Preconception Vitamin D Level and In Vitro Fertilization: Pregnancy Outcome.

OBJECTIVE: Vitamin D deficiency impairs female fertility and the success of in vitro fertilization (IVF). The recommended serum 25-hydroxyvitamin D (25(OH)D) level in IVF-conceived pregnancies is still debated. We aimed to explore the relationship of the preconception serum 25(OH)D level with pregnancy outcome following IVF treatment. We also explored the utility of the currently recommended serum 25(OH)D cutoff of ≥50 nmol/L for women undergoing IVF therapy. METHODS: Retrospective cohort of women who had undergone IVF therapy. Of the women who started IVF therapy (n = 354), 218 completed the study. They were divided into 2 groups: (1) women who achieved a successful pregnancy (pregnant group, n = 160) and (2) those who did not achieve a successful pregnancy (nonpregnant group, n = 58). Preconception serum samples were analyzed for reproductive hormones, fasting glucose, insulin, and 25(OH)D levels. RESULTS: Overall, the median (interquartile range) age, body mass index, and hemoglobin A1c level were 32 (6) years, 25.7 (7.4) kg/m2, and 5.2% (0.6%), respectively. The 25(OH)D level was significantly higher at preconception in the pregnant group (56.4 [21.4] vs 47.9 [29.16] for nonpregnant, P = .001). The preconception 25(OH)D level was a significant predictor of IVF outcome (B = 0.04; 95% CI, 1.01-1.06; P = .001), with greater IVF success associated with a serum 25(OH)D level of ≥50 nmol/L (odds ratio, 0.46; P = .01). CONCLUSION: Preconception 25(OH)D sufficiency (≥50 nmol/L) is associated with successful pregnancy outcome following IVF therapy.

Early Predictors of Gestational Diabetes Mellitus in IVF-Conceived Pregnancies.

OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. This study aimed to identify early and reliable GDM predictors that would enable implementation of preventive and management measures. METHODS: The participants were a 28-week prospective cohort of in vitro fertilization (IVF)-conceived pregnant women (≤39 years, body mass index [BMI] 18.5-38 kg/m2) without a known history of diabetes mellitus. Fasting blood samples were analyzed at baseline (pre-IVF) and 12 weeks' gestation for reproductive hormones, glucose, serum insulin, lipids, thyroid function, adiponectin, and lipopolysaccharide-binding protein. At 28 weeks, a 75-g oral glucose tolerance test was used to screen for GDM. RESULTS: For the overall group at baseline, 22% had BMI ≥30 kg/m2, 45% had polycystic ovary syndrome, 16% had hemoglobin A1C of 5.7% to 6.1%, and 14% had a past history of GDM. At 28 weeks of gestation (n = 158), 34 women had developed GDM and 124 had not. Significant baseline predictors of GDM onset included greater BMI (29.0 vs 25.8 kg/m2), older age (34 vs 32 years), higher levels of follicle-stimulating hormone/luteinizing hormone ratio (1.2 vs 1.0), hemoglobin A1C (5.5 vs 5.2%), insulin (10.6 vs 7.1 µIU/mL), homeostatic model assessment of insulin resistance (2.2 vs 1.7), total cholesterol (199 vs 171 mg/dL), and low-density lipoprotein cholesterol (123 vs 105 mg/dL), and lower triglyceride levels (74 vs 76 mg/dL). Significant 12-week GDM predictors included greater maternal weight gain (delta: 3.4 vs 1.5 kg) and higher levels of insulin (11.3 vs 7.6 µIU/mL), triglycerides (178 vs 120 mg/dL), and homeostatic model assessment of insulin resistance (2.3 vs 1.5). Twelve-week BMI is a predictor of GDM following adjustment for polycystic ovary syndrome status and maternal age. CONCLUSION: While preconception maternal BMI, age, and follicle-stimulating hormone/luteinizing hormone ratio are predictors of subsequent development of GDM, early IVF-conceived gestational weight gain is the best predictor of GDM onset.

Effects of in vitro fertilization (IVF) therapies on metabolic, endocrine and inflammatory status in IVF-conceived pregnancy.

RATIONALE: In vitro fertilization (IVF) is a common treatment for infertility. In mice, IVF is associated with development of glucose intolerance. However, human data are limited regarding the metabolic, endocrine and inflammatory effects of IVF therapy in IVF-conceived pregnancies. OBJECTIVE: To explore effects of IVF therapies on metabolic, endocrine and inflammatory parameters in IVF-conceived pregnancy. METHODOLOGY: Twelve-week prospective observational study of adult normoglycaemic women, BMI 18.5-38 kg/m2 and ≤ 39 years awaiting IVF therapy. Fasting blood samples were collected at baseline and 12 weeks, and serum analysed for reproductive hormones, glucose, lipids, insulin sensitivity, thyroid status, adiponectin inflammatory marker and lipopolysaccharide-binding protein (LBP). RESULTS: Two hundred and seventy-five women were analysed: 158 IVF-conceived pregnant women and 117 with failed IVF. Compared with baseline, nonpregnant women had significant (P < .001) increases in 12-week glucose (86.04-87.62 mg/dL), insulin (8.72-9.37 µIU/mL), HOMA-IR (1.9-2.1), T-Chol (169.5-174.9 mg/dL), TG (71.0-83.7 mg/dL) and HDL-C (52.0-54.11 mg/dL) levels. At 12 weeks, pregnant women also had (P < .001) increases in T-Chol (177.5-199.5 mg/dL), TG (73.5-126.78 mg/dL) and HDL-C (55.3-65.1 mg/dL), while a significant reduction in glucose (86.15-82.19 mg/dL), HbA1c (5.3-5.08%) and TSH (1.71-1.36 µIU/mL) levels from baseline. Adiponectin and LBP levels remained the same in either group. CONCLUSION: In vitro fertilization hormonal therapy impairs glucose and insulin levels; these effects are masked in early pregnancy. Changes in lipid profile occur following IVF therapies regardless of pregnancy outcome. Neither adiponectin nor LBP is affected by IVF therapies and during early IVF-conceived pregnancy.

Impact of contraception and IVF hormones on metabolic, endocrine, and inflammatory status.

Assisted reproductive technologies (ART) represent commonly utilized management strategies for infertility with multifactorial causes (including genetically predisposed diseases). Amongst ART, in vitro fertilization (IVF) is the most popular. IVF treatment may predispose the mother to increased risks and complications during pregnancy, and there may be adverse fetal outcomes. Hormonal therapies, including oral contraceptives, may impair glucose and lipid metabolism, and promote insulin resistance and inflammation. IVF treatment involves administration of reproductive hormones, similar in composition but in much higher doses than those used for oral contraception. The provision of IVF reproductive hormones to mice associates with glucose intolerance. In addition, the physiological and hormonal changes of pregnancy can trigger an inflammatory response, and metabolic and endocrine changes. There is controversy regarding the potential effects of IVF hormonal therapies in the promotion of diabetogenic and inflammatory states, additional to those that occur during pregnancy, and which may therefore predispose women with IVF-conceived pregnancies to adverse obstetric outcomes compared with women with spontaneously conceived pregnancies. This review summarizes the limited published evidence regarding the effect of IVF-based fertility therapies on glucose homeostasis, insulin resistance, cardio-metabolic profile, and markers of inflammation.

Prevalence of Dietary Supplement Use and Associated Factors Among College Students in the United Arab Emirates.

The use of dietary supplements (DS) is increasing worldwide, however, there are limited studies examining the characteristics of people who take supplements in the United Arab Emirates. To examine the use of DS and their association with sociodemographic/lifestyle factors among college students in the UAE. A cross-sectional study conducted on 452 (18 to 24 years) college students (247 females and 205 males). A self-administered questionnaire that included sociodemographic and lifestyle characteristics, DS use, attitudes, and behavior was used. The prevalence of DS users was 35.6%. Dietary supplement use was significantly more among males than females (P = 0.008). The males preferred protein supplements (29.4%), while females consumed multivitamin and mineral supplements. Dietary supplement use was related to physical activity and the existence of a health problem. Males took DS for medical needs and to increase their muscle mass while females took them for medical needs (P = 0.001). While there a was significant difference between DS users and non-users related to knowledge (P = 0.000). The majority of DS users agreed that supplements are essential for health (68.3%) and only 39.8% agreed it was safe to use. Dietary supplement users source of information was health care providers (30.5%) followed by social media (22.2%). The prevalence of supplement use among college students was moderate among college students in the UAE. The results draw the attention for increasing public awareness about the DS appropriate use and safety from reliable sources so they could make more informed choices.

Relationship between Maternal Serum Thyroid-Stimulating Hormone and in vitro Fertilisation-Conceived Pregnancy Outcomes.

Background: Thyroid dysfunction impairs female fertility and pregnancy outcome. Optimal preconception and gestational TSH level is still debatable in IVF-conceived pregnancies. Aims: To explore the relationships of IVF success and pregnancy outcomes with maternal serum levels of TSH (at both preconception and 12-week IVF-conceived pregnancy). Also, to confirm or refute the recommended TSH level ≤2.5µIU/mL. Study Setting and Design: Retrospective cohort. Material and Methods: 158 IVF-conceived pregnant women and 117 age-matched controls non-pregnant (≤39years, BMI 18.5-38kg/m2) were recruited. Preconception and 12-week IVF-conceived pregnancy serum samples were analysed for reproductive hormones, fasting glucose, insulin and TSH levels. Data of pregnant women at 28 weeks for GDM screening (75-gram OGTT) and up until delivery were included. Statistical Analysis: Binary logistic regression used to predict association between preconception TSH levels and IVF success, and pregnancy outcomes. Association of delta change of hormones was determined with linear regression. Significance level P≤0.05 with 95% confidence interval (CI). Results: Overall, median (IQR) age was 32(6)years, BMI 25.4(6.9)kg/m2, HbA1c 5.2(0.52)% and TSH 1.82(1.4)µIU/mL. There was no significant association between preconception TSH level and IVF success rate. During the first trimester of IVF-conceived pregnancy, delta change in TSH level was associated with that of progesterone (P=0.03). 12-week gestation TSH level did not predict adverse pregnancy outcomes (i.e. onset of GDM, delivery type and premature delivery); but a higher TSH level predicted earlier delivery in weeks. There was a higher risk of delivery by caesarean section when TSH>2.5µIU/mL. Conclusion: Variation of maternal TSH within normal range (0.4-4.0µIU/mL) at preconception and 12-week gestation has no predictive effect on IVF success and pregnancy outcomes in IVF-pregnancy. Our data provide no support for a recommended preconception TSH level ≤2.5µIU/mL in IVF-conceived pregnancy, but rather promote a preconception TSH level within normal range.

The Effect of Music Therapy in Reducing Dental Anxiety and Lowering Physiological Stressors.

BACKGROUND AND AIM: The anxiolytic effects of music have been studied during the past twenty years in different medical therapies. The aim of this study is to evaluate the effect of music therapy on patients' dental anxiety, salivary cortisol, heart rate, blood pressure and body temperature during dental treatment. METHODS: In this randomized control study, 46 patients were randomly selected from the Urgent Care dental clinic who needed urgent endodontic treatment (endodontic access and pulp extirpation). Participants were divided into two groups: intervention group (N=23) which was exposed to slow rhythm melody music and had no lyrics throughout the entire procedure and a control group (N=23) who undergoes the same dental procedure without being exposed to music. Participants' blood pressure, heart rate, body temperature and salivary cortisol were measured before and after the treatment for both groups. RESULTS: Patients in the intervention group showed lower salivary cortisol, blood pressure, heart rate and body temperature compared to those in the control group, however, the differences did not reach to statistical significance. CONCLUSION: -Despite the change in the dental anxiety and stress during treatment with music, the findings of this study could not establish evidence of the effect of music in reducing dental anxiety and lowering physiological stressors. Therefore, further studies with larger sample size may be needed. (www.actabiomedica.it).

Lean Body Mass and Self-Perceived Body Image among Youth in the United Arab Emirates.

BACKGROUND AND AIM: Lean body mass may be a promising tool to screen body image disorders. This study aim was to explore the relationships between fat free mass index (FFM-I) on self-perceived body image and shape among university students in the United Arab Emirates. METHODS: Cross-sectional study, using questionnaires to evaluate demographics, body figure, shape and image dissatisfaction; in addition to anthropometrics like BMI and FFM-I. Accordingly, participants were categorized into adequate muscle mass (AMM) and low muscle mass (LMM) individuals. RESULTS: A total of 402 participants (50.4% females) aged between 18 and 25 years, were recruited. Almost third (33.8%) of the participants were overweight/obese, 81% had AMM; 48.5% and 76.3% of them were concerned about their body shape and image, respectively; 55.2% desired to be thinner. Males (M) had significantly higher BMI and body fat compared to females (F). Subjects with LMM, irrespective of sex, were underweight (49% F; 40.7% M), desired to be heavier (44.9% F; 74.1% M) and they had a lower agreement in their perceived BMI versus actual (k=0.024; poor) compared with those with AMM (k=0.408; fair); and in general males had a better agreement between their perceived and actual BMI compared to females (0.432, moderate vs. 0.308, fair). CONCLUSIONS: Our results conclude that female sex and LMM were associated with higher body image and shape dissatisfaction; thus, highlighting the importance of increasing awareness among youth to assess body composition and engage in muscle mass building activities as an effective step towards improving body image perception. (www.actabiomedica.it).

Body Mass Index Perception, Body Image Dissatisfaction and Their Relations with Weight-Related Behaviors among University Students.

The prevalence of obesity is increasing globally and is linked with poor body image perception. The aim of the present study was to identify the relationships of body image (BI) and body mass index (BMI) with weight control practices among university students. A cross-sectional study on a sample of 308 university students (150 males and 158 females) aged between 18 and 25 years was carried out. Face-to-face interviews were conducted based on a questionnaire that included socio-demographic, physical activity, the Figure Rating Scale (FRS) and body image dissatisfaction (BID) questions. The majority of the participants (81%: 58.2% females and 41.8% males) were dissatisfied with their BI. Females desired to lose weight and preferred diet to exercise, while males desired to gain weight and preferred exercise to diet (p < 0.001). About 56%, 39.5%, and 4.5% of the participants were normal, overweight/obese, and underweight, respectively. There was a significant, strong correlation (R2 = 0.84, p < 0.001) between perceived BMI and actual BMI. Actual BMI showed a significant strong correlation with the BID (r = 0.57, p < 0.001). The results highlighted the need to increase awareness of the importance of healthy eating behaviors and regular physical activities to improve body size, shape perception, and satisfaction among college males and females.

Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals.

AIM: Excessive visceral adiposity is a major risk factor for developing insulin resistance and systemic low-grade inflammation. Ramadan diurnal fasting (RDF) is a religious ritual practiced by more than one billion Muslim throughout the world. It has been considered as one of the most common types of complementary and integrative health practices. The aim of this study is to examine the impact of RDF on visceral adiposity, circulating adipokines and glucoregulatory markers in patients with overweight or obesity. METHODS: Overweight and obese subjects (n = 61; 23 men and 38 women) were included in the study. Body weight, visceral fat tissue area (measured by 3D-MRI), glucoregulatory factors, serum adipokines concentrations, dietary intake, and physical activity were assessed one week before and at the end of the lunar month of Ramadan. RESULTS: From baseline, body weight and visceral fat tissue area serum total cholesterol, triglycerides, HDL-cholesterol, and systolic blood pressure significantly decreased (P < 0.05 for each) at the end of Ramadan. The serum levels of adiponectin, IL-6, TNF-α, and IGF-1 significantly decreased (P < 0.05 for each), but serum visfatin, leptin, apelin, IL-10, and IL-10/IL-6 ratio significantly increased (P < 0.05 for each) at the end of Ramadan. Changes in visceral adiposity significantly correlated with changes in plasma glucose (r = 0.4, P < 0.5) and resistin (r = 0.44, P < 0.001) at the end of Ramadan. CONCLUSION: RDF lowers visceral adiposity, body weight and variably affects adipokines without adversely affecting markers of glucose homeostasis in individuals with overweight or obesity.

Eating disorders and body image concerns as influenced by family and media among university students in Sharjah, UAE.

BACKGROUND AND OBJECTIVES: Eating disorders (ED) can be influenced by psychological and socio-cultural factors. The aim of this study was to explore the association between parental and media influences and body image concerns as factors in the onset of ED. METHODS AND STUDY DESIGN: A cross-sectional study was conducted among 662 students (407 women and 255 men) attending one of three universities in United Arab Emirates (UAE). The study employed an online self-administered questionnaire with validated scales: Eating Attitudes Test-26 (EAT-26), Body Shape Questionnaire (BSQ), Media Influences Scale, and Family Influences Scale (FIS). RESULTS: About 33% of the sample had EAT- 26 scores >=20 and 45% showed mild to marked concerns about their body shape. Women students were significantly more concerned about their shape, and more influenced by media than men. There were significant differences in the means of all scores, except for media influence, among the four BMI groups. The EAT-26 score showed strongest correlation with BSQ (r=0.48), followed by FIS, Media and BMI (r=0.419, r=0.276 and r=0.18 respectively). The BSQ was the best predictor of ED and was inversely associated with the EAT-26 score (B=-1.51, OR=0.219, 95% CI: 0.152-0.316, p<0.001). CONCLUSIONS: The findings of this study indicate that ED and body shape concerns are highly prevalent among the university student sample, and highlight the strong influence that both the media and families exert on the development of ED among young adults. These findings provide baseline data for future longitudinal studies to investigate factors influencing ED.

Association of Vitamin D receptor gene polymorphisms with metabolic syndrome and its components among adult Arabs from the United Arab Emirates.

AIMS: The aim was to investigate relationships of Vitamin D receptor gene (VDR) polymorphisms to the components of MetS among Arabs adult residing in the United Arab Emirates. METHODS: A cross-sectional study of 198 Arabs adult (50 males and 148 females). Serum levels of glucose, vitamin D, HDL-C, and TG, and blood pressure were measured. FokI, BsmI & TaqI genotyping of VDR were investigated using PCR-RFLP technique. RESULTS: Age of the participants was 21(9) years with a BMI of 26.8(7.8) kg/m2. About 15% had MetS with serum vitamin D levels of 25.5(18.2) nmol/L. VDR genotyping yielded: FokI: 57.1% FF and 38.9% Ff, BsmI: 29.8% bb and 51.5% Bb, while TaqI showed 39.4% TT and 43.4% Tt. The ff carriers had higher total cholesterol [174(12.4) mg/dl] than FF and Ff genotypes. Bb carriers showed higher BMI and LDL-C than BB and bb genotypes. In females, FokI VDR polymorphism showed significant association with systolic blood pressure (SBP) and F allele carriers were at higher risk of developing high SBP [x2=4.4, df1, OR=0.29 (95%CI: 0.087-0.98), p=0.035]. CONCLUSION: VDR gene polymorphisms were not associated with MetS, yet it may affect the severity of some of components of MetS, namely the association of BsmI with obesity, FokI and BsmI with dyslipidemia and FokI with SBP.