long term weight management to promote reproductive health in over weight/obease women with...
TRANSCRIPT
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LONG TERM WEIGHT
MANAGEMENT TO PROMOTE REPRODUCTIVE HEALTH IN
OVER WEIGHT/OBEASE WOMEN WITH POLYCYSTIC
OVARIAN SYNDROME.
DR.PREMA.H.S,
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INTRODUCTION
• Obesity in women induces a range of co-morbidities like irregular menstrual cycle, anovulatory infertility, hirsutism, acne, hyperinsulinemia, dyslipidemia and hyperandrogenism. These are said to constitute the polycystic ovarian syndrome
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• PCOS is an excellent example of a syndrome for which early recognition and intervention of -
• Weight control• Diet modification• Life style changes • Prevent or delay the development of further
problems.• Hence long-term holistic interest is needed
to correct the reproductive health of the affected women.
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Objectives
• To evaluate the somatic status of the obese women with PCOS.
• To evaluate the relationship between obesity and PCOS.
• Planning and evaluating the wt. management in reversal of the condition
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SELECTION OF SUBJECTS
• subjects having a BMI greater than 25 with the clinical manifestation of menstrual irregularities, were selected.
• While selecting the subjects it was found out that some of them are with or with out hirsutism, acne, dyslipidemia, hyprerinsulinemia with PCOS.
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DEVELOPMENT OF TOOLS
• Personal data
• Anthropometrical measurements
• Co-morbidites associated with obese PCOS
• Dietary pattern,food preferences and food frequency
• Health practices
• Physical activities
• Behavioral pattern
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METHODOLOGY
• Assessment of somatic state of obesity through anthropometrics- Ht. Wt. MUAC. SFT. W&H
• Assessment of body composition by bio-electrical impendence
• Bio-chemical assessment of serum Hb, RBS, PPBS,serum insulin & lipid profile.
• Assessment of presence of ovarian cysts by ultra sound scanning (pelvic or TVS).
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• Initially dietary counseling was given to all the subjects in the presence of their family members.
• Dietary modification was aimed to provide hypo caloric diet with 12 to 15 % of fat.
• Assessment of effective wt. reduction through anthropometrics i.e. wt, skin fold thick ness, MAC, W&H Measurements was done periodically.
• Assessment of presence of ovarian cysts and size of the ovaries were checked by ultra sound scanning at a specific period.
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RESULTS • A loss of an average of 10 kg over a period
of 5 months
• Reduced ovarian size and the disappearance of or reduction of cysts in both the ovaries or in a single ovary.
• Subjects showing on an average a reduction of 10kg body wt., were found to have regular menstrual cycles.
• While the subjects losing, on an average, 2 kg body wt. still continue to show menstrual irregularities.
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• As assessed by bio-electrical impedance body compositions suggest reduced fat % with elevated TBW & FFM.
• The improvement of WHR.
• Three of the married subjects conceived spontaneously without any medical intervention
• These findings suggest that the wt. reduction through dietary modification have a role in the improvement of reproductive health of obese women with PCOS.
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Normal uterus with bilateral polycystic ovaries.
Right ovary measured 2.5x1.6x3.1 cm(volume 6.2 cc)
Left ovary measured 3.1x1.7x2.9 cm(volume 7.6 cc)
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Findings are suggestive of a very early intra-uterine gestation of about 5+ weeks. Both ovaries appeared
normal and Corpus-luteum was seen in the right ovary.
3.1x1.2x2.0(volume 3.7 cc)
3.0x2.1x3.6 cm(Corpus-luteum –
1.8x1.5x1.8 cm)
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Bilateral polycystic ovaries with slight decrease in size since last scan done.
Before wt. loss 3.7x2.2 cmAfter wt. loss 3.4x1.7 cm
Before wt. loss 3.8x2.0 cmAfter wt. loss 3.1x1.7 cm
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Size of the ovary before and after the dietary treatment
Right ovary(cm)
Left ovary(cm)
Total loss of volume (cm)
Before After Before After After treatment
4.0× 2.1 2.0 ×1.9 4.0× 2.3 3.5× 1.8 7.5
3.6 ×2.0 2.5× 1.7 3.0 ×2.2 2.6 ×1.6 5.39
4.8 ×1.1 2.6× 1.0 4.8× 1.1 1.8× 0.6 6.88
4.4 ×2.0× 2.7 3.4× 1.2× 1.5 3.4 ×1.9 ×2.1 1.8× 0.2× 2.0 6.84
3.0× 2.4 1.1× 1.6 2.6× 2.2 1.6×0.5 6.72
4.3×2.4 1.9× 0.5 5.0×2.8 2.9×1.3 19.6
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Average wt. Loss of the respondents.
1st reading 3.2±1.62nd reading 1.7±0.983rd reading 1.45±0.694th reading 1.6±0.94total period 8.05±2.84
Avg wt. Loss (kg) in
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Average reduction of WHR of the respondents.
1st reading2nd reading3rd reading4th readingtotal period 0.029±0.033
0.006±0.0160.003±0.0210.007±0.0210.013±0.019
Avg reduction WHR
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Average reduction of fat % of the respondents
1st reading2nd reading3rd reading4th readingtotal period
0.750±0.4702.852±1.202
Avg reduction in fat%0.994±0.4950.667±0.4880.489±0.295
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CONCLUSION • Obesity appears to be a major cause for the
development/progression of PCOS. Hence effective wt. Management among PCOS cases is imperative to restore the normal menstrual cycles