LRIOG 2021-4

Weight excess and inflammation in menopause: pathophysiology of a dangerous liaison and role of lifestyles

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Weight excess and inflammation in menopause: pathophysiology of a dangerous liaison and role of lifestyles

Gabriella Pugliese1 – Orcid, Annamaria Colao1,2 – Orcid, Alessandra Graziottin3 – Orcid

1 – Department of Clinical Medicine and Surgery, Endocrinology Section, “Federico II” University of Naples, Naples, Italy

2 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples, Italy

3 – Center for Gynecology and Medical Sexology H. San Raffaele Resnati Milan, Italy; Graziottin Foundation for the treatment of pain in women, ONLUS, Italy

Corresponding Author: Gabriella Pugliese

robiniapugliese@gmail.com

DOI: 10.53146/lriog1202151

Abstract

Weight gain is a common condition in menopause. It recognizes both non- modifiable and modifiable multifactorial etiological mechanisms. The first include: age, climacteric hormonal changes, alteration of hunger and satiety circuits, reduction of energy expenditure and sleep disorders; while among non-modifiable factors: sedentary lifestyle and nutrition, including the ea- ting time (chrononutrition and chronotype). The redistribution of adipo- se tissue, mainly from the subcutaneous site to the visceral site, acts as a real endocrine organ capable of secreting adipokines and proinflammatory cytokines such as TNF-a, IL-1, IL-6 and leptin. This contributes to the meno- pausal chronic low-grade inflammation, that increases the risk of metabolic disorders, cardiovascular events and neurovegetative disorders. Lifestyles interventions are the first line approach to cope with this condition. To date there are no specific dietary and exercise recommendations to be prescribed in overweight/obese women at menopause. The purpose of this review is, first, to analyse the mechanisms that favour weight gain, with focus on the role of sleep disorders and of proinflammatory mediators produced by the adipose tissue; second, to provide practical recommendations focused on li- festyles, useful in the general clinical management of postmenopausal wo- men. The potential role of bowel microbiota and chronotype will be finally briefly discussed.

Keywords: menopause; obesity; inflammation; sleep disorders; adipose tissue; adipokines.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

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Endocrine-metabolic syndrome and nutritional aspects: polycystic ovary syndrome

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Endocrine-metabolic syndrome and nutritional aspects: polycystic ovary syndrome

Luigi Barrea1,2 – Orcid, Ludovica Verde3 – Orcid, Giovanna Muscogiuri2,3,4 – Orcid

1 – Department of Humanities, Pegaso Telematic University, Naples, Italy

2 – Italian Center for the Care and Wellbeing of Patients with Obesity (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, Federico II University, Naples, Italy

3 – Department of Clinical Medicine and Surgery, Endocrinology Unit, Federico II University, Naples, Italy

4 – Unesco Chair “Education for health and sustainable development”, Federico II University, Naples, Italy

Corresponding Author: Luigi Barrea

luigi.barrea@unina.it

DOI: 10.53146/lriog1202150

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine and me- tabolic disorders in women of reproductive age, defined by a combination of signs and clinical or biochemical symptoms of androgen excess and ova- rian dysfunction in the absence of other specific endocrine diagnoses. The aetiology of PCOS is largely unknown, but different evidence suggests that this syndrome might be a complex multifactorial disorder with strong envi- ronmental and epigenetic influences, including lifestyle factors, such as nutri- tion. Specific nutrients per sè or via weight loss improve endocrine features, cardiometabolic risk profile, and reproductive function. Different foods and a change in dietary habits are associated with the reduction of body weight and with improvement PCOS clinical severity. Of interest, beyond obesity se- veral comorbidities, including infertility, metabolic syndrome, impaired glu- cose tolerance, insulin resistance, type 2 diabetes, and increased cardiovascu- lar risk are associated with PCOS. In this context, specific recommendations on macronutrient intake should be provided to patients with obesity and PCOS. In particular, high intake of high glycemic index carbohydrate contributes to weight gain and metabolic alterations, including insulin resistance, dysli- pidemia and metabolic syndrome, and stimulates hunger and carbohydrate craving. The nutritional approach in PCOS must be to reach specific goals including as improving insulin resistance and metabolic disorders that will be possible through an hypocaloric diet reducing the intake of simple and refined carbohydrates with a high glycemic index, limiting of saturated fatty acids (<10% of total energy intake), and attention to possible deficiencies of several micronutrients, including vitamin D, chromium and omega-3. The main aim of this narrative review is to discuss the role of diet as therapeutic treatment in management of women with obesity and PCOS.

Keywords: polycystic ovary syndrome; obesity; nutrition; diet.

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Parathyroid disease, bone health and metabolic syndrome

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Parathyroid disease, bone health and metabolic syndrome

Roberta Modica1 – Orcid, Roberto Minotta1 – Orcid, Giuseppe Cannavale1 – Orcid, Alessia Liccardi1 – Orcid, Renata Simona Auriemma1 – Orcid, Annamaria Colao1,2,4– Orcid

1 – Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi Federico II Napoli

2 – Cattedra Unesco Educazione alla salute e allo Sviluppo Sostenibile, Università degli Studi Federico II Napoli

Corresponding Author: Roberta Modica

robertamodica@libero.it

DOI: 10.53146/lriog1202153

Abstract

BACKGROUND: Parathyroid diseases are related to parathyroid hormone (PTH) dysregulation by parathyroid cells or alteration of PTH function. They include hypoparathyroidism (PTH deficiency), pseudohypoparathyroidism (PTH resistance) and hyperparathyroidism (PTH excess). They are known to al- ter calcium metabolism and consequently bone health. Little is known about correlation between parathyroid diseases and metabolic syndrome. METHODS: Aim of this paper is to analyse the literature to identify the role of parathyroid diseases in bone health and metabolic syndrome.
RESULTS: Hypoparathyroidism and pseudohypoparathyroidism reduce bone remodelling, destroying mineral density with increase of fracture risk. Con- versely, hyperparathyroidism induces increase of bone reabsorption with increased fracture risk. Metabolic syndrome may negatively influence pa- rathyroid diseases and worsen bone health.
CONCLUSIONS: Available data confirm the role of parathyroid diseases in worsening bone health and highlight an important relationship between pa- rathyroid diseases, especially hyperparathyroidism, and metabolic syndrome, which is increasingly widespread.

Keywords: parathyroid hormone; hyperparathyroidism; hypoparathyroidism; bone; calcium; metabolic syndrome.

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Thyroid diseases and female infertility

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Thyroid diseases and female infertility

Chiara Graziadio1,2 – Orcid, Emanuele Filice1 – Orcid, Rosa Pirchio1 – Orcid, Renata Simona Auriemma1 – Orcid, Alessandra Graziottin3 – Orcid,

Annamaria Colao1,2,4– Orcid

1 – Department of Clinical Medicine and Surgery, Federico II University, Naples

2 – Italian Center for the care and well-being of the obese patient (C.I.B.O.), Federico II University, Naples

3 – H. San Raffaele Resnati Center of Gynecology, Milan

4 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples

Corresponding Author: Chiara Graziadio

chiaragraziadio@live.it

DOI: 10.53146/lriog1202152

Abstract

BACKGROUND: Thyroid diseases (hypothyroidism, hyperthyroidism and thyroid autoimmunity) have been independently associated with fertility di- sorders and pregnancy failure, both in case of spontaneous conception and/ or after assisted reproduction technology (ART). Several studies have looked at the association between thyroid dysfunctions, thyroid autoimmunity (TAI) and reproduction. The aim of this paper is to identify the impact of thyroid diseases, starting from birth, on female infertility, by means of review of the recent pertinent literature.
METHODS: We reviewed the pertinent literature regarding the association between thyroid diseases and female infertility off the main international database (MEDLINE, PubMed).
RESULTS: Thyroid dysfunctions, associated or not with thyroid autoimmunity, can alter ovulation and the associated immunoendocrine processes with con- sequent menstrual irregularities. These complexes endocrine disruptions can result in mild to severe fertility disorders and increased spontaneous abor- tions. Thyroid autoimmunity is associated with an increased risk of miscar- riage and preterm delivery, both in spontaneous pregnancies as well as in pregnancies after ART.
CONCLUSIONS: Thyroid dysfunctions may lead to menstrual disorders and infertility via direct and indirect interactions with the hypothalamo-pituitary- ovarian axis and the reproductive organs.
In the management of the infertile woman, the complete screening of thyroid hormones and autoimmunity is recommended in order to promptly treat any hormonal dysfunctions that may be a cofactor or the cause of infertility. Fur- ther studies are needed to improve diagnostic and therapeutic fertility issues associated with or due to thyroid disorders.

Keywords: hashimoto’s thyroiditis; Basedow-Graves’disease; hyperthyroidism; hypothyroidism; female infertility; thyroid autoimmunity.

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e-ISSN: 1824-0283

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The role of environmental pollutant in the pathogenesis of endometriosis: a systematic review of literature

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The role of environmental pollutant in the pathogenesis of endometriosis: a systematic review of literature

Alessandro Conforti1 – Orcid, Silvia Picarelli1 – Orcid , Giuseppe Gabriele Iorio1 – Orcid, Luigi Carbone1 – Orcid, Ida Strina1 – Orcid, Carlo Alviggi1 – Orcid

1 – Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Italy

Corresponding Author: Alessandro Conforti

alessandro.conforti@unina.it

DOI: 10.53146/lriog1202143

Abstract

Based on preliminary data, environmental pollutants such as bisphenols, perfluorochemicals, particulate matter and benzophenone derivatives have been suspected to play a role in the etiopathogenesis of endometriosis. Ho- wever, data from recent epidemiological studies are still mixed and the real impact of environmental pollutants on endometriosis is still a matter of de- bate. Consequently, this important issue, which has wide-ranging implica- tions, remains to be solved. In the attempt to clarify this issue, we carried out a systematic review of studies related to the aforementioned pollutants and endometriosis with no time restriction. Only articles regarding the asso- ciation between endometriosis and environmental pollutants published on peer reviewed articles were included. Exclusion criteria were: in vitro studies; case report or case series; unpublished data; study involving animals; the use of a not conservative statistical method (Bayesian analysis). The following studies were included in our analysis; 4 papers bisphenols; 1 paper about perfluorochemicals and particulate matter; 2 papers about benzophenone derivatives. Regarding bisphenol A, results are mixed despite an increased risk was observed in women with non-ovarian pelvic endometriosis. A signi- ficantly associations between perfluorochemicals [perfluorooctanoic acid (PFOA) and perfluorononanoic (PFNA)] and two benzophenone metaboli- tes [2,4-dihydroxybenzophenone (2OH-BP)] with endometriosis. No associa- tion with particulate matter was reported. Relevant differences were found among studies regarding the diagnostic method, type of pollutant analyzed, selection of controls and method adopted for the assessment of contami- nants. Due to the relevant heterogeneity among studies no definitive con- clusion could be still drawn. According to the current data, the possible as- sociation between endometriosis and environmental pollution could not be excluded. More prospective well-designed and less heterogeneous trials are demanded.

Keywords: endometriosis; environmental pollution; perfluorochemicals; bisphenols, air pollution.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

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The vagina: therapeutic role of estrogen

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The vagina: therapeutic role of estrogen
Vincenza Di Stasi 1 – Orcid, Irene Scavello1 – Orcid , Elisa Maseroli 1,2 – Orcid, Sarah Cipriani1,2– Orcid, Linda Vignozzi1,2 – Orcid

1 -Department of Experimental and Clinical Biomedical Sciences “Mario Serio”. University of Florence

2 -Andrology, Female Endocrinology and Gender Incongruence. Careggi University Hospital, Florence

Corresponding Author: Linda Vignozzi

linda.vignozzi@unifi.it

DOI: 10.53146/lriog1202146

Abstract

Estrogen plays a fundamental role in women’s well-being in general and par- ticularly in vaginal health. After menopause there is a gradual reduction in circulating estrogen levels which often results in the onset of symptoms of the Genitourinary Syndrome of Menopause (GSM). In the absence of con- traindications, local estrogens are among the most used drugs in relieving signs and symptoms of GSM. There are different formulations available and the choice of one over the other depends on the severity of the symptoms, the preferences of the patients and the risk / benefit ratio of each. In women with a history of hormone-responsive cancer or at high risk for this disease, the decision to undertake local estrogen-based hormone therapy to treat GSM should be assessed on a case-by-case basis and after appropriate multi- disciplinary counseling with the oncologists.

Keywords: estrogens; vagina; menopause; local therapies.

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e-ISSN: 1824-0283

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