Metabolic inflexibility in women with polycystic ovary syndrome: a systematic review

Abstract

Polycystic ovary syndrome (PCOS) is a risk factor for dysglycemia, insulin resistance, and type 2 Diabetes Mellitus (T2DM). Inefficient energy oxidation, metabolic inflexibility, is a marker of blunted metabolism. We conducted a systematic review on metabolic inflexibility in women with PCOS. We searched MEDLINE, EMBASE and Cochrane central (inception-October 2018) for studies evaluating metabolic inflexibility and reporting on changes in Respiratory Quotient (ΔRQ). We extracted data and assessed quality using The Newcastle–Ottawa Scale. We included five prospective cohort studies (461 women). Three compared PCOS women to unaffected subjects, one to women with obesity or T2DM, and one to adolescent girls; all had medium quality. Three studies showed higher metabolic inflexibility in women with PCOS (ΔRQ range 0.05–0.098) compared to unaffected subjects. Women with PCOS had similar metabolic inflexibility compared to those with T2DM (ΔRQ 0.05 ± 0.03 vs 0.06 ± 0.04, p = .98) and obesity (p = .06). Inflexibility was higher in hyperandrogenemic women with PCOS (ΔRQ 0.091 ± 0.060 vs 0.120 ± 0.010, p = .014). ΔRQ was lower in PCOS women with insulin resistance vs those with normal insulin sensitivity (0.04 ± 0.02 vs. 0.07 ± 0.04, p = .007). In conclusion, women with polycystic ovary syndrome appear to have higher metabolic inflexibility associated with hyperandrogenemia and insulin resistance.

摘要

多囊卵巢综合征(PCOS)是血糖异常、胰岛素抵抗和2型糖尿病(T2 DM)的危险因素。低效的能量氧化, 代谢失调, 是新陈代谢迟缓的标志。我们对患有多囊卵巢综合征的女性的代谢失调进行了系统的回顾。我们在MEDLINE、EMBASE和Cochrane Central （开始-2018年10月）上搜索了评估代谢失调和报告呼吸商（△RQ）变化的研究。我们提取了数据, 并使用纽卡斯尔-渥太华量表进行了质量评估。我们纳入了五项前瞻性队列研究（461名女性）。三项是将PCOS女性与健康受试者进行比较, 一项与肥胖或T2 DM女性比较, 一项与青春期女孩比较；所有的研究都是中等质量的。三项研究表明, 与健康受试者相比, 患有多囊卵巢综合征（△RQ范围0.05-0.098）的女性代谢失调程度更高。与T2DM（△RQ0.05±0.03vs0.06±0.04, p.98）和肥胖者（p=.06）相比, PCOS女性有相似的代谢障碍。伴高雄激素血症的多囊卵巢综合征妇女的代谢失调程度更高(△RQ 0.091±0.060 vs 0.120±0.010, p=.014)。伴有胰岛素抵抗的PCOS患者的△RQ低于正常胰岛素敏感者(0.04±0.02比0.07±0.04, p=.007)。总而言之, 患有多囊卵巢综合征的女性似乎有更高的代谢失调, 这与高雄激素血症和胰岛素抵抗相关。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Metabolic flexibility
• inflexibility
• polycystic syndrome
• systematic review

Disclosure statement

The authors report no conflict of interest

Additional information

Funding

BHA is funded through an NIHR lectureship.