Background: Polycystic ovary syndrome (PCOS) is amongthe most common endocrine disorders in women of reproductive age and has astrong genetic component.
It is characterized by ovarian dysfunction and itsclinical manifestations may include obesity, increased insulin resistance andcompensatory hyper-insulinemia, oligo-/anovulation and infertility.. Methods: This prospective study was conducted on 100 patientsof PCOS both suspected as well as already diagnosed at department of obstetrics and gynecology at kailashcancer hospital and Research center, Goraj,Vadodara,Gujarat from 2012-2013.
Diagnosisof PCOS was made by Rotterdam 2003 criteria. A detailed assessment was done andpreformed proforma was filled. Estimation of serum vitamin D3 was done from allparticipants by chemiluminence method in central laboratory of our institute.Obtained data was analysed statistically by calculating p value and chi squaretest. Results: Inthis study, the prevalence of vitamin D3 deficiency in patients of PCOS wasfound to be 86% which is significant. Various parameters associated with PCOSlike waist-hip ratio, obesity, AN of neck and hirsutism score showed positivesignificant correlation with vitamin D3 deficiency and physical activity ofpatients of PCOS showed negative correlation with the same. Conclusions: From Our studywe would like to conclude that improvement of vitamin D3 levels at a youngerage can contribute to prevention of PCOS. Each and Every patients of PCOSshould be screened by measuring the level of serum vitamin D3.
Correction ofVitamin D3 deficiency may prevents the complication of PCOS. Keywords: Vitamin D3,PCOS,DeficiencyPolycystic ovarian syndrome is a common endocrine disordersamong women of reproductive age. Its worldwide prevalence has been estimatedbetween 2.2% and 26%, which is reported about 7.1% among Iranianpopulation 1. These patientsgenerally are more likely have irregular menstruation, hyperandrogenism, and defectsin ovulation and polycystic ovaries 2 . Studies regarding Vitamin D status inpatients with PCOS show an inverse correlation between Vitamin D levels andmetabolic risk factors, e.g.
insulin resistance, BMI, waist-to-hip-ratio,triglycerides, total testosterone and a positive correlation with insulinsensitivity 3,4. Data on the roleof gene variants involved in Vitamin D metabolism in PCOS are sparse butsuggest an association of VDR and Vitamin D level-related variants withmetabolic and endocrine parameters in women with PCOS. Several studies althoughlimited by modest sample sizes have suggested associations between VDRpolymorphisms and the development of PCOS as well as insulin resistance 5,6.Stress is one of the important factors in the aetiology ofPCOS; it is seen in patients of PCOS from the young age till old. There arethree major sets of diagnostic criteria for the diagnosis of PCOS.
7 Vitamin D deficiency is a global health issue. Inadequateexposure to sun light is one of the main causes of this deficiency, since fooddietary contains natural sources of vitamin D supplement 8.In addition, older individuals with increased fat deposits are also prone todevelop vitamin D deficiency. Hypovitaminosis D may be associated with a numberof mental and physical disorders such as MBS, type 2 diabetes, PCOS and cancer.
MATERIAL & METHODThis prospective study wasconducted on 100 patients of PCOS both suspected as well as already diagnosedat department of obstetricsand gynecology kailash cancer hospital and Research center,Goraj,Vadodara,Gujarat from 2012-2013.. Inclusion criteria :All newly suspected and diagnosedcases of PCOS. Exclusion criteria :Any diagnosed case of PCOS who wason and had history of taking vitamin D and calcium supplement within period ofone 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 ofPCOS was made by Rotterdam 2003 criteria. A detailed assessment was done andperformed proforma was filled. Demographic data was collected, relevant historyand chief complaints were noted. Any comorbidities like diabetes, hypertensionand thyroid dysfunction present or absent in subjects was mentioned. Lifestyle ofsubjects was assessed by physical activity which was graded as 1) active, 2)moderate and 3) sedentary activity. Standardanthropometric data height, weight, BMI, waist circumference, hip circumferencewas measured.
Waist-hip ratio (WHR) was calculated and classified according toWHO 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 andcases were divided into non-obese (BMI<25) and obese (BMI >25) then meanwas calculated and compared.Hirsutism wasquantified according to modified Ferriman-Gallwey-Score which was filled bysubjects in the chart Figure 2 and total score was calculated and quantified as<8 non-hirsutisms, hirsutism >8-15 and overt hirsutism >15 . 9Estimation ofserum vitamin D3 by Chemiluminencemethod in fully automated analyzer.Out of 100 PCOS patients, 38% of the patients having agegroup between 16-20 year followed by 30% 21-25 years and 15% 26-30 years.Age wise distributionof 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 serumvitamin D3 levels less than required i.e. 30ng/dl and only 14% (14) hadsufficient 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 PCOSpatients 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 andnon 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 PCOSpatients 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: Distributionof Vit D3 level in PCOS patients according to Presence of Acanthosis nigricans DISCUSSION Vitamin D plays a physiologic role inreproduction including ovarian follicular development and luteinization viaaltering anti-müllerian hormone (AMH) signalling, follicle-stimulating hormonesensitivity and progesterone production in human granulosa cells1. It also affectsglucose homeostasis through manifold roles.
The potential influences of vitaminD on glucose homeostasis include the presence of specific vitamin D receptor(VDR) in pancreatic ?-cells and skeletal muscle, the expression of1-?-hydroxylase enzyme which can catalyze the conversion of 25-hydroxy vitaminD 25(OH)D to 1,25-dihydroxyvitamin D, and the presence of a vitamin Dresponse element in the human insulin gene promoter. 10 Li HW et al, in an observational study 2011 including 25women with PCOS and 27 controls to the prevalence of vitamin D deficiency inPCOS women in Scotland found the majority of PCOS subject’s n=18, 72% werefound to be vitamin D deficient. 11 In an observational study, involving 206 PCOS women werestudied by Wher et al, wherein 72.8% (150 women) of PCOS populationdemonstrated vitamin D deficiency. 12 Majority of cases in this study had complaint of oligomenorrheaand 86.2% of them were noted with vitamin D3 deficiency. Clinical features ofhyperandrogenism 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 serumvitamin D3 levels with hirsutism score who statistically significant had lowerlevels of vitamin D than non-hirsute women. 12 Obesity is one of the most important features of PCOS, BMIand WHR are well defined parameters to assess it. In this study, also both werefound statistically significant inversely correlated with vitamin D3 levels,inferring association between central obesity and vitamin D3 level. Li HW etal, showed inverse association of vitamin D3 level with BMI in PCOS patientwith pvalue <0.
05, in contrast no relationship found in control ovulatorygroup. 13Mahmoudi et al, also reported overweight and obese womenwith PCOS had significantly decreased levels of vitamin D3 compared with normalweight women with PCOS but that was not found statistically significant.14 CONCLUSION From Our studywe would like to conclude that improvement of vitamin D3 levels at a youngerage can contribute to prevention of PCOS. Each and Every patients of PCOSshould be screened by measuring the level of serum vitamin D3.Correction ofVitamin D3 deficiency may prevents the complication of PCOS. REFERENCES 1. WehrE, Pilz S, Schweighofer N, Giuliani A, Kopera D, et al. (2009) Associationof hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome.
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