Effects of nutritional intervention with or without metformin on insulin resistance in adolescents with polycystic ovary syndrome: A preliminary study

Main Article Content

Karolina Łagowska
Karina Kapczuk

Keywords

polycystic ovary syndrome, adolescents, obesity, nutrition,

Abstract

The aim of the study is show whether, and to what extent, nutritional interventions (NI )with or without metformin   that effectively result in weight reduction in obese adolescents with Polycystic Ovary Syndrome (PCOS) can help to alleviate insulin resistance. 35 obese adolescents with PCOS and insulin resistance were recruited to the study and they were randomly assigned to one of two subgroups: sixteen to a group given a nutritional intervention and metformin treatment (NM) and nineteen to a group given only nutritional intervention (N). Body weight, body composition, energy and nutrients intake as well insulin and glucose levels were measured at the beginning of the study and after 8 weeks of the NI. In both groups after 8 weeks of  NI the reduction in body weight and fat mass were observed. Fasting insulin concentrations measured after 8 weeks of NI were found to be significantly lower in the MN group. In group N, the 8 weeks of intervention proved insufficient for the changes in fasting insulin concentrations. Longer term studies are needed to see if this therapy can result in sustained decreases in body weight and improvements in insulin resistance.

Downloads

Download data is not yet available.
Abstract 100 | PDF Downloads 9

References

1. Steinberger J, Daniels SR, Eckel RH, Daniels SR, Eckel RH, Hayman L, Lustig RH et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009; 119: 628-647.
2. Williams RM, Ong KK, Dunger DB. Polycystic ovarian syndrome during puberty and adolescence. Mol Cell Endocrinol 2013; 5, 61-67.
3. O'Brien B, Dahiya R, Kimble R. Hyperandrogenism, insulin resistance and acanthosis nigricans (HAIR-AN syndrome): an extreme subphenotype of polycystic ovary syndrome. BMJ Case Rep. 2020; 9:13(4): pii: e231749.
4. Marsh KA, Steinbeck KS, Atkinson FS Petocz P, Brand-Miller JC. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr 2010; 92: 83–92.
5. Garnett SP, Gow M, Ho M, Baur LA, Noakes M, Woodhead HJ, Broderick CR, Chisholm K, Briody J, De S, Steinbeck K, Srinivasan S, Ambler GR, Cowell CT Improved insulin sensitivity and body composition, irrespective of macronutrient intake, after a 12 month intervention in adolescents with pre-diabetes; RESIST a randomised control trial. BMC Pediatrics 2014; 14: 289.
6. Wang R, Mol BW. The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria? Hum Reprod. 2017; 32(2): 261-264.
7. van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years. Hum Reprod. 2004;19(2):383–392.
8. Southam AL, Richart RM. The prognosis for adolescents with menstrual abnormalities. Am J Obstet Gynecol. 1966;94(5):637–645.
9. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinal Metab 1961; 21: 1440.
10. Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015; 19(1): 160–164.
11. McCrory MA, Molé PA, Gomez TD, Dewey KG, Bernauer EM. Body composition by air-displacement plethysmography by using predicted and measured thoracic gas volumes. J Appl Physiol 1998; 84: 1475–147.
12. Kunachowicz H, Nadolna I, Przygoda B, Ivanow K: Tables of nutritional value of foodstuffs and dishes. 3rd extended and updated edition, Warsaw, Instytut Żywności i Żywienia, 2005.
13. Jarosz M, Bułhak-Jachymczyk B. Normy Żywienia Człowieka. Podstawy prewencji otyłości i chorób niezakaźnych. Instytut Żywności i Żywienia. Warszawa, Lekarskie PZWL. 2008.
14. Zhang J, Zhou K, Luo L, Liu Y, Liu X, Xu L. Effects of exercise and dietary habits on the occurrence of polycystic ovary syndrome over 5 years of follow-up. Int J Gynaecol Obstet 2018; 142: 329-337.
15. Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 28:3.
16. Moran LJ, Noakes M, Clifton P, Buckley J, Brinkworth G, Thomson R, Norman RJ. Predictors of Lifestyle Intervention Attrition or Weight Loss Success in Women with Polycystic Ovary Syndrome Who Are Overweight or Obese. Nutrients 2019; 26:3.
17. Carolo AL, Mendes MC, Rosa E, Vieira CS, Silva de Sá MF, Ferriani RA, Reis RMD. Nutritional Counseling Promotes Changes in the Dietary Habits of Overweight and Obese Adolescents with Polycystic Ovary Syndrome. Rev Bras Ginecol Obstet 2017; 39: 692-686.
18. Salama AA. Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome. N Am J Med Sci 2015; 7: 310-316.
19. Clarson CL, Mahmud FH, Baker JE, Clark HE, McKay WM, Schauteet VD et al. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocrine 2009; 36:141-146.
20. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393.
21. Pasquali R, Stener-Victorin E, Yildiz BO, Duleba AJ, Hoeger K, Mason H, Homburg R, Hickey T, Franks S, Tapanainen JS, Balen A, Abbott DH, Diamanti-Kandarakis E, Legro RS. PCOS Forum: research in polycystic ovary syndrome today and tomorrow. Clin Endocrinol 2011; 74:424-433.
22. Wilson DM, Abrams SH, Aye T, Lee PD, Lenders C, Lustig RH, Osganian SV, Feldman HA. Metformin extended release treatment of adolescent obesity: a 48-week randomized, double-blind, placebo-controlled trial with 48-week follow-up. Arch Pediatr Adolesc Med 2010; 164:116-123.
23. Bridger T, MacDonald S, Baltzer FC, Rodd C. Randomized placebo-controlled trial of metformin for adolescents with polycystic ovary syndrome. Arch Pediatr Adolesc Med 2006; 160: 241-246.
24. Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab 2008; 93: 4299-4306.
25. Arslanian SA, Lewy V, Danadian , Saad K. Metformin Therapy in Obese Adolescents with Polycystic Ovary Syndrome and Impaired Glucose Tolerance: Amelioration of Exaggerated Adrenal Response to Adrenocorticotropin with Reduction of Insulinemia/Insulin Resistance. J Clin Endocrinol Metab 2002; 87:1555-1559.
26. Erensoy H, Niafar M, Ghafarzadeh S, Aghamohammadzadeh N, Nader ND. A pilot trial of metformin for insulin resistance and mood disturbances in adolescent and adult women with polycystic ovary syndrome. Gynecol Endocrinol 2019; 35:72-75.