Total L-carnitine and insulin resistance in non-obese and obese Iraqi women with polycystic ovary syndrome

Maad M. Shallal; Najmah M. Mahmood; Zina A.  Hussein

doi:10.32007/jfacmedbagdad.6512040

Authors

Maad M. Shallal Department of Obstetrics and Gynecology, College of Medicine, University of Baghdad, Baghdad. Iraq
Najmah M. Mahmood Department of Obstetrics and Gynecology, College of Medicine, University of Baghdad, Baghdad. Iraq https://orcid.org/0000-0002-6923-4222
Zina A. Hussein Department of Obstetrics and Gynecology, College of Medicine, University of Mustansyria, Baghdad. Iraq

DOI:

https://doi.org/10.32007/jfacmedbagdad.6512040

Keywords:

L-Carnitine, Insulin resistance, PCOS, : L-Carnitine, Insulin resistance, Obesity, Women, PCOS.

Abstract

Background: Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine illnesses affecting reproductive - age women. L-carnitine has important roles in oxidative stress, energy production and glucose metabolism. It affects insulin resistance as decreased plasma carnitine level has been well reported in type II diabetes mellitus. Hence, it means L-carnitine may reduce insulin resistance which is found in PCO disease.

Objective: This study aims to measure the level of L-carnitine and insulin resistance in both obese and non- obese patients with PCOS.

Patients and Methods: Sixty women within the reproductive age with PCOS (30 obese and 30 non- obese) were recruited from the Gynecology and Obstetrics Outpatient Clinic in Baghdad Teaching Hospital from June 2016 to June 2017. The data collected for each case included: Height, weight, waist circumference, blood pressure, obstetrical, medical, and medication history as well as ultrasound results. A physical examination was done to evaluate the clinical signs of hyperandrogenism. Biochemical measurements included fasting blood sugar, leutinizing hormone, follicular stimulating hormone, Testosterone and lipid profile were measured together with total L-carnitine (using L-Carnitine Assay Kit Sigma-Aldrich Co.). Insulin resistance was diagnosed according to National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III). PCOS is diagnosed according to the Rotterdam criteria.

Results: This study revealed that insulin resistance (IR) was present in 51.7% of PCOS patients, which was higher in obese PCOS patients (73.3%) than in the non-obese (30%). Age of patients, serum cholesterol, LH, and FSH were not related to IR. High mean BMI, waist circumference, FBS and triglyceride were significantly associated with IR (p < 0.05), while low serum HDL and L-Carnitine were associated with IR (p < 0.05). The mean serum total L-carnitine in this study was 34.03μmol/L. Obese women had lower carnitine levels than non-obese women and low serum L-Carnitine was associated with IR. Serum triglyceride, FBS and testosterone were correlated negatively with serum L-carnitine (p < 0.05) and serum HDL correlated positively with serum L-carnitine (p value = 0.001).

Conclusions: The mean value of serum total L-carnitine among the non-obese PCOS women was higher than among the obese ones. Low serum L-carnitine is associated with insulin resistance

Downloads

Download data is not yet available.

References

Baer TE, Milliren CE, Walls C, DiVasta AD. Clinical Variability in Cardiovascular Disease Risk Factor Screening and Management in Adolescent and Young Adult Women with Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol. October 2015, Volume 28, Issue 5, Pages 317-323.

Lebbe M, Woodruff TK. Involvement of androgens in ovarian health and disease. Mol Hum Reprod. 2013 Dec; 19(12):828-37.

Gottschau M, Kjaer SK, Jensen A, Munk C, Mellemkjaer L. Risk of cancer among women with polycystic ovary syndrome: A Danish cohort study. Gynecol Oncol. 2014 Nov 20; 14: 1475-9.

Li L, Baek KH. Molecular genetics of polycystic ovary syndrome: an update. Curr Mol Med. 2015; 15(4):331-42.

Ha L, Shi Y, Zhao J, Li T, Chen ZJ. Association Study between Polycystic Ovarian Syndrome and the Susceptibility Genes Polymorphisms in Hui Chinese Women. PLoS One. 2015; 10(5):e0126505.

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Society. Fertil Steril 2004, 81:19-25.

March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies M J. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010 Feb; 25(2):544-51.

Moledina DG, Wilson FP. Pharmacologic Treatment of Common Symptoms in Dialysis Patients: A Narrative Review. Semin Dial. 2015 Apr 25:212-216.

Rebouche CJ: Kinetics, pharmacokinetics, and regulation of L-carnitine and acetyl-L-carnitine metabolism. Ann N Y Acad Sci 2004, Vol 1033, Issue 1, page 30-41.

Mescka CP, Guerreiro G, Hammerschmidt T, Faverzani J, de Moura Coelho D, Mandredini V, et al. L-Carnitine supplementation decreases DNA damage in treated MSUD patients. Mutat Res. May 2015, Volume 775, Pages 43-47

Judith L Flanagan, Peter A Simmons, Joseph Vehige, Mark DP Willcox and Qian Garrett. Role of carnitine in disease. Nutrition and Metabolism 2010, 7: 30- 54.

Tong PC, Kong AP, So WY, Yang X, Ho CS, MA RC, et al . The Usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III Definitions of the Metabolic Syndrome in Predicting Coronary Heart Disease in Subjects with Type 2 Diabetes, Diabetes Care, 2007;30(5):1206–1211

Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, et al. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013 Sep; 28(9):2562-9.

Li X, Lin JF. Clinical features, hormonal profile, and metabolic abnormalities of obese women with obese polycystic ovary syndrome. Zhonghua Yi Xue Za Zhi. 2005 Dec 7; 85 (46):3266-71.

Lankarani M, Valizadeh N, Heshmat R, Peimani M, and Sohrabvand F. Evaluation of insulin resistance and metabolic syndrome in patients with polycystic ovary syndrome. Gyne cological Endocr inology , August 2009; 25(8): 504–507

Popovska-Dimova Z, Krstevska B. The frequency of insulin resistance calculated upon the basis of a fasting glucose to insulin ratio and characteristics of insulin resistant women with polycystic ovary syndrome. Prilozi. 2006 Jul;27(1):87-95.

Vrbikova J, Dvorakova K, Grimmichova T, Hill M, Stanicka S, Cibula D, et al. Prevalence of insulin resistance and prediction of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovary syndrome. Clin Chem Lab Med. 2007; 45(5):639-44.

Celik C, Tasdemir N, Abali R, Bastu E, Yilmaz M. Progression to impaired glucose tolerance or type 2 diabetes mellitus in polycystic ovary syndrome: a controlled follow-up study. Fertil Steril. 2014 Apr; 101(4):1123-8.e1

Suresh S, Vijayakumar T. Correlations of Insulin Resistance and Serum Testosterone Levels with LH:FSH Ratio and Oxidative Stress in Women with Functional Ovarian Hyperandrogenism. Indian J Clin Biochem 2015 Jul; 30(3): 345-50.

Essah PA, Nestler JE. The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest. 2006 Mar; 29(3):270-80.

Fenkci SM, Fenkci V, Oztekin O, Rota S and Karagenc N. Serum total Lcarnitine levels in non-obese women with polycystic ovary syndrome. Human Reproduction 2008; 23(7): 1602 – 1606.

Vigerust NF, Bohov P, Bjørndal B, Seifert R, Nygård O, Svardal A, et al. Free carnitine and acylcarnitines in obese patients with polycystic ovary syndrome and effects of pioglitazone treatment. Fertil Steril. 2012 Dec; 98(6):1620-6.

Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. Int J Obes. 2002, 26(7): 883–896

Barrios MR, Arata-Bellabarba G, Valeri l, Velázquez-Maldonado E. Relationship between the triglyceride/high-density lipoprotein-cholesterol ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome. Endocrinol Nutr. 2009;56(2):59-65

Lee H, Oh JY, Sung YA, Chung H, Cho WY. The prevalence and risk factors for glucose intolerance in young Korean women with polycystic ovary syndrome. Endocrine 2009; 36:326–32

Peppard HR, Marfori J, Iuorno MJ, Nestler JE. Prevalence of polycystic ovary syndrome among premenopausal women with type 2 diabetes. Diabetes Care. 2001; 24:1050-2.

Graff SK, Mário FM, Alves BC, Spritzer PM. Dietary glycemic index is associated with less favorable anthropometric and metabolic profile in PCOS women with different phenotypes. Fertil Steril. 2013; 100(4):1081-8.

Flores-Martínez SE, Castro-Martínez AG, López-Quintero A, García-Zapién AG, Torres-Rodríguez RN, Sánchez-Corona J. [Association analysis of SNP-63 and indel-19 variant in the calpain-10 gene with polycystic ovary syndrome in women of reproductive age]. Cir Cir. 2015 Jan-Feb;83(1):35-42.

Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril. 2011; 95:1073-9.

Zheng Y, Stener-Victorin E, Ng EHY, Li J, Wu X, and Ma H. How does acupuncture affect insulin sensitivity in women with polycystic ovary syndrome and insulin resistance? Study protocol of a prospective pilot study. BMJ Open. 2015; 5(4): e007757.