DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212936

Association of serum ferritin with insulin resistance in women with polycystic ovarian syndrome

Taslima Begum, Shakeela Ishra, Begum Shaira Sharifa, Shamsun Nahar, Hosne Ara Begum, Sadia Sultana Khan, Mahbuba Khanum

Abstract


Background: Emerging scientific evidence has disclosed unsuspected influences between iron metabolism, insulin resistance and type 2 diabetes. Even mildly elevated body iron stores are associated with statistically significant increases in glucose homeostasis indices. But till now high serum ferritin associated with type 2 diabetes is not recognized as an entity in the current clinical guidelines for the management of type 2 diabetes.

Methods: This was a Cross sectional study carried out from September 2016 to March, 2017 at PCO clinic of infertility outpatient department (OPD), department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study population consisted of all the diagnosed PCOS patients. Purposive sampling Main outcome variable: serum ferritin level and insulin resistance index (Homeostatic model assessment of insulin resistance: HOMA-IR).

Results: Most of the (90.9%) patients were aged 20-30 years having BMI >25 kg/m2, mostly overweight (52.53%) or obese (25.25%). Significant increase of serum ferritin level (72.89±34.97; p=0.001) was noted in PCOS patients with insulin resistance. Marked increase in serum ferritin (82.81±31.57, p<0.001), fasting serum insulin (16.39±7.1; p<0.001), HOMA-IR (3.51±1.55; p<0.001) and more cases with insulin resistance (78.3%; p<0.001) were found in women with high ferritin level (when ≥45.5 ng/ml). Statistically significant strong positive correlation between serum ferritin level and fasting insulin level (r=0.528; p<0.001) as well as HOMA-IR (r=0.492; p<0.001) were observed.

Conclusions: These results demonstrated that elevated level of serum ferritin was associated with insulin resistance in PCOS women.


Keywords


Serum ferritin, Insulin resistance, Polycystic ovarian syndrome

Full Text:

PDF

References


Morreale HF, Ramirez M, Blasco F, Carretero JI, Sancho J, Millan JL. Body iron stores are increased in overweight and obese women with polycystic ovary syndrome. Diabetes Care. 2005;28(8):2042-4.

Morreale HF. Iron metabolism and the polycystic ovary syndrome. Trends Endocrinol Metab. 2012;23(10):509-15.

Ko PC, Huang SY, Hsieh CH, Hsu MI, Hsu CS. Serum ferritin levels and polycystic ovary syndrome in obese and nonobese women. Taiwan J Obstet Gynecol. 2015;54(4):403-7.

Crownover BK, Covey CJ. Hereditary hemochromatosis. Am Fam Physician. 2013;87(3):183-90.

Real JM, Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51(8):2348-54.

Jiang R, Manson JE, Meigs JB, Ma J, Rifai N, Hu FB. Body iron stores in relation to risk of type 2 diabetes in apparently healthy women. JAMA. 2004;291(6):711-7.

Judith AS, Donald AM. Iron and Diabetes Risk. Cell metabolism. 2013;17(3):329-41.

Wilson MS, Thompson EW. Venesection is an effective non-pharmacological treatment for patients with high serum ferritin type 2 diabetes. J Clinical Translational Endocrinol Case Rep. 2017;3:1-5.

Tuomainen TP, Nyyssonen K, Salonen R, Tervahauta A, Korpela H, Lakka T, et al. Body iron stores are associated with serum insulin and blood glucose concentrations. Population study in 1,013 eastern Finnish men. Diabetes Care. 1997;20(3):426-8.

Le TD, Bae S, Ed HC, Singh KP, Blair SN, Shang N. Effects of Cardiorespiratory Fitness on Serum Ferritin Concentration and Incidence of Type 2 Diabetes: Evidence from the Aerobics Center Longitudinal Study (ACLS). Rev Diabet Stud. 2008;5(4):245-52.

Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774-800.

March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544-51.

Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7.

Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod. 2014;29(4):791-801.

Unluturk U, Harmanci A, Kocaefe C, Yildiz BO. The Genetic Basis of the Polycystic Ovary Syndrome: A Literature Review Including Discussion of PPAR-gamma. PPAR Res. 2007;49109.

Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2012;(5):3053.

Jakubowicz D, Wainstein J, Homburg R. The link between polycystic ovarian syndrome and type 2 diabetes: preventive and therapeutic approach in Israel. Isr Med Assoc J. 2012;14(7):442-7.

Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update. 2010;16(4):347-63.

Lim SS, Davies M J, Norman R J, and Moran L J Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update. 2012;18(6):618-37.

Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.

Lee H, Oh JY, Sung YA, Chung H. Is insulin resistance an intrinsic defect in asian polycystic ovary syndrome?. Yonsei Med J. 2013;54(3):609-14.

Wang HS, Wang TH. Polycystic ovary syndrome (PCOS), insulin resistance and insulin-like growth factors (IGfs)/IGF-binding proteins (IGFBPs). Chang Gung Med J. 2003;26(8):540-53.

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.

Dumitrescu R, Mehedintu C, Briceag I, Purcarea VL, Hudita D. The polycystic ovary syndrome: an update on metabolic and hormonal mechanisms. J Med Life. 2015;8(2):142-5.

Sakumoto T, Tokunaga Y, Terada Y, Tanaka H, Nohara M, Nakaza A, et al. Implications of Insulin Resistance/Hyperinsulinemia on Reproductive Function in Infertile Women with Polycystic Ovary Syndrome. 2012.

Zamily HA. Iron Status and Lipid Profile in Irregular Cycle Women with Polycystic Ovary Syndrome. Int J Sci Res. 2015;4(10):1153-58.

Jehn M, Jeanne MC, Guallar E. Serum ferritin and risk of metabolic syndrome in U.S. adults. Diabetes Care. 2004;27:2422-28.

Emma A. Ferritin (serum, plasma). Association for Clinical Biochem. 2012;1-8.

Acton RT, Barton JC, Barton JC. Serum ferritin, insulin resistance, and metabolic syndrome: clinical and laboratory associations in 769 non-hispanic whites without diabetes mellitus in the HEIRS study. Metab Syndr Relat Disord. 2015;13(2):57-63.

Huang J, Karnchanasorn R, Ou HY, Feng W, Chuang LM, Chiu KC, et al. Association of insulin resistance with serum ferritin and aminotransferases-iron hypothesis. World J Exp Med. 2015;5(4):232-43.

Yousouf R, Khan M, Kounsar Z, Ahanga S, Lone A W. Polycystic Ovarian Syndrome: Clinical Correlation with Biochemical Status. Surgical Sci. 2012;3:245-8.

Wen PC, Cheng TYD, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutrition. 2008; 12(4):497-506.

Ehrmann DA, Sturis J, Byrne MM, Karrison T, Rosenfield RL, Polonsky KS, et al. Insulin secretory defects in polycystic ovary syndrome. Relationship to insulin sensitivity and family history of non-insulin-dependent diabetes mellitus. J Clinical Investig. 1995;96(1):520-7.

Pedersen SD, Brar S, Faris P, Corenblum B. Polycystic ovary syndrome: validated questionnaire for use in diagnosis. Can Fam Physician. 2007;53(6):1042-7.

Faranak S, Sahar M, Nouraddin M. High Serum Ferritin Concentrations in Polycystic Ovary Syndrome Is Not Related to Insulin Resistance. Iranian J Diabet Obesity. 2011;3(2):47-53.

Jung CH, Lee MJ, Hwang JY, Jang JE, Leem J. Elevated Serum Ferritin Level Is Associated with the Incident Type 2 Diabetes in Healthy Korean Men: A 4 Year Longitudinal Study. PLoS ONE. 2013;8(9):75250.