndrome and is associated with increased insulin resistance. Clin Endocrinol (Oxf). 1992;36:537-543.
Romualdi D, Versace V, Tagliaferri V, et al. The resting metabolic rate in women with polycystic ovary syndrome and its relation to the hormonal milieu, insulin metabolism, and body fat distribution: a cohort study. J Endocrinol Invest. 2019;42:1089-1097.
Sellix MT, Menaker M. Circadian clocks in mammalian reproductive physiology: effects of the "other" biological clock on fertility. Discov Med 2011; 11(59):273-81.
Pendergast FJ, Livingstone KM, Worsley A, McNaughton SA. Correlates of meal skipping in young adults: a systematic review. Int J Behav Nutr Phys Act 2016; 13(1):125-39.
Bowen J, Brindal E, James-Martin G, Noakes M. Randomized Trial of a High Protein, Partial Meal Replacement Program with or without Alternate Day Fasting: Similar Effects on Weight Loss, Retention Status, Nutritional, Metabolic, and Behavioral Outcomes. Nutrients 2018; 10(9):1145-60.