Weight Gain Caused By Polycystic Ovary Syndrome in Us African American Women Leads to Diabetes

 

 Abstract

Polycystic ovary syndrome (PCOS) is a reproductive disorder causing complications in health conditions and affecting metabolic processes. PCOS increases insulin resistance (IR) type 2 diabetes, cardiovascular diseases, and obesity among women within the childbearing age, 18-45 years. The purpose of this research is to examine how weight gain caused by polycystic ovary syndrome in African American women leads to diabetes. The research reveals that this syndrome is common among women of color, African American women, as opposed to white, which is attributed to environmental and genetic factors. Ethnicity has also been a factor that can be responsible for PCOS. However, the ideal cause of the disorder remains unclear, which makes its diagnosis difficult among medical experts. The use of Ferriman-Gallwey method and Rotterdam Criteria have been used for the diagnosis of PCOS.

Keywords: Polycystic ovary syndrome, PCOS, Insulin Resistance, Diabetes, Obesity, Childbearing age, African American.

 

Weight Gain Caused By Polycystic Ovary Syndrome in US African American Women Leads to Diabetes

Introduction

Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women in their productive age. PCOS is a problem that causes infertility among women, with a prevalence of between 5 to 12 percent of United States women in their reproductive age. Studies have revealed that across the world 80 percent of overweight and obese women, with PCOS were from the US. A common cause of this reproductive complication is a hormonal disorder in women of childbearing age. This problem is found in women with high levels of male hormones, which are less sensitive to insulin, making them overweight. The latter is known to increase risks of diabetes, sleep apnea, uterine cancer, and heart diseases. As stated previously, PCOS makes the body develop problems in using the insulin hormone, which is useful in the conversion of sugars and starch into energy. This makes glucose build in the bloodstream, insulin concentrates causing the development of androgens, the male hormones, which is responsible for body hair growth, irregular periods, and weight gain, obesity.

Although this complication affects all women within the childbearing age, its prevalence among women of color, African American, is much severe. According to the American journal of obstetrics and Gynecology, PCOS affects women of color more frequently and severely than white women. This reproductive syndrome is associated with metabolic syndrome. In order to understand prevention strategies for PCOS, it is essential to examine the racial and ethical differences in metabolic syndrome among women. The blacks and the Latinx have been found to have higher morbidity and mortality, which results from cardiovascular diseases and diabetes (Barber et al., 2019). These black women also have greater hyperinsulinemia and insulin resistance when compared with white women. A reason for the increased cases of this problem is that black women feel that they do not get proper treatment and thus foregoing treatment. This paper is research to evaluate how weight gained by PCOS is responsible for causing diabetes among US African American women.

Aims and Objectives

The purpose of this research is to examine how weight gain caused by polycystic ovary syndrome leads to diabetes in women. To narrow down the discussion the study focuses mainly on the African American women living in the US. By the end of this study, we will be able to point out the differences in severity of PCOS between African American women and whites.

Research Purpose

The purpose of this research is to validate the research topic on how “weight gain caused by polycystic ovary syndrome in us African American women leads to diabetes.” More precisely we will find out;

• How PCOS causes diabetes among women
• Why PCOS affects African American women more severely than the whites

Hypothesis

Various statements of hypothesis can be formulated based on the research topic, which then can be validated at the end of the research. Some of these hypotheses include:

• There is no relationship between PCOS and diabetes in women.
• There is no association between PCOS and women of color.

 

Literature Review

Polycystic Ovary Syndrome (PCOS) in the United States and African Women

In the United States, reports from statistics show that the prevalence of obesity and overweight is a common feature of polycystic ovary syndrome (PCOS). In addition, obesity and overweight associated with obesity prevail to over 80% within the United States and reduces in African women. Primarily, this implies that environmental factors such as lifestyle stimulate obesity development in the obesity and polycystic ovary syndrome. However, the relationship between weight gain and PCOS is biological, for instance, obesity (weight gain) increases the vulnerability of many reproductive and metabolic disorders or abnormalities associated with PCOS. It is important to understand that obesity and weight gain are related, but does not mean the same thing (Rosen et al., 2018). For instance, a woman may gain weight, and this does not mean that she is obese. Women in America and Africa who experience PCOS are likely to gain weight, which further leads to diabetes. Also, PCOS is associated with health risks such as type 2 diabetes, infertility, high cholesterol, liver diseases, obesity, high blood pressure, metabolic syndrome, depression, and anxiety among others.

Insulin Resistance and Weight Gain

Boles et al (2017) also add that PCOS is associated with insulin resistance and weight gain. Moreover, polycystic ovary syndrome refers to an endocrine system disorder that interferes with the productivity of women in their productive years. The major signs associated with PCOS include changes in menstrual cycles, excess air growth, and this may lead to infertility. Also, most women suffering from this condition develop type 2 diabetes before reaching menopause. At this age, many women are reported to have obesity and overweight. Since the genes responsible for PCOS are not yet clear, there is a likelihood that these genes may also influence weight gain in women in their productive years. However, the author emphasizes that some environmental factors such as lack of physical exercise and high-weight diets increase the chances of weight gain and obesity in women with PCOS condition.

PCOS and Women Productive Age

According to Barber et al (2019), polycystic ovary syndrome is an endocrine disorder that shows up in the reproductive age of women. In addition, it entails anovulation, clinical signs of hyperandrogenism, and polycystic ovaries. Primarily, PCOS is categorized as a plus-metabolic syndrome, as it is associated with long-term health risks such as infertility, obesity, fibrinolytic alterations, and diabetes mellitus (insulin resistance). PCOS is closely related to weight gain and obesity, and these features precede as ovulatory cycles begin. Insulin resistance during the PCOS is stimulated visceral adiposity, which causes reproductive and abnormalities in body metabolism activities. Moreover, weight gain is associated with irregular menstrual cycles, hyperandrogenemia, and hirsutism. The intensity of obesity and weight gain in women with PCOS is greater as compared to their lean counterparts. According to his work, he suggests that polycystic ovary syndrome is not necessarily related or rather associated with weight gain, obesity, and metabolic syndrome. In agreement, women with PCOS are vulnerable to developing type 2 diabetes and gestational diabetes mellitus.

PCOS and Gestational Diabetes Mellitus (GDM)

Behboudi-Gandevani et al (2016) insist that polycystic ovary syndrome and gestational diabetes mellitus (GDM) are major endocrine disorders that manifest in the productive age of women.  These disorders are related in that they are associated with weight loss or obesity and insulin resistance. Studies and reports show that PCOS increases the risks of GDM. However, overweight gained during the PCOS condition is an indicator of GDM. From the research, the authors concluded that PCOS is not an independent risk factor for gestational diabetes mellitus and that the prevalence of GDM in women with PCOS is related mainly to adiposity.

Weight Gain, Obesity and Diabetes (Type 2 Diabetes)

According to Rubin et al (2017), PCOS affects 5 to 20% of women who are productive worldwide. Most importantly, the condition entails hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology (PCOM). In this context, metabolic dysfunction increases the risks of type 2 diabetes. This is because it causes insulin resistance and hyperinsulinemia in metabolism activities thus affecting individuals. Besides, PCOS may lead to other complications such as gestational diabetes, pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular diseases, and endometrial cancer (Mozaffarian, 2016). Individuals that are overweight (excess weight around the tummy) or obese are at greater risk of developing type 2 diabetes.

Body Metabolism and Obesity (Weight Gain)

According to Li et al (2017), statistics report that abdominal fat triggers the release of pro-inflammatory chemicals. These chemicals reduce the ability of the body to be sensitive to the production of insulin thus affecting the functionality and the ability of insulin-responsive cells, a condition known as insulin resistance. On the other hand, weight gain also triggers some changes in the body’s metabolism. The change is associated with the release of fat molecules from the adipose tissue into the blood. This further affects the efficiency of insulin-responsive cells leading to reduced sensitivity. In general, the obesity and weight gain associated with PCOS could lead to type 2 diabetes as they cause prediabetes, a metabolic condition that automatically develops into type 2 diabetes. The role of weight gain and obesity in type 2 diabetes is related to insulin resistance, for instance, weight loss plays an important role in controlling type 2 diabetes.

Weight Gain and PCOS

The relationship between weight gain and PCOS is not denial. Women with PCOS are more vulnerable to problems associated with insulin resistance and weight gain. Also, these women instead of having a pear shape, instead they have an apple shape. PCOS makes it difficult for the body to utilize insulin hormone, which plays an important role in converting starch and sugar from food into energy (Dokras et al., 2016). This leads to a condition commonly known as insulin resistance. This leads to the production of large amounts of male hormones (androgens) in women, leading to symptoms such as rapid hair growth, acne, weight gain, and irregular periods. However, the weight gained with women experiencing PCOS is a major determinant factor of diabetes (type 2 diabetes).

Methods

The success of the research is determined by the participants who are examined. Participants play the most important role, in providing information that is needed for the research. For this research, the group of respondents needed are the women, within the childbearing age and again who adults are. Then we would request females aged 18-45 to participate, both from the African American and the white. Now that every female within this age group cannot be included in the research we selected a sample of 369 women, 174 white and 195 African American women. The primary objective was to examine the prevalence of PCOS for Black women, and how this is associated with diabetes in the US. For the success of this occupational health, nurses were trained on how to use the modified Ferriman-Gallwey method, to measure the degree of hirsutism. The purpose of this score was to quantitate the presence of terminal hairs over nine body parts, upper lips, and chest, and chin, upper and lower abdomen, upper and lower back thighs, and upper arms.

Women are entitled to see nurses investigate the extent of hirsutism. The nurses would record the presence of acne, and apply a specific system. In order to maximize uniformity among all the respondents the F-G score, women with a score above 3 would be recalled and hirsutism was re-scored by the investigators. Also, to minimize treatment bias all women regardless of hormonal therapy were included. For these women the history of the menstrual cycle is determined before performing a hormonal or surgical therapy, to establish the reason for treatment. The investigation of circulating androgen levels will also be determined but not for women receiving the hormonal treatment. It must be noted that for participation the intended should do so with informed consent and the entire study approved by the research institutional review.

Discussion

Causes, Risk Factors, and Diagnosis

PCOS is a condition whose prevalence is high in developed countries a good example being the US, with a prevalence of 5-12 percent of the females. This is a polygenic condition mainly attributed to genetic and environmental factors. However, in recent days, the majority of research reveals that this is a defect in insulin action is the core cause of PCOS. Giving a clear picture of the environmental factors, it has been discovered that they contribute to the pathogenesis of PCOS. Besides, the socio-economic status and unhealthy behavior which include a poor diet, lack of exercise, and smoking which is an exercise common with the African American community, is a common reason which is a result of increased obesity. Similarly, with the high rate of co-morbidity in PCOS.

Additionally, genetic factors have been found to play a very important role in causing PCOS, passed from fertile carrier males to sub-fertile females, which is commonly evident in high familial rates of hyperandrogenism as well as type diabetes, in first-degree relatives of women with PCOS. On the contrary, various studies have been revealed that ethnicity is also associated with PCOS, where the prevalence among the Blacks was found to be 10 percent and about 5 percent among the white women. But it must be noted that this study is among women between 18 – 45 years, which is deemed as the productive age.

For diagnosis, there are three diagnostic features used for PCOS, mainly using the Rotterdam Criteria. These features include anovulation, hyperandrogenism, and polycystic ovaries. Therefore, for a woman to be diagnosed with the disorder she must portray at least two of the latter symptoms. However, based on reports anovulation, among the three features is the most common phenotype among the PCOS patients, with over 95 percent of women. On the other hand, hyperandrogenism is also persistent with approximately 60 percent of women, assessed biologically by measuring the circulating androgen levels (Sam, 2007). In addition, polycystic ovaries (PCOS) are also used in the diagnosis, though it alone cannot guarantee PCOS. Women with PCOS have been revealed to develop a more consistent menstrual cycle as they grow older, with the androgen levels decreasing and the insulin resistance decreasing.

PCOS and Associated Health Conditions

Some various health complications are associated with PCOS, with some of them resulting in long-lived effects. For this reason, our concern is basically on metabolic complications, obesity, and cardiovascular risks. Women with insulin resistance (IR) have a prevalence of between 60-80 percent with PCOS and 95 percent of them were found to be obese. Obesity was found to be caused by metabolic disturbances, which is the cause of anovulation, hyperandrogenism, and cardiovascular risks (Li et al., 2017). In addition, it causes gestational diabetes, glucose tolerance, and type 2 diabetes. Further, obesity has been found present in at least 30 percent of PCOS patients, the majority of women living in the United States.

Obesity and ages are responsible for increased risks of cardiovascular problems. Also, further studies have revealed that increased risks of cardiovascular risks are a result of increased severity of PCOS among women whether obese or not. There is a need to study the clinical characteristics of women beyond childbearing age to determine the risks, which would be useful in the development of prevention of this risk and its associated cardiovascular problems (Sam, 2007). Other complications include neurological and psychological functions, cancer among women, and infertility. The latter is caused by menstrual irregularities, which is a symptom of PCOS.

Conclusion

In general, PCOS is a common disorder among women within their reproductive age. This complication reveals itself with complications that are long-lived. Its prevalence among women in the United States has been high in the African American women as opposed to the whites, with a prevalence of about 10% and 5% respectively. However, the complex diagnostic criteria and wide complexity characteristics have been a challenge with this syndrome. Lower socioeconomic status, poor environmental factors, and genetics have been discovered to be the major cause of the high prevalence of PCOS, among African American women. PCOS is the reason for weight gain and thus obesity. Future research should determine the genetics and pathophysiology risk factors of PCOS, which will help in realizing successful treatment modalities for this syndrome.

 

References

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Dokras, A., Sarwer, D. B., Allison, K. C., Milman, L., Kris-Etherton, P. M., Kunselman, A. R., ... & Legro, R. S. (2016). Weight loss and lowering androgens predict improvements in health-related quality of life in women with PCOS. The Journal of Clinical Endocrinology & Metabolism, 101(8), 2966-2974.

https://www.cdc.gov/diabetes/basics/pcos.html

https://www.medicalnewstoday.com/articles/265309

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Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation, 133(2), 187-225.

Rosen, E. D., Kaestner, K. H., Natarajan, R., Patti, M. E., Sallari, R., Sander, M., & Susztak, K. (2018). Epigenetics and epigenomics: implications for diabetes and obesity. Diabetes, 67(10), 1923-1931.

Rubin, K. H., Glintborg, D., Nybo, M., Abrahamsen, B., & Andersen, M. (2017). Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3848-3857.

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