ORCID Profile
0000-0002-5204-107X
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Publisher: Wiley
Date: 19-07-2018
DOI: 10.1111/CEN.13795
Abstract: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Governance included a six continent international advisory and a project board, five guideline development groups (GDGs), and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (a) considerable refinement of in idual diagnostic criteria with a focus on improving accuracy of diagnosis (b) reducing unnecessary testing (c) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life and (d) emphasizing evidence based medical therapy and cheaper and safer fertility management. Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program.
Publisher: Oxford University Press (OUP)
Date: 19-07-2018
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.JSBMB.2017.07.012
Abstract: Polycystic ovary syndrome (PCOS) is a common condition characterised by both reproductive and metabolic features (obesity, insulin resistance, diabetes risk). Some evidence suggests that women with PCOS have lower vitamin D levels compared to healthy controls. Vitamin D binding protein (DBP) is the main carrier of vitamin D in circulation and plays an important role in regulating vitamin D concentration and bioavailability for target tissues. To our knowledge, no previous studies have examined DBP, bioavailable and free 25-hydroxyvitamin D (25(OH)D) in women with PCOS. The primary aim of this study was to compare DBP, bioavailable and free 25(OH)D concentrations in women with PCOS and controls. The secondary aim was to investigate relationships between DBP, bioavailable and free 25(OH)D and metabolic features (anthropometric measures, insulin resistance, and lipid profile). In a cross sectional study using bio-banked s les, we measured 25(OH)D, DBP and albumin. Bioavailable and free 25(OH)D were calculated using previously validated formula. BMI, body composition (dual X-ray absorptiometry, DXA), insulin resistance (homeostatic model assessment of insulin resistance (HOMA-IR)) and glucose infusion rate (GIR) from hyperinsulinaemic euglycaemic cl and serum lipids (ELISA) were also measured in a physically and biochemically well-characterised cohort of women with and without PCOS. We studied 90 women with PCOS and 59 controls aged 18-48 years. DBP concentrations were lower in PCOS compared to controls (median [IQR]: 443.40 [314.4] vs 482.4 [156.8] μg/ml, p=0.02). No significant differences were found in bioavailable or free 25(OH)D concentrations between groups. DBP was not associated with BMI, percent body fat or markers of insulin resistance (all p>0.2). High-density lipoprotein (HDL) was the main determinant of DBP in the overall cohort (β=-0.12, p=0.02), after adjusting for covariates including PCOS/control status, age, BMI, total 25(OH)D and HOMA-IR. In PCOS, total and free 25(OH)D were related to markers of insulin resistance and lipids. Only the associations between free 25(OH)D and triglycerides (p=0.02), and HDL (p=0.03) remained significant after adjusting for age and BMI. In conclusion, women with PCOS had lower DBP, but similar bioavailable or free 25(OH)D concentrations compared to controls, independent of BMI and age. DBP was not associated with insulin resistance or BMI in PCOS. Further studies are needed to investigate the pathophysiology and clinical implications of reduced DBP in PCOS.
Publisher: EDP Sciences
Date: 08-2022
DOI: 10.1051/0004-6361/202142878
Abstract: Context. Cosmic rays and magnetic fields are key ingredients in galaxy evolution, regulating both stellar feedback and star formation. Their properties can be studied with low-frequency radio continuum observations that are free from thermal contamination. Aims. We define a s le of 76 nearby ( 30 Mpc) galaxies with rich ancillary data in the radio continuum and infrared from the CHANG-ES and KINGFISH surveys, which will be observed with the LOFAR Two-metre Sky Survey (LoTSS) at 144 MHz. Methods. We present maps for 45 of them as part of the LoTSS data release 2 (LoTSS-DR2), where we measure integrated flux densities and study integrated and spatially resolved radio spectral indices. We investigate the radio–star formation rate (SFR) relation using SFRs derived from total infrared and H α + 24-μm emission. Results. The radio–SFR relation at 144 MHz is clearly super-linear with L 144 MHz ∝ SFR 1.4−1.5 . The mean integrated radio spectral index between 144 and ≈1400 MHz is ⟨ α ⟩= − 0.56 ± 0.14, in agreement with the injection spectral index for cosmic ray electrons (CREs). However, the radio spectral index maps show variation of spectral indices with flatter spectra associated with star-forming regions and steeper spectra in galaxy outskirts and, in particular, in extra-planar regions. We found that galaxies with high SFRs have steeper radio spectra we find similar correlations with galaxy size, mass, and rotation speed. Conclusions. Galaxies that are larger and more massive are better electron calorimeters, meaning that the CRE lose a higher fraction of their energy within the galaxies. This explains the super-linear radio–SFR relation, with more massive, star-forming galaxies being radio bright. We propose a semi-calorimetric radio–SFR relation that employs the galaxy mass as a proxy for the calorimetric efficiency.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.NUTRES.2011.01.009
Abstract: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Around 60% of PCOS patients are obese. Weight loss has consistently been shown to improve the clinical status of women with PCOS. We hypothesized that dietary factors are associated with the hormonal and metabolic abnormalities of PCOS. This case-control study included 43 women with PCOS and 37 ovulatory, nonhirsute controls matched to the study group by body mass index. Age ranged from 14 to 38 years. Both groups underwent anthropometric, laboratory, and nutritional assessment. End points included diet composition, body fat, and hormonal and metabolic variables related to insulin resistance. The groups had similar intake of energy, carbohydrate (53.51% ± 8.36% vs 51.83% ± 10.06%), protein (15% [12-18] vs 16% [13-19]), and total fat (30.51% ± 7.90% vs 30.80% ± 7.97%). Total body fat, sum of trunk skinfold measurements, and waist circumference were higher in the PCOS group (P < .05). Sex hormone-binding globulin was lower in PCOS patients than in controls, whereas total testosterone, free androgen index, postprandial glucose, fasting and postprandial insulin, homeostatic model assessment index, triglycerides, and total and low-density lipoprotein cholesterol (P < .050) were higher. Homeostatic model assessment index was correlated with central obesity in PCOS patients and controls alike. No association was detected between androgen status and macronutrient intake. In conclusion, central obesity and insulin resistance were not strictly associated with energy intake or dietary macronutrient composition in women with PCOS.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.FERTNSTERT.2008.06.049
Abstract: To evaluate the effects of low-dose oral hormone therapy and nonoral hormone therapy on endothelial function markers and on anthropometric, metabolic, and hormonal variables in early postmenopausal women. Cross-over, randomized clinical trial. Gynecological Endocrinology Unit. Healthy postmenopausal women. Twenty patients received oral E(2) 1 mg plus drospirenone 2 mg/d for 2 months. Another group of 20 patients received 3 mg/d 17beta intranasal E(2), and then 200 mg/d vaginal micronized P for 14 days during two 28-day cycles. At the end of this period, the patients were crossed over for another 2 months. Endothelial function markers and anthropometric, metabolic, and hormonal variables before and after hormone therapy. Mean age was 51.2 +/- 2.7 years. Mean time since menopause was 23.1 +/- 10 months. After low-dose treatment, a reduction in waist circumference, waist-to-hip ratio, and high-density-lipoprotein cholesterol was observed. Triglycerides and von Willebrand factor levels decreased significantly with nonoral treatment. Fasting glucose and insulin levels did not change. In both groups, total and non-high-density-lipoprotein cholesterol levels decreased below basal levels, and endothelin-1, fibrinogen, and C-reactive protein levels remained unchanged. Neither treatment induced deleterious effects in the short term on variables related to cardiovascular risk in early postmenopausal women.
Publisher: Elsevier BV
Date: 08-2018
Publisher: Informa UK Limited
Date: 31-05-2011
DOI: 10.3109/09513590.2011.564686
Abstract: The aim of the present study was to assess the effects of a high protein (HP) and a normal protein (NP) diet on patients with polycystic ovary syndrome (PCOS) and body mass index-matched controls in a s le of southern Brazilian women. This 8-week randomized trial was carried out at a university gynecological endocrinology clinic and included 18 patients with PCOS and 22 controls. Changes in weight, body composition, hormone, and metabolic profile were analyzed in women randomized to receive HP (30% protein, 40% carbohydrate, and 30% lipid) or NP (15% protein, 55% carbohydrate, and 30% lipid). The energy content was estimated for each participant at 20-25 kcal/kg current weight/day. Physical activity, blood pressure, homeostasis model assessment (HOMA) index, and fasting and 2-h glucose and insulin remained stable during the intervention in PCOS and controls, even in the presence of weight loss. There were no changes in lipid profile in either group. In contrast, body weight, body mass index (BMI), waist circumference, percent of body fat, and sum of trunk skinfolds decreased significantly after both diets in both groups. Total testosterone also decreased in PCOS and controls regardless of diet. In conclusion, calorie reduction, rather than protein content, seemed to affect body composition and hormonal profile in this short-term study. These findings emphasize the role of non-pharmacological interventions to reduce weight and ameliorate the anthropometric and clinical phenotype in PCOS.
Publisher: Bioscientifica
Date: 23-03-2011
DOI: 10.1530/JOE-11-0022
Abstract: Infertility, associated with oligo/anovulation, increased ovarian volume, numerous follicular cysts, and metabolic disturbances such as obesity and insulin resistance (IR) are characteristics common to polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age. Here, we show that New Zealand obese (NZO) mice display similar metabolic characteristics such as obesity, leptin insensitivity, glucose intolerance, and IR. Importantly, NZO mice are poor breeders however, the mechanism for this has not been investigated. The aim of this study was to assess the ovarian structure/morphology and sex hormone levels in female NZO and lean C57BL/6J control mice. Twenty-five NZO and twenty female control mice were studied at three different ages (young, adult, and aged). The animals were weighed, an insulin tolerance test was carried out, and blood was collected for measurement of hormone levels. The ovaries were removed for histological analysis. As expected, NZO mice presented higher body weights ( P =0.001), increased basal plasma glucose ( P =0.007), and insulin levels ( P =0.001) as well as IR, compared with control mice. NZO mice showed an increased ovarian volume, reduced numbers of corpora lutea, and higher total follicle numbers ( P =0.0001). The number of primordial follicles increased ( P =0.02) at the young stage, as well as the amount of atretic follicles ( P =0.03), in NZO compared with control mice. NZO mice also displayed reduced plasma LH and increased estradiol levels. In conclusion, NZO mice show a poor breeding performance due to decreased ovulation, increased number of primordial and atretic follicles, and ovarian size. Given that NZO mice are obese, hyperinsulinemic and insulin resistant, they are suitable for investigating pathophysiological mechanisms linking metabolic alterations with reproductive defects.
No related grants have been discovered for Poli Mara Spritzer.