Purpose: To evaluate the effect of balanced hypocaloric diet therapy on the anthropometric and basic metabolic indicators in obese women with infertility. Methods: The follow up interventional clinical study included 23 infertile women in reproductive age with grade I gluteofemoral obesity . All patients have prescribed a balanced hypocaloric diet (1200 kcal/day), underwent exercise and behavioral therapy. Before and after 12 - month treatment, an anthropometric study was conducted, determining the level of metabolic and hormonal indicators. Results: The total final number of study participants was 20 patients. A decrease in body weight was achieved in 87% of patients from 4 to 24 kg, on the average, by 10.58 ± 5.70 kg, there was also a decrease in BMI from 32.53 ± 1.40 to 28.55 ± 2.50 kg/m2 (p < 0.001). The decrease in body weight was accompanied by a statistically significant decrease in leptin levels (p < 0.001), E1 (p = 0.049), E2 (p = 0.032), fasting glucose (p < 0.001), HOMA-IR (p = 0.002), cholesterol (p < 0.001), TG (p = 0.004), LDL-C (p = 0.001), atherogenic index of plasma (p <0.001) and an increase in progesterone levels (p = 0.030). Ovulatory menstrual cycles were resumed in all women (p = 0.007) and pregnancy occurred within a year in 1 patient. Conclusion: The implementation of a hypocaloric diet for 12 months in infertile women with first - degree obesity helps to normalize metabolic and hormonal indicators, reduces body weight and restores ovulatory menstrual cycle in all patients.
Currently, there is substantial evidence that obesity is a growing problem worldwide and is associated with serious health risks [
Obese pregnant women have also a higher risk of fetal death, newborn asphyxia and early neonatal death. The offspring of obese women has a higher incidence of certain malformations, macrosomia, malnutrition, cerebral palsy, epilepsy, and neuropsychic developmental disorders [
There is growing evidence that obesity can develop in utero. For example, Sellayah D. [
There is substantial evidence that obesity also affects reproductive potentials of women especially in those with PCOS resulting in infertility [
Weight loss during pregnancy planning is an important intervention, both to address fertility issues and to prevent adverse maternal and perinatal outcomes, as well as to prevent metabolic and cardiovascular disease in the offspring of these women [
Both medication [
The aim of this study was to evaluate the dynamics of anthropometric, hormonal and metabolic parameters in infertile obese women with a balanced hypocaloric diet.
A prospective, interventional study was conducted at the M.A. Podgorbunsky Kemerovo City Clinical Hospital No. 3 in the city of Kemerovo-Russian Federation. The study design was approved by the Ethics Committee of the Kemerovo State Medical Academy. Informed consent was obtained from all individual participants included in the study. The study initially included 23 patients. Criteria for inclusion in the study: reproductive age (18 - 45 years), the presence of gluteofemoral obesity of the first degree (BMI 30 - 34.9 kg/m2), anovulatory type of infertility. Exclusion criteria: age less than 18 and older than 45 years, other infertility factors (tubal, male and immunological factors), BMI less than 30 kg/m2 and more than 34.9 kg/m2, organic damage to the hypothalamic-pituitary region, adrenal glands (according to magnetic resonance imaging, computed tomography). Blood samples were taken from all participants after 12 - 14 hours fasting to determine the lipid profile and other hormonal levels before intervention and after 12 months.
All patients were prescribed balanced hypocaloric nutrition (1200 kcal/day) with physiological nutrient content: carbohydrates—50%, proteins—20%, fats—30% and fiber daily consumption of 30 - 40 g in dry form (grain and vegetables). Calorie distribution: breakfast—40%, lunch—40%, dinner—20%. If necessary, 2 - 3 additional meals were allowed. Physical exercises: walking 1 - 2 hours a day at a speed of 120 steps per minute. Behavioral therapy to correct eating disorders: diary of food and lifestyle, motivational phone calls every week.
Before and 12 months after inclusion in the study, all patients underwent a standard survey with filling out a statistical map, a general clinical examination, an anthropometric examination: measuring height, body weight, waist circumference (WC) and hip circumference (HC). Body mass index (BMI) was calculated by the formula: BMI = body weight (kg)/height (m2). The severity of obesity was determined in accordance with the recommendations of WHO [
The nature of the distribution of fat was determined by calculating the ratio of WC/HC. The sagittal diameter (SD) was determined in the position of the subject on the back using a ruler, measuring the conditional perpendicular from the upper edge of the trunk at the level of the iliac crest to the surface on which the subject was lying (cm). To calculate the indicators of fat volumes (V, l) and mass (M, kg) of total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) of anthropometric measurements the following formulas were used: VTAT (l) = 1.36 × body weight (kg)/height (m) − 42.0; VVAT (l) = 0.731 × SD − 11.5; VSAT (l) = VTAT (l) − VVAT (l); MTAT (kg) = VTAT × 0.923; fat-free mass (FFM, kg) = body weight (kg) − MTAT (kg).
The glycemic level in serum of capillary blood was determined by the glucose oxidase method (or the method of enzyme electrodes) on an empty stomach after 12 hours of fasting on an EXAN-G analyzer. Total cholesterol (cholesterol), triglycerides (TG), high-density lipoprotein cholesterol (HDL-cholesterol) were determined on an Express-550 biochemical multichannel analyzer, Ciba-Corning (Great Britain), after 16-hour fasting, using reagents Human (Germany), International Bio-Analytic Industries (USA). Total cholesterol was evaluated in the cleavage and oxidation reactions (using the peroxidase/phenol/n-amino-antipyrine system), triglycerides were determined after enzymatic hydrolysis with an enzymatic colorimetric test, and HDL-C using the precipitation method. Low-density lipoprotein cholesterol (LDL-C) and atherogenic index of plasma (AIP) were determined by the calculation method according to A. N. Klimov [
Hormonal studies were performed by enzyme-linked immunosorbent assay using standard kits Alkor Bio (Russia), Diagnostic system laboratories (DSL) (USA) in accordance with the instructions attached to the kits. The levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estrone (E1), estradiol (E2), and serum testosterone were studied on days 5 - 6 of the menstrual cycle, progesterone levels were evaluated on days 21 - 22 of the menstrual cycle. Determination of the content of leptin, immune-reactive insulin (IRI) was carried out regardless of the phases of the menstrual cycle. A small mathematical model of glucose homeostasis (Homeostasis Model Assessment—HOMA) was used to assess the degree of insulin resistance. The study of calorie and nutritional balance was carried out using a nutrition diary with daily self-control and doctor’s control, initially after 2 weeks, and then every month.
Statistical AnalysisStatistical processing of the results was carried out using the application package Excel 2000, Statistica 6.0. For each feature in the compared groups, the arithmetic mean value (M) and the mean square deviation of the samples (σ) were determined. The distribution of parameters in the groups was visualized using the corresponding frequency histograms. The hypothesis of equality of general means in the two compared groups was tested using the nonparametric Mann-Whitney U-test for independent samples. When comparing indicators in three or more independent groups, analysis of variance was used analysis of variance (non-parametric Kruskal-Wallis method) followed by pairwise posterior comparison of groups. To assess the significance of changes in symptoms in patients during treatment, the Wilcoxon W-test was used for dependent samples. Comparison of the general fractions (frequencies) was carried out using analysis of contingency tables (according to the χ2 criterion). The study of the relationship between quantitative traits was carried out using the Spearman rank correlation coefficient (r). As a method of mathematical modeling, cluster analysis was used to search for unknown patterns of relationship of signs. The study of the relationship between quantitative traits was carried out using the Spearman rank correlation coefficient (r). As a method of mathematical modeling, cluster analysis was used to search for unknown patterns of relationship of signs. The significance of the parameters in the distribution of cases (observations) by groups was evaluated using the Fisher F-test. The null hypothesis was rejected in all cases at a critical significance level of p < 0.05.
Twenty (87%) of the 23 women included in the study completed the treatment protocol. 3 patients dropped out of the study due to non-compliance with the diet regimen. These patients required the appointment of additional drug therapy. A decrease in body weight from 4 to 24 kg was found in all patients who completed the protocol by an average of 10.58 ± 5.70 kg (p < 0.001). The dynamics of the main anthropometric indicators in the examined patients, against the background of diet therapy, are presented in
The results of the study also showed that in study participants, against the background of diet therapy, there was a statistically significant decrease in BMI from 32.53 ± 1.40 to 28.55 ± 2.50 (p < 0.001). Waist circumference (WC) for 12 months of diet therapy decreased on average by 9 cm, from 94.18 ± 7.15 cm to 85.05 ± 8.86 cm (p < 0.001), Hip circumference HC (cm) also decreased from 114.90 ± 4.99 to 106.85 ± 5.61, p < 0.001 in addition, the WC/HC ratio decreased from 0.82 to 0.79 (p < 0.001). A statistically significant decrease in the volume of adipose tissue was recorded both due to subcutaneous and visceral fat and other indices p < 0.001). Indicators of hormonal and metabolic status against the background of ongoing diet therapy in infertile obese women are presented in
In the dynamics when using diet therapy in infertile obese patients with a decrease in body weight, a statistically significant decrease in leptin levels of 1.8 times (p < 0.001), E1 (p = 0.049), E2 (p = 0.032) and an increase in progesterone content (p = 0.030), which indicates the restoration of the ovulatory menstrual cycle. There was a statistically significant decrease in fasting glycemia (p < 0.001), the insulin resistance HOMA-IR decreased by 1.3 times (p = 0.002). Normalization of the blood lipid spectrum was noted: a decrease in the level of
Parameters | Before treatment | After treatment | P |
---|---|---|---|
Weight (kg) | 85.15 ± 8.62 | 75.10 ± 9.28 | <0.001 |
BMI (kg/m2) | 32.53 ± 1.40 | 28.55 ± 2.50 | <0.001 |
Waist circumference WC (сm) | 94.18 ± 7.15 | 85.05 ± 8.86 | <0.001 |
Hip circumference HC (сm) | 114.90 ± 4.99 | 106.85 ± 5.61 | <0.001 |
WC/HC | 0.82 ± 0.06 | 0.79 ± 0.07 | <0.001 |
Sagittal diameter (cm) | 23.85 ± 1.18 | 19.68 ± 2.01 | <0.001 |
Volume of total adipose fat tissue (VTAT), l | 29.0 ± 4.61 | 21.07 ± 5.44 | <0.001 |
Volume of visceral adipose tissue (VVAT), l | 5.95 ± 0.92 | 2.93 ± 1.36 | <0.001 |
Volume of subcutaneous adipose tissue (VSAT), l | 23.09 ± 4.12 | 18.09 ± 4.64 | <0.001 |
Mass of total adiposetissue (MTAT), kg | 26.77 ± 4.25 | 19.45 ± 5.02 | <0.001 |
Fat-free mass (FFM), kg | 58.34 ± 4.71 | 56.14 ± 4.19 | <0.001 |
Parameters | Before treatment | After treatment | P |
---|---|---|---|
FSH, IU/mL | 4.82 ± 1.34 | 5.04 ± 1.35 | 0.220 |
LH, IU/mL | 5.05 ± 1.55 | 4.67 ± 1.16 | 0.211 |
LH/FSH | 1.17 ± 0.52 | 1.09 ± 0.67 | 0.062 |
Immune-reactive Insulin, mIU/L | 11.96 ± 4.92 | 10.07 ± 4.90 | 0.054 |
Leptin, ng/ml | 56.32 ± 14.84 | 32.84 ± 15.11 | <0.001 |
Е1, pmol/l | 716.13 ± 457.88 | 575.54 ± 383.90 | 0.049 |
Е2, pmol/l | 97.00 ± 43.08 | 80.44 ± 25.86 | 0.032 |
Testosterone, nmol/l | 1.73 ± 0.80 | 1.75 ± 0.77 | 0.860 |
Progesterone, nmol/l | 18.97 ± 13.52 | 25.33 ± 11.99 | 0.030 |
Fasting blood sugar (FBS), mmol/l | 4.82 ± 0.64 | 4.25 ± 0.53 | <0.001 |
2 hours FBS, mmol/l | 5.04 ± 0.94 | 4.86 ± 0.65 | 0.289 |
HOMA-IR | 2.61 ± 1.06 | 1.92 ± 0.95 | 0.002 |
Cholesterol, mmol/l | 5.39 ± 0.80 | 4.81 ± 0.83 | <0.001 |
Triglycerides, mmol/l | 1.56 ± 0.62 | 1.19 ± 0.53 | 0.004 |
HDL, mmol/l | 1.31 ± 0.48 | 1.52 ± 0.51 | 0.092 |
LDL, mmol/l | 3.41 ± 0.66 | 2.61 ± 0.82 | 0.001 |
Atherogenic Index plasma (AIP) | 3.74 ± 1.67 | 2.39 ± 0.91 | <0.001 |
cholesterol (p <0.001), TG (p = 0.004), LDL cholesterol (p = 0.001), and Ka (p <0.001). When included in the study, 9 (45%) patients complained of menstrual irregularities (oligomenorrhea), 12 months after treatment, menstrual irregularities were absent in all women (p = 0.002). The biphasic ovulatory menstrual cycle recovered in all women, the desired pregnancy within a year occurred in 1 patient.
The results of the study showed that in women with a gluteofemoral type of obesity (BMI of 30 - 34.9 kg/m2), without pronounced disorders of carbohydrate and lipid metabolism, eating disorders, lack of arterial hypertension or the presence of transient arterial hypertension, minor hormonal disorders, with the presence of menstrual irregularities in a small number of cases, diet therapy in combination with a complex of physical exercises, psychotherapy and correction of eating behavior was highly effective active and allowed most of them to reduce and maintain their weight gain for 12 months to improve metabolic and hormonal indicators, normalize menstrual function, thus improving their reproductive capabilities. Our results are consistent with other reports [
The average loss of 10 kg during a 12-month period showed significant positive effect in all parameters studied. This decrease was due to the improvements in both visceral and adipose fat tissue volumes.
Our results showed that diet therapy corrected menstrual irregularities manifested as oligomenorrhea in all our participants. Central obesity is related to an increased risk of anovulation [
Most importantly, the intervention resulted in the improvement of both leptin, FBS and HOMA-IR which are very important aspects of PCOS-related infertility. In addition, all lipid profile indices improved specifically the LDL levels, which is a vital issue for the future risk of cardiovascular disease, highly prevalent in obese women [
A study by Rashad M. et al. [
Currently, there are epidemiological studies that have shown that as soon as a woman finds out about pregnancy, she should not change her lifestyle [
Despite the obvious evidence of the need to reduce body weight at the stage of pregnancy planning, the nature of nutrition at the preconception stage and during pregnancy in obese people is widely discussed. For example, a study by H Al Wattar B. [
In addition, according to van Elten TM [
One of the main weaknesses of this study is the relatively small number of participants. However, the main strengths are the fact that it is one of few papers that combined low fat diet and exercise to maximize the final effect and compressively explored biometric and hormonal dynamics before and after intervention.
In conclusion, the implementation of balanced hypocaloric diet for 12 months in infertile women with gluteofemoral obesity of the first degree contributes to the normalization of metabolic processes, weight loss and, in 100% of cases, the restoration of the ovulatory menstrual cycle and should be recommended to all women with infertility and obesity.
The authors thank all patients participated in this study.
The authors declare no conflicts of interest regarding the publication of this paper.
Artymuk, N.V., Sukhova, N.A., Tachkova, O.A. and Al-Jefout, M. (2019) The Effect of Balanced Hypocaloric Diet on the Anthropometric and Basic Metabolic Indicators in Infertile Women with Gluteofemoral Obesity. Open Journal of Obstetrics and Gynecology, 9, 1325-1335. https://doi.org/10.4236/ojog.2019.910128