Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : BC05 - BC09 Full Version

Correlation of Serum Leptin with Body Mass Index and Insulin Resistance in Polycystic Ovarian Syndrome in a Tertiary Care Centre of Southern Odisha, India


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57527.17126
Prachi Jena, Rasmita Kumari Padhy, Devi Prasad Pradhan, Nirupama Devi

1. Senior Resident, Department of Biochemistry, MKCG Medical College, Berhampur, Odisha, India. 2. Associate Professor, Department of Biochemistry, MKCG Medical College, Berhampur, Odisha, India. 3. Assistant Professor, Department of Biochemistry, MKCG Medical College, Berhampur, Odisha, India. 4. Professor, Department of Biochemistry, MKCG Medical College, Berhampur, Odisha, India.

Correspondence Address :
Dr. Prachi Jena,
Senior Resident, Department of Biochemistry, MKCG Medical College, Berhampur-760004, Odisha, India.
E-mail: jenaprachi@gmail.com

Abstract

Introduction: Leptin is an adipocyte derived hormone encoded by ob gene which serves as a relay link between metabolic signals and brain that regulate the hypothalamic pituitary ovarian axis. Leptin is related with obesity, which is a most important cause of Polycystic Ovarian Syndrome (PCOS) in women of reproductive age group.

Aim: To evaluate leptin concentration and to analyse its correlation with Body Mass Index (BMI) and insulin resistance in PCOS.

Materials and Methods: This case-control study was conducted from December 2018 to December 2019 at Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 60 PCOS subjects, aged between 15-30 years (30 obese PCOS and 30 lean PCOS) and 30 age-matched, normal ovulatory healthy controls were included in the study. Parameters such as serum leptin, fasting plasma insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), Fasting Plasma Glucose (PPG), Postprandial Plasma Glucose (PPPG) were estimated using commercial kits. One-way Analysis of Variance (ANOVA) test was used for data analysis and the Pearson’s correlation method was used to find the correlation between the parameters.

Results: The mean age of women in all the three PCOS groups was found to be 22.4±3.13 years. The BMI of obese PCOS patients (31.9±4.7 kg/m2) and lean PCOS patients (21.4±2.2 kg/m2) were higher than that of healthy controls (20.7±1.8 kg/m2) which was statistically significant (p-value <0.001). The serum leptin in obese PCOS were significantly higher (28.0±17.8 ng/mL) than lean PCOS (5.8±2.2 ng/mL) and fasting plasma insulin in lean PCOS were (10.9±2.4 μIU/mL) significantly lower than obese PCOS (30.2±14.8 μIU/mL). Mean serum leptin levels had significant positive correlation with BMI in lean and obese PCOS and insulin resistance in obese PCOS.

Conclusion: In the present study, high leptin concentration was observed in PCOS patients and there was positive correlation of leptin with BMI in both lean and obese PCOS groups and leptin was positively correlated with insulin resistance in obese PCOS.

Keywords

Adipocyte, Basal metabolic index, Obesity, Plasma glucose

The PCOS is characterised by irregular or absence of menstruation, acne, hirsutism and obesity. In developed countries, approximately 5-10% of the female population are affected with PCOS which is a complex metabolic, endocrine and reproductive disorder (1). The PCOS is commonly seen in countries having higher prevalence rate of obesity and type 2 diabetes (2). The women with PCOS vary in degrees of weight, out of total PCOS cases 30-75% of cases are mostly overweight or obese associated with central obesity (3). The central obesity is associated with insulin resistance, hyperinsulinaemia, type 2 diabetes, hyperandrogenaemia, metabolic syndrome and infertility (4). There appears to be a link between symptoms associated with PCOS with either high androgen or insulin hormone levels (5),(6). However, it cannot be concluded that, not all women with polycystic ovaries have PCOS and not all women with PCOS have polycystic ovaries (7). Presently, PCOS is diagnosed using Rotterdam criteria (2003): two out of the three following features i.e., Ovulatory dysfunction (<21 or >35 days), Hyperandrogenism (clinically or biochemically), Polycystic ovaries in ultrasound with exclusion of thyroid disease (TSH), hyperprolactinemia (prolactin) and Non classical Congenital Adrenal Hyperplasia [NCCAH (17-hydroxy progesterone)] (8).

Adipose tissue produces Leptin which is a product of ob gene of chromosome 7, which is not only responsible for causing obesity, but also has a long list of endocrine functions (9). Higher and lower levels of leptin are also related with infertility though the mechanism of involvement is still undiscovered (10),(11). There is association of leptin and its receptors in PCOS associated with obesity and insulin resistance (12),(13). High serum level of leptin was found in obese women (14). If the inter-relationship between leptin, obesity, and insulin action is taken into consideration then there might be a role of Leptin in the pathophysiology of PCOS. Hence, PCOS patients may serve as a reliable study population for the assessing the relationship between hyperinsulinaemia with leptin concentrations besides its association with obesity (15). No relevant documentation about the role of leptin and its association with insulin in pathophysiology in PCOS was found in Southern Odisha. Thus, the present study sought to evaluate leptin concentration and its correlation with insulin resistance and BMI in patients with PCOS. This study is a part of authors previous research thesis titled “Evaluation of leptin concentration, insulin resistance and its correlation with reproductive hormones” which was done to assess role of leptin with reproductive hormones in PCOS by the same authors with same sample size, study duration and demographic data (16).

Material and Methods

This case-control study was conducted from December 2018 to December 2019 at Department of Biochemistry in collaboration with Department of Obstetrics and Gynaecology, MKCG Medical College and Hospital, Berhampur, Odisha, India after obtaining Institutional ethical clearance [IEC 673/2018]. Both case and control groups gave informed consent for participation in the study.

Inclusion criteria: Newly diagnosed PCOS cases aged between 15-30 years as per Rotterdam Criteria who came to Gynaecology Outpatient Department (OPD) (8) were included. Healthy age-matched normal ovulatory females were randomly chosen from attendants of patients, nursing and MBBS students and from general populations with BMI <25 kg/m2.

Exclusion criteria: Subjects with family history of any chronic illness such as diabetes, hypothyroidism, women using oral contraceptive pills or insulin sensitising drugs atleast three months prior to study period were excluded from the study. Women with dysmenorrhoea, infertility due to tubal blockage and other pelvic abnormality were also excluded from the study.

Sample size calculation: From the previous data records it was observed that on an average 25 to 30 cases of PCOS had visited the Gynaecology OPD of MKCG MC, Berhampur per month. So on an average 15 newly diagnosed PCOS cases as per the Rotterdam criteria (8) and considering the exclusion criteria with attrition of 5%, data collection was done for four months dedicated to sample collection as a convenient purposeful sampling comprised of 60 patients.

According to the BMI, the cases were divided into two groups as lean PCOS group with BMI <25 kg/m2 and obese PCOS group with BMI ≥25 kg/m2. Thirty healthy age-matched normal ovulatory females with BMI <25 kg/m2, were included as controls. The menstrual history of last menstrual period, amenorrhoea, dysmenorrhoea, oligomenorrhoea, infertility due to tubal blockage and other pelvic abnormality were taken according to a predesigned data collection proforma. The anthropometric measurements like height, weight and BMI were collected.

Study Procedure

A total of 5 mL of blood sample was collected on day 2-3 of menstrual cycle of all controls and blood of PCOS cases were collected independently of menstrual cycle due to irregular menses and were labelled properly and serum was stored at -20ºC.

The routine biochemical parameters were assayed using commercially available kits (AGAPPE Diagnostics Ltd.) by TOSHIBA 120 FR auto analyser. Thyroid profile, serum Luteinising Hormone (LH), FSH and Prolactin (assessed for diagnostic purpose only), fasting plasma insulin, FPG and PPPG were assayed by Roche Cobas e411 electrochemiluminescence and both the internal and external quality control were maintained. All the normal ranges of parameters are mentioned in (Table/Fig 1) (17),(18),(19),(20).

Estimation of Serum Leptin

The serum leptin level was assayed by using commercial kit of Diagnostic Biochem Canada Inc, in a sandwich type of enzyme immunoassay. This enzyme immunoassay technique uses two highly specific monoclonal antibodies. One of them is a monoclonal antibody specific for leptin and another is monoclonal antibody specific for different epitope of leptin which is conjugated to biotin (17),(18).

Estimation of HOMA-IR

Insulin resistance was calculated using the HOMA-IR using the following formula:

HOMA-IR=[fasting glucose (mg/dL)×fasting plasma insulin (mU/mL)/
405]

or

HOMA-IR=[fasting glucose (nmol/L)×fasting insulin (μU/mL)/22.5]

HOMA-IR value <3 is categorised as normal, 3-5 as moderate and >5 as severe insulin resistance (21),(22).

Statistical Analysis

The statistical analysis of the data was done using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 25.0. Data analysis was done using one-way Analysis of Variance (ANOVA) test and represented as represented as mean±standard deviation, correlation was calculated by using the Pearson’s correlation method and their relationship between variables was shown by scatter plot. A ‘p-value of <0.05 was taken as significant.

Results

Both the study population were age-matched. The control group did not have any gynaecological abnormality. Out of the 60 PCOS cases, 65% presented with history of amenorrhoea and 35% with oligomenorrhoea of more than two months duration.

The mean age in PCOS women in all the three groups were found to be (22.5±2.8 years) in controls, (22.0±2.8 years) in lean PCOS and (22.8±3.7 years) in obese PCOS which were statistically not significant (p=0.602). The mean BMI of lean and obese PCOS patients were (21.4±2.2 years) and (31.9±4.7 years) respectively which was higher than that of healthy controls and was statistically significant (p<0.001) (Table/Fig 2).

The mean PPPG of lean and obese PCOS patients were (118.2±15.5 mg/dL) and (120.9±19.6 mg/dL) respectively which was higher than that of healthy controls (110.03±8.9 mg/dL) and was statistically significant (p=0.020). There was no statistically significant difference observed in case of FPG level in all groups (p=0.076). The mean values in lean and obese PCOS of HOMA-IR (2.15±0.7, 6.9±3.7) and serum leptin (5.8±2.2, 28.0±17.8) were respectively, which were higher among both the case groups than the healthy controls and was found to be statistically significant (p<0.001) (Table/Fig 3).

There was significant positive correlation of serum leptin with BMI in lean PCOS (r=0.549, p=0.002) and obese PCOS (r=0.802, p<0.001). There was significant positive correlation of serum leptin with PPPG in obese PCOS (r=0.361, p=0.016) but fasting plasma glucose did not correlate with leptin in any study population. Fasting plasma insulin level in lean PCOS (r=0.384, p=0.036) and obese PCOS (r=0.556, p<0.001) groups had positive correlation with leptin which was statistically significant. HOMA-IR positively correlated with serum leptin only in obese PCOS (r=0.517, p=0.003) which was statistically significant (Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9).

Discussion

In the present study, it was observed that FPG was in normal range and no statistical difference in FPG levels between cases and controls. However, the PPPG values were significantly higher in obese PCOS cases than lean category of PCOS and controls with significant statistical difference between cases and controls. So, it may be concluded that obese PCOS having impaired glucose tolerance are more prone to develop type 2 diabetes mellitus. Similar study done by Bala M et al., found no statistical difference in FPG level, however HbA1c levels in cases were increased which were statistically significant showing that PCOS cases are prone to develop diabetes (23).

In the present study, the serum leptin level was significantly raised in obese PCOS cases as compared to lean PCOS and healthy controls which had significant positive correlation with body weight and BMI. Erturk E et al., and Jalilian N et al., had found positive association of serum leptin with BMI (24),(25). Chakrabarti J and Sadaria RG and Ravi BV study findings corroborate this study findings which has significant positive correlation between serum leptin and BMI in PCOS (p-value <0.001) (9),(26). Thus, leptin is secreted from adipocytes into circulation, acting as a sensing hormone to hypothalamus to inform the brain about excess amount of fat present in the body (27).

The fasting plasma insulin level was significantly increased in obese PCOS cases than lean and controls (p<0.001). The HOMA-IR value was greater in obese PCOS than lean and controls indicating that insulin resistance was significantly higher in obese PCOS. In this study, positive correlation was observed between serum leptin levels with HOMA-IR which was similar to the study conducted by Jahromi BN et al., their study found out positive correlation of leptin and insulin with BMI in obese PCOS which explains that adipose tissue plays a dynamic role in overall energy homeostasis of the body and reproductive system (HPO axis) by acting as an endocrine organ (28).

The present study was similar with Hahn S et al., and Mohiti-Ardekani J et al., they have shown that serum leptin values higher in obese patients who also have higher insulin resistance confirming the association between them and suggesting that hyperinsulinaemia leading to insulin resistance causes hyperleptinaemia. So, insulin resistance and hyperinsulinaemia may also be the factors that affect serum leptin levels (29),(30). Mendonca HC et al., also found the correlation between leptin, insulinaemia and BMI and observed that serum insulin levels were increased in PCOS patients, who were normal weight PCOS and obese PCOS (31). This result suggests that insulin resistance does not only depend on obesity but also presence of PCOS.

Erturk E et al., stated that serum leptin level correlate with obesity but not with insulin level in PCOS (24). However, in the same year Moschos S et al., in their study on leptin gene expression in PCOS showed that that insulin causes hyperleptinaemia which leads to leptin resistance (32). Chakrabarti J and Athrey M et al., suggested that hyperleptinaemia in PCOS may have a masking effect in hyperinsulinaemia. Insulin could increase leptin mRNA in adipocytes and has a possible role in stimulating leptin secretion. Increased serum leptin level leading to leptin resistance will further increase obesity leading to development of metabolic syndrome and cardiovascular disease (9),(33).

Leptin is satiety hormone that sends signal to hypothalamus in brain about the energy homeostasis. In case of obesity, the signalling pathway is hampered i.e., despite having abundant body fat stores the body continue to secrete increased level of serum leptin that stimulate brain to increase food intake, thus leads to leptin resistance. While copious amount of leptin may be present, the brain doesn’t get appropriate signals, so it erroneously thinks body is starving even though it has more than enough energy stored. Hyperleptinaemia in obese PCOS is due to leptin resistance (28).

Ovary is a dynamic multicompartmental organ with ever-changing tissue which is under the chief regulatory control of hypothalamic-pituitary axis. In many reproductive functions such as gametogenic and steroidogenic activities of ovary, leptin has emerged as potential peripheral signal and regulator (9). Leptin is now considered as a possible link between nutrition and reproduction and may be directly associated with obesity by preserving homeostasis of energy which is associated with reduced food intake and increased energy spending (10). It is observed that high leptin levels are presumed to exert a negative influence on the normal ovarian function and fertilisation which is required for the development of the embryo and decreased leptin levels disrupt the neuroendocrine regulation of reproduction (15). The concept of leptin resensitisation has evolved as a new hypothesis, that refers to the reversal of leptin-resistant states which is linked to reduction of body adiposity and leptinaemia (34).

Limitation(s)

Present study did not evaluate the other reproductive parameters like testosterone and estradiol hormones which may have association with leptin in PCOS due to unavailability of test parameters. The sample size of the present study was less and were enrolled using convenient sampling.

Conclusion

Mean serum leptin levels were increased in obese PCOS group than lean PCOS group and healthy controls which had significant positive correlation with BMI and insulin resistance. PCOS patient of insulin resistance and leptin resistance can be treated with insulin sensitising agents, such as metformin, to improve endocrine and metabolic disturbances to reduce long-term health risks. Large sample size with estimation of other hormones like oestrogen, testosterone and HbA1c can be done for further assessment which were not feasible in the present study. Genetic polymorphism on leptin gene and fat mass and obesity associated (FTO) gene can be done to find out their influence on pathophysiology of PCOS.

Acknowledgement

The authors thank all staff of Biochemistry section of Regional Diagnostic Centre for their constants support and Department of Obstetrics and Gynaecology of MKCG Medical College for allowing to collect information and sample from appropriate patient.

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DOI and Others

DOI: 10.7860/JCDR/2022/57527.17126

Date of Submission: May 03, 2022
Date of Peer Review: Jun 04, 2022
Date of Acceptance: Jul 20, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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