Turkiye Klinikleri Journal of Internal Medicine

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Karmaşık İlişki: D Vitamini, İnsülin Direnci ve Polikistik Over Sendromu
Complex Relationship: Vitamin D, Insulin Resistance and Polycystic Ovary Syndrome
Emre Batuhan KENGERa, Tuğçe ÖZLÜa, Rümeysa GÜRDOĞANa, Kevser ÇELİKa
aBahçeşehir Üniversitesi Sağlık Bilimleri Fakültesi, Beslenme ve Diyetetik Bölümü, İstanbul, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2020;5(1):27-33
doi: 10.5336/intermed.2019-70547
Article Language: TR
Full Text
ÖZET
 Polikistik over sendromu (PKOS); menstrüel düzensizlik, yükselmiş androjen seviyeleri ve polikistik görünümlü overler gibi özellikleri ile üreme çağındaki kadınlarda en sık görülen endokrinopatidir. Kalıtım, obezite, diyabet hastalığı PKOS için başlıca risk faktörlerindendir. Bununla birlikte, mevcut kanıtlar insülin direncinin PKOS patogenezinde merkezi bir role sahip olduğunu ve altta yatan metabolik anormallikleri şiddetlendiren önemli bir faktör olarak öne çıktığını göstermektedir. Gözlemsel çalışmalar D vitamini eksikliğinin de PKOS gelişiminde rol oynayabileceğini düşündürmektedir. PKOS'lu kadınlarda D vitamini eksikliği yaygın görülen bir sorundur. PKOS'lu kadınların %67-85'inin ortalama 25-hidroksi vitamin D (25OHD) düzeyleri 20 ng/mL'nin altındadır. D vitamini eksikliği özellikle obezite, hiperandrojenizm, üreme fonksiyonlarında bozukluk durumlarını daha da ağırlaştırarak PKOS gelişimine zemin hazırlayabilmektedir. Bununla birlikte yapılan çalışmalar D vitamini eksikliğinin, PKOS patogenezinde başlıca rol oynayan insülin direncinin gelişiminde önemli bir rol oynadığını ortaya çıkarmıştır. Yakın geçmişte PKOS tedavisinde D vitamini takviyesinin etkilerini değerlendiren bazı randomize kontrollü çalışmalar dâhil olmak üzere yapılan çeşitli çalışmaların sonuçları ise değişkenlik göstermektedir. Vitamin D takviyesinin PKOS yönetimi için yararlı olabileceği düşünülse de PKOS'lu kadınlarda D vitamini desteğinin insülin direnci ve diğer semptomlar üzerindeki etkileri ve bu etkilerin hangi yolaklarla sağlandığı konuları hâlâ belirsizliğini korumaktadır. Bu çalışmada, D vitamininin PKOS ve insülin direnci patogenezindeki olası etkilerini ve PKOS tedavisindeki rolünü ortaya koymak amaçlanmıştır.

Anahtar Kelimeler: D vitamini eksikliği; insülin direnci; polikistik over sendromu
ABSTRACT
 Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with features such as menstrual irregularity, elevated androgen levels and polycystic ovaries. Family history, obesity, diabetes are the main risk factors for PCOS. However, current evidence suggests that insulin resistance plays a central role in the pathogenesis of PCOS and appears to be an important factor that compounds underlying metabolic abnormalities. Observational studies suggest that vitamin D deficiency may also play a role in the development of PCOS. Vitamin D deficiency is a common problem in women with PCOS. 67-85% of women with PCOS have 25-hydroxy vitamin D (25OHD) levels below 20 ng/mL. Vitamin D deficiency may aggravate the conditions of obesity, hyperandrogenism and reproductive functions, and may pave the way for the development of PCOS. However, studies have shown that vitamin D deficiency plays an important role in the development of insulin resistance, which plays a major role in PCOS pathogenesis. The results of several recent studies, including some randomized controlled trials evaluating the effects of vitamin D supplementation in PCOS treatment are variable. Although vitamin D supplementation is thought to be beneficial for PCOS management, the effects of vitamin D supplementation on insulin resistance and all other symptoms in women with PCOS and the ways in which these effects are provided remain unclear. In this review, we aimed to investigate the possible effects of vitamin D on the pathogenesis of PCOS and insulin resistance and its role in the treatment of PCOS.

Keywords: Vitamin D defiency; insulin resistance; polycystic ovary syndrome
REFERENCES:
  1. Stein I, Leventhal M. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181-5. [Crossref] 
  2. Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. [Crossref]  [PubMed] 
  3. Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev. 2016;37(5):467-520. [Crossref]  [PubMed]  [PMC] 
  4. Brakta S, Lizneva D, Mykhalchenko K, Imam A, Walker W, Diamond MP, et al. Perspectives on polycystic ovary syndrome: is polycystic ovary syndrome research underfunded? J Clin Endocrinol Metab. 2017;102(12):4421-7. [Crossref]  [PubMed] 
  5. 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. [Crossref] 
  6. Firouzabadi Rd, Aflatoonian A, Modarresi S, Sekhavat L, Mohammad Taheri S. Therapeutic effects of calcium & vitamin D supplementation in women with PCOS. Complement Ther Clin Pract. 2012;18(2):85-8. [Crossref]  [PubMed] 
  7. Sung CC, Liao MT, Lu KC, Wu CC. Role of vitamin D in insulin resistance. J Biomed Biotechnol. 2012;2012:634195. [Crossref]  [PubMed]  [PMC] 
  8. Yılmaz SA, Altınkaya SÖ, Kebabçılar A, Kerimoğlu ÖS, Pekin AT, Abuşoğlu S, et al. The relationship between polycystic ovary syndrome and vitamin D levels. Turk J Obstet Gynecol. 2015;12(1):18-24. [Crossref]  [PubMed]  [PMC] 
  9. Wimalawansa SJ. Vitamin D in the new millennium. Curr Osteoporos Rep. 2012;10(1):4-15. [Crossref]  [PubMed] 
  10. McCarty MF. Poor vitamin D status may contribute to high risk for insulin resistance, obesity, and cardiovascular disease in Asian Indians. Med Hypotheses. 2009;72(6):647-51. [Crossref]  [PubMed] 
  11. He C, Lin Z, Robb SW, Ezeamama AE. Serum vitamin D levels and polycystic ovary syndrome: a systematic review and meta-analysis. Nutrients. 2015;7(6):4555-77. [Crossref]  [PubMed]  [PMC] 
  12. Karadağ C, Yoldemir T, Yavuz DG. Effects of vitamin D supplementation on insulin sensitivity and androgen levels in vitamin-D-deficient polycystic ovary syndrome patients. J Obstet Gynaecol Res. 2018;44(2):270-7. [Crossref]  [PubMed] 
  13. Thomson RL, Spedding S, Buckley JD. Vitamin D in the aetiology and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2012;77(3):343-50. [Crossref]  [PubMed] 
  14. Panidis D, Balaris C, Farmakiotis D, Rousso D, Kourtis A, Balaris V, et al. Serum parathyroid hormone concentrations are increased in women with polycystic ovary syndrome. Clin Chem. 2005;51(9):1691-7. [Crossref]  [PubMed] 
  15. Gupta T, Rawat M, Gupta N, Arora S. Study of effect of vitamin D supplementation on the clinical, hormonal and metabolic profile of the PCOS women. J Obstet Gynecol India. 2017;67(5):349-55. [Crossref]  [PubMed]  [PMC] 
  16. Mahmoudi T. Genetic variation in the vitamin D receptor and polycystic ovary syndrome risk. Fertil Steril. 2009;92(4):1381-3. [Crossref]  [PubMed] 
  17. Trummer C, Pilz S, Schwetz V, Obermayer-Pietsch B, Lerchbaum E. Vitamin D, PCOS and androgens in men: a systematic review. Endocr Connect. 2018;7(3):R95-R113. [Crossref]  [PubMed]  [PMC] 
  18. Pergialiotis V, Karampetsou N, Panagopoulos P, Trakakis E, Papantoniou N. The effect of vitamin D supplementation on hormonal and glycaemic profile of patients with PCOS: a meta-analysis of randomised trials. Int J Clin Pract. 2017;71(6):1-8. [Crossref]  [PubMed] 
  19. Wehr E, Pieber TR, Obermayer-Pietsch B. Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: a pilot study. J Endocrinol Invest. 2011;34(10):757-63.
  20. Fang F, Ni K, Cai Y, Shang J, Zhang X, Xiong C. Effect of vitamin D supplementation on polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 2017;26:53-60. [Crossref]  [PubMed] 
  21. Irani M, Seifer DB, Grazi RV, Julka N, Bhatt D, Kalgi B, et al. Vitamin D supplementation decreases TGF 1 bioavailability in PCOS: a randomized placebo-controlled trial. J Clin Endocrinol Metab. 2015;100(11):4307-14. [Crossref]  [PubMed] 
  22. Corduk N, Abban G, Yildirim B, Sarioglu-Buke A. The effect of vitamin D on expression of TGF β1 in ovary. Exp Clin Endocrinol Diabet. 2012;120(8):490-3. [Crossref]  [PubMed] 
  23. Piperi C, Adamopoulos C, Dalagiorgou G, Diamanti-Kandarakis E, Papavassiliou AG. Crosstalk between advanced glycation and endoplasmic reticulum stress: emerging therapeutic targeting for metabolic diseases. J Clin Endocrinol Metab. 2012;97(7):2231-42. [Crossref]  [PubMed] 
  24. Irani M, Minkoff H, Seifer DB, Merhi Z. Vitamin D increases serum levels of the soluble receptor for advanced glycation end products in women with PCOS. J Clin Endocrinol Metab. 2014;99(5):E886-90. [Crossref]  [PubMed] 
  25. Cefalu WT. Insulin resistance: cellular and clinical concepts. Exp Biol Med (Maywood). 2001;226(1):13-26. [Crossref]  [PubMed] 
  26. Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am. 2004;33(2):283-303. [Crossref]  [PubMed] 
  27. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981-1030. [Crossref]  [PubMed]  [PMC] 
  28. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril. 2002;77(6):1095-105. [Crossref] 
  29. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Sur. 2004;59(2):141-54. [Crossref]  [PubMed] 
  30. Vrbı́ková J, Cibula D, Dvor̆áková K, Stanická S, Sindelka G, Hill M, et al. Insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004;89(6):2942-5. [Crossref]  [PubMed] 
  31. Al-Shoumer KA, Al-Essa TM. Is there a relationship between vitamin D with insulin resistance and diabetes mellitus? World J Diabetes. 2015;6(8):1057-64. [Crossref]  [PubMed]  [PMC] 
  32. Wimalawansa SJ. Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. J Steroid Biochem Mol Biol. 2018;175:177-89. [Crossref]  [PubMed] 
  33. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutr. 2004;79(5):820-5. [Crossref]  [PubMed] 
  34. Bland R, Markovic D, Hills CE, Hughes SV, Chan SL, Squires PE, et al. Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in pancreatic islets. J Steroid Biochem Mol Biol. 2004;89-90(1-5):121-5. [Crossref]  [PubMed] 
  35. Liu E, Meigs JB, Pittas AG, McKeown NM, Economos CD, Booth SL, et al. Plasma 25-hydroxyvitamin D is associated with markers of the insulin resistant phenotype in nondiabetic adults. J Nutr. 2008;139(2):329-34. [Crossref]  [PubMed]  [PMC] 
  36. Chiu KC, Chuang LM, Lee NP, Ryu JM, McGullam JL, Tsai GP, et al. Insulin sensitivity is inversely correlated with plasma intact parathyroid hormone level. Metabolism. 2000;49(11):1501-5. [Crossref]  [PubMed] 
  37. Özkan B, Döneray H. [Non-skeletal effects of vitamin D]. Çocuk Sağlığı ve Hastalıkları Dergisi. 2011;54:99-119.
  38. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92(6):2017-29. [Crossref]  [PubMed]  [PMC] 
  39. Maestro B, Campión J, Dávila N, Calle C. Stimulation by 1, 25-dihydroxyvitamin D3 of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells. Endocr J. 2000;47(4):383-91. [Crossref]  [PubMed] 
  40. Chen S, Villalta SA, Agrawal DK. FOXO1 mediates vitamin D deficiency-induced insulin resistance in skeletal muscle. J Bone Miner Res. 2016;31(3):585-95. [Crossref]  [PubMed]  [PMC] 
  41. Muscogiuri G, Policola C, Prioletta A, Sorice G, Mezza T, Lassandro A, et al. Low levels of 25(OH)D and insulin-resistance: 2 unrelated features or a cause-effect in PCOS? Clin Nutr. 2012;31(4):476-80. [Crossref]  [PubMed] 
  42. Selimoglu H, Duran C, Kiyici S, Ersoy C, Guclu M, Ozkaya G, et al. The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome. J Endocrinol Invest. 2010;33(4):234-8. [Crossref]  [PubMed] 
  43. Rashidi H, Ghaderian SB, Moradi L. The effect of vitamin D3 on improving lipid profile, fasting glucose and insulin resistance in polycystic ovary syndrome women with vitamin D deficiency. Middle East Fertility Society Journal. 2018;23(3):178-83. [Crossref] 

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