Background: 86% which is significant. Various parameters associated

Background: Polycystic ovary syndrome (PCOS) is among
the most common endocrine disorders in women of reproductive age and has a
strong genetic component. It is characterized by ovarian dysfunction and its
clinical manifestations may include obesity, increased insulin resistance and
compensatory hyper-insulinemia, oligo-/anovulation and infertility..

 

Methods: This prospective study was conducted on 100 patients
of PCOS both suspected as well as already diagnosed at department of obstetrics and gynecology at kailash
cancer hospital and Research center, Goraj,Vadodara,Gujarat from 2012-2013. Diagnosis
of PCOS was made by Rotterdam 2003 criteria. A detailed assessment was done and
preformed proforma was filled. Estimation of serum vitamin D3 was done from all
participants by chemiluminence method in central laboratory of our institute.
Obtained data was analysed statistically by calculating p value and chi square
test.

 

Results: In
this study, the prevalence of vitamin D3 deficiency in patients of PCOS was
found to be 86% which is significant. Various parameters associated with PCOS
like waist-hip ratio, obesity, AN of neck and hirsutism score showed positive
significant correlation with vitamin D3 deficiency and physical activity of
patients of PCOS showed negative correlation with the same.

 

 

Conclusions: From Our study
we would like to conclude that improvement of vitamin D3 levels at a younger
age can contribute to prevention of PCOS. Each and Every patients of PCOS
should be screened by measuring the level of serum vitamin D3.Correction of
Vitamin D3 deficiency may prevents the complication of PCOS.

 

 

Keywords: Vitamin D3,PCOS,
DeficiencyPolycystic ovarian syndrome is a common endocrine disorders
among women of reproductive age. Its worldwide prevalence has been estimated
between 2.2% and 26%, which is reported about 7.1% among Iranian
population 1. These patients
generally are more likely have irregular menstruation, hyperandrogenism, and defects
in ovulation and polycystic ovaries 2 . Studies regarding Vitamin D status in
patients with PCOS show an inverse correlation between Vitamin D levels and
metabolic risk factors, e.g. insulin resistance, BMI, waist-to-hip-ratio,
triglycerides, total testosterone and a positive correlation with insulin
sensitivity 3,4. Data on the role
of gene variants involved in Vitamin D metabolism in PCOS are sparse but
suggest an association of VDR and Vitamin D level-related variants with
metabolic and endocrine parameters in women with PCOS. Several studies although
limited by modest sample sizes have suggested associations between VDR
polymorphisms and the development of PCOS as well as insulin resistance 5,6.Stress is one of the important factors in the aetiology of
PCOS; it is seen in patients of PCOS from the young age till old. There are
three major sets of diagnostic criteria for the diagnosis of PCOS. 7 Vitamin D deficiency is a global health issue. Inadequate
exposure to sun light is one of the main causes of this deficiency, since food
dietary contains natural sources of vitamin D supplement 8.
In addition, older individuals with increased fat deposits are also prone to
develop vitamin D deficiency. Hypovitaminosis D may be associated with a number
of mental and physical disorders such as MBS, type 2 diabetes, PCOS and cancer.    MATERIAL & 
METHODThis prospective study was
conducted on 100 patients of PCOS both suspected as well as already diagnosed
at department of obstetrics
and gynecology kailash cancer hospital and Research center,
Goraj,Vadodara,Gujarat from 2012-2013..  Inclusion criteria :All newly suspected and diagnosed
cases of PCOS. Exclusion criteria :Any diagnosed case of PCOS who was
on and had history of taking vitamin D and calcium supplement within period of
one year. Diagnosed cases of PCOS who was under treatment and recovered with treatment
(medical and surgical)Patients who were not willing to take part in the study.  Diagnosis of
PCOS was made by Rotterdam 2003 criteria. A detailed assessment was done and
performed proforma was filled. Demographic data was collected, relevant history
and chief complaints were noted. Any comorbidities like diabetes, hypertension
and thyroid dysfunction present or absent in subjects was mentioned. Lifestyle of
subjects was assessed by physical activity which was graded as 1) active, 2)
moderate and 3) sedentary activity. Standard
anthropometric data height, weight, BMI, waist circumference, hip circumference
was measured. Waist-hip ratio (WHR) was calculated and classified according to
WHO guided health risks into low, moderate and high risks as <0.80, 0.80-0.85 and >0.85 respectively. BMI was classified by WHO classification and
cases were divided into non-obese (BMI<25) and obese (BMI >25) then mean
was calculated and compared.Hirsutism was
quantified according to modified Ferriman-Gallwey-Score which was filled by
subjects in the chart Figure 2 and total score was calculated and quantified as
<8 non-hirsutisms, hirsutism >8-15 and overt hirsutism >15 . 9Estimation of
serum vitamin D3  by Chemiluminence
method in fully automated analyzer.

Out of 100  PCOS patients, 38% of the patients having age
group between 16-20 year followed by 30% 21-25 years and 15% 26-30 years.

Age wise distribution
of the participants is mentioned below Table 1.

Age Group

Number(n)

Percentage

<15 yr 02 2% 16-20 yr 38 38% 21-25 yr 30 30% 26-30 yr 15 15% 31-35 yr 13 13% >35
yr

02

2%

 

Table 1: Age wise distribution of participants

 

86% (86) had serum
vitamin D3 levels less than required i.e. 30ng/dl and only 14% (14) had
sufficient levels (Table 2).

 

Vit D3 Level

Number(n)

Percentage

Deficiency(<20 ng/ml) 54 54% Insufficiency(20-30 ng/ml) 32 32% Sufficiency(>30%)

14

14%

 

Table 2: Concentration of Vit D3 level in participants

 

 

Presenting complaints

Vitamin D3 Sufficient

Vitamin D3 Insufficient

Vitamin D3
Deficient

Total

Menorrhagia

2 (6.0%)

11(33%)

20 (60.60%)

33

Amenorrhoea

3 (9.0%)

11(33%)

19 (57.57%)

33

Acne

9 (17.30%)

15 (28.84%)

28(53.84%)

52

Acanthosis nigricans

2 (7.6%)

11 (42.30%)

13 (50%)

26

Oligomenorrhea

10 (14.7%)

43 (63.23%)

47 (69.11%)

34

Alopecia

1 (4.76%)

5(14.7%)

15 (71.42%)

21

Infertility

5 (14.70%)

13(38%)

16 (47.05%)

34

Weight gain

9 (14.75%)

21 (34.44%)

31 (50.81%)

61

Hirsutism
 

6(12%)

18(36%)

26(52%)

50

 

Table 3:Distribution of Vit D3 level in PCOS
patients based on their complain

Activity

Vitamin D3 Sufficient

Vitamin D3 Insufficient

Vitamin D3 Deficient

Total

Active

9 (50%)

3 (16.66%)

6 (33.33%)

18 (18%)

Moderate

3 (4.8%)

27 (43.54%)

32 (51.61%)

62 (62%)

Sedentary

2 (10%)

2(10%)

16 (80%)

20 (28.6%)

Total

14

32

54

100(100%)

 

Table 4:
Distribution of Vit D3 level in PCOS patients according to physical activity

 

Hirsutism score

Vitamin D3
Sufficient

Vitamin D3 Insufficient

Vitamin D3 Deficient

Total

Non-hirsutism

4(12.5%)

14 (43.75%)

14 (43.75%)

32 (32%)

Hirsutism

10 (17.24%)

14 (24.13%)

34 (58.62%)

58 (58%)

Overt hirsutism

0 (0%)

4 (40%)

6 (60%)

10(10%)

Total

14

30

54

100 (100%)

 

Table 5:
Distribution of Vit D3 level in PCOS patients Based on hirsutism score

BMI

Number(n)

VitD3
concentration(ng/ml)
Mean  SD

Non
obese(BMI <25) 46 21.54 ±5.45 Non obese(BMI >30)

54

14.52±7.53

 

Table 6:Comparison of Vit D3 level between obese and
non obese PCOS patients based on BMI

 

 
Waist – Hip Ratio

Vitamin D3 Sufficient

Vitamin D3 Insufficient

Vitamin D3
Deficient

Total

Low risk (<0.8) 5 (62.50%) 3 (37.50%)  0(0.0%) 8 (8.0%) Moderate risk (0.8-0.85) 3 (13.63%) 5 (22.72%) 14 (63.63%) 22 (22.0%) High risk (>0.85)

6 (8.5%)

24 (34.28%)

40 (57.14%)

70 (70%)

Total

36

23

11

70 (100%)

 

 

Table 7: Distribution of Vit D3 level in PCOS
patients Based on Waist hip ratio(W/H ratio)

 

 

 

Acanthosis nigricans
 

Vitamin D3 Sufficient

Vitamin D3 Insufficient

Vitamin D3
Deficient

Total

Neck

1 (2.1%)

20(43.47%)

27 (58.69%)

46

Axilla

5 (14.28%)

11(31.42%)

19 (54.28%)

35

Elbow

0 (0%)

5 (21.73%)

18(78.26%)

23

Knuckles
 

0 (0%)

10 (41.66%)

14 (58.33%)

24

Knee

0 (0%)

05 (21.73%)

18 (78.26%)

23

 

 

Table 8: Distribution
of Vit D3 level in PCOS patients according to Presence of Acanthosis nigricans

 

 

 

 

 

DISCUSSION

 

 

Vitamin D plays a physiologic role in
reproduction including ovarian follicular development and luteinization via
altering anti-müllerian hormone (AMH) signalling, follicle-stimulating hormone
sensitivity and progesterone production in human granulosa cells1. It also affects
glucose homeostasis through manifold roles. The potential influences of vitamin
D on glucose homeostasis include the presence of specific vitamin D receptor
(VDR) in pancreatic ?-cells and skeletal muscle, the expression of
1-?-hydroxylase enzyme which can catalyze the conversion of 25-hydroxy vitamin
D 25(OH)D to 1,25-dihydroxyvitamin D, and the presence of a vitamin D
response element in the human insulin gene promoter. 10

 

Li HW et al, in an observational study 2011 including 25
women with PCOS and 27 controls to the prevalence of vitamin D deficiency in
PCOS women in Scotland found the majority of PCOS subject’s n=18, 72% were
found to be vitamin D deficient. 11

 

In an observational study, involving 206 PCOS women were
studied by Wher et al, wherein 72.8% (150 women) of PCOS population
demonstrated vitamin D deficiency. 12

 

Majority of cases in this study had complaint of oligomenorrhea
and 86.2% of them were noted with vitamin D3 deficiency. Clinical features of
hyperandrogenism include hirsutism, acne and alopecia in the women with PCOS.
In our study, low levels of vitamin D3 associated with higher hirsutism score,
that was found to be statistically significant.

 

Wehr et al, also observed negative correlation between serum
vitamin D3 levels with hirsutism score who statistically significant had lower
levels of vitamin D than non-hirsute women. 12

 

Obesity is one of the most important features of PCOS, BMI
and WHR are well defined parameters to assess it. In this study, also both were
found statistically significant inversely correlated with vitamin D3 levels,
inferring association between central obesity and vitamin D3 level. Li HW et
al, showed inverse association of vitamin D3 level with BMI in PCOS patient
with pvalue <0.05, in contrast no relationship found in control ovulatory group. 13Mahmoudi et al, also reported overweight and obese women with PCOS had significantly decreased levels of vitamin D3 compared with normal weight women with PCOS but that was not found statistically significant. 14     CONCLUSION   From Our study we would like to conclude that improvement of vitamin D3 levels at a younger age can contribute to prevention of PCOS. Each and Every patients of PCOS should be screened by measuring the level of serum vitamin D3.Correction of Vitamin D3 deficiency may prevents the complication of PCOS. REFERENCES   1. Wehr E, Pilz S, Schweighofer N, Giuliani A, Kopera D, et al. (2009) Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol 161: 575-582. 2. Diamanti-Kandarakis E, Kouli C, Bergiele A, Filandra F, Tsianateli T, Spina G, et al. A Survey of the Polycystic Ovary Syndrome in the Greek Island of Lesbos: Hormonal and Metabolic Profile. J Clini Endocrinol Metab. 1999;84(11):4006-11. 3. Yildizhan R, Kurdoglu M, Adali E, Kolusari A, Yildizhan B, et al. (2009) Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Arch GynecolObstet 280: 559-563. 4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25 5. T. Apridonidze, P.A. Essah, M.J. Iuorno, J.E. Nestler.Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome .J Clin Endocrinol Metabolism, 90 (4) (2005), pp. 1929-1935 6. Holick M. Vitamin D Deficiency. New England J Medic. 2007;357(3):266-81. 7. Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intrnal Medic. 2008;264(6):599-609. 8. G. Garg, G. Kachhawa, R. Ramot, R. Khadgawat, N. Tandon, V.Sreenivas,.Effect of vitamin D supplementation on insulin kinetics and cardiovascular risk factors in polycystic ovarian syndrome: a pilot study Endocrine Connections, 4 (2) (2015), pp. 108-116 9. Firouzabadi R, Aflatoonian A, Modarresi S, Sekhavat L, Mohammad Taheri S. Therapeutic effects of calcium and vitamin D supplementation in women with PCOS. Complementary Therap Clini Pract. 2012;18(2):85-88. 10. Wehr E, Pilz S, Schweighofer N, Giuliani A, Kopera D, et al. (2009) Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol 161: 575-582.   11. Hahn S, Haselhorst U, Tan S, Quadbeck B, Schmidt M, Roesler S . Low Serum 25-Hydroxyvitamin D Concentrations are Associated with Insulin Resistance and Obesity in Women with Polycystic Ovary Syndrome. Experment Clini Endocrinol Amp Diab. 2006;114(10):577-83   12. Wehr E, Pilz S, Schweighofer N, Giuliani A, Kopera D, Pieber T, et al. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. European J Endocrinol. 2009;161(4):575-82. 13.Li HW, Brereton R, Anderson R, Wallace A, Ho C. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metab. 2011;60(10):1475-81.   14. Mahmoudi T, Gourabi H, Ashrafi M, Yazdi R, Ezabadi Z. Calciotropic hormones, insulin resistance, and the polycystic ovary syndrome. Fertil Steril. 2010;93(4):1208-14.  

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