Effects of Chromium, Inositol and Resistant Starch Supplementation In Pcos: A Systematic Review :Nandita Krishnan, Supriya Velraja, Biomedical and Biotechnology Research Journal (BBRJ)

REVIEW ARTICLE
Year : 2023 | Volume : 7 | Issue : 1 | Page : 32--36

Effects of Chromium, Inositol and Resistant Starch Supplementation In Pcos: A Systematic Review

Nandita Krishnan, Supriya Velraja
Department of Clinical Nutrition, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Correspondence Address:
Supriya Velraja
Department of Clinical Nutrition, Sri Ramachandra Institute of Higher Education and Research, Chennai - 600 116, Tamil Nadu
India

Abstract

Polycystic ovary syndrome (PCOS) is a diverse condition that has distinct signs and symptoms such as hyperandrogenism and chronic anovulation. It is a major hormonal disorder that affects the health-related quality of life and mental health of young women. The etiology of PCOS still remains uncertain but insulin resistance is one of the major factors seen in PCOS individuals which are characterized by the presence of acanthosis nigricans. Dietary interventions and lifestyle modification are being considered to be a first-line treatment for women with PCOS. Proper diet, adequate nutritional status, and following a physical activity routine help in alleviating the symptoms of PCOS. Dietary interventions should focus on weight management and insulin regulation. An abnormal gut microbiome function results in ovarian dysfunction, immune changes, insulin resistance, and disruption in bile synthesis. Therefore, gut health of women suffering from PCOS should be prioritized and interventions that improve the gut health should be followed. This systematic review is performed to investigate the association between micronutrient supplementation and PCOS. The related articles were searched using the databases PubMed, Science Direct, and Google Scholar. All the studies involving micronutrient supplementation and PCOS were included in this systematic review. Micronutrient supplementation was significantly inversely associated with improving PCOS prognosis. The main finding of the systematic review is that it concludes there is a direct association between micronutrient supplementation as it helps in alleviating the symptoms and maintaining a proper lifestyle in women with PCOS.

How to cite this article:
Krishnan N, Velraja S. Effects of Chromium, Inositol and Resistant Starch Supplementation In Pcos: A Systematic Review.Biomed Biotechnol Res J 2023;7:32-36

How to cite this URL:
Krishnan N, Velraja S. Effects of Chromium, Inositol and Resistant Starch Supplementation In Pcos: A Systematic Review. Biomed Biotechnol Res J [serial online] 2023 [cited 2023 Mar 28 ];7:32-36
Available from: https://www.bmbtrj.org/text.asp?2023/7/1/32/371687

Full Text

Introduction

Polycystic ovary syndrome (PCOS), a condition which has been having a significant focus in recent years is characterized by an excessive production of male hormones (androgens) by the ovaries and adrenal gland. It is commonly observed in women during their reproductive age. It can develop as early as 12 years of age and can also be seen in women who are in their premenopausal phase (45 years of age). Its worldwide prevalence is between 8.2% and 22.5%.[1] There are four types of PCOS of which insulin Resistant PCOS is the most common type of PCOS seen almost in 70% of the cases. It is characterized by excessive sugar and salty food cravings, rapid weight gain, fatigue and acanthosis nigricans, irregular menstrual cycle, hyperinsulinemia, and hyperandrogenism. The risk factors associated with insulin resistance PCOS include diabetes, gestational diabetes, and cardiovascular complications. Gut microbiome composition and genetic factors contribute to the etiology of PCOS.[2] Micronutrient supplementation is one of the most recent interventions that has been carried out as it has been found to be beneficial in improving the insulin sensitivity, achieving weight loss, improving the digestive and colon health, blood sugar, and insulin regulation. This systematic review aims to analyze the effects of resistant starch and micronutrient supplementation such as chromium and inositol in the gut microbiome composition of women with PCOS.[3]

The Symptoms and relationship of PCOS related to poor gut health is shown in [Figure 1].[4]{Figure 1}

Methods

Search strategy

A systematic review was performed by searching the databases PubMed, ScienceDirect, and Google Scholar using terms related to nutrients supplementation such as inositol, chromium, and resistant starch in PCOS with applying a time restriction of 5 years from September 2017 to September 2022; however, one of the articles considered for review of resistant starch was dated, July 2015. The studies involving inositol, chromium, and resistant starch supplementation in PCOS are included in this systematic review [Figure 2].{Figure 2}

Ethical issues

Not Applicable.

Selection criteria

Studies involving inositol, chromium, and resistant starch supplementation in were included in this review. Only the clinical trials and the research articles were included in this study. There are also certain review article findings included in this review to conclude the findings that were observed.

Results and Discussion

Effects of chromium supplementation in polycystic ovary syndrome

Insulin resistance is one of the key factors influencing PCOS. Understanding and correlating the pathophysiology of PCOS have led to the idea of improving insulin resistance of individuals with PCOS with dietary supplements. Chromium is known to be one of the micronutrients that helps in combatting insulin resistance. Hence, chromium was supplemented in women with PCOS in several clinical trials and its beneficial effects in improving their gut health and its other abnormalities were determined.[5] [Table 1] shows the chromium interventions that were carried till date.{Table 1}

Effects of inositol supplementation in polycystic ovary syndrome

PCOS is evidenced by two major signs and symptoms, i.e. insulin resistance and hyperandrogenism. The therapy for PCOS includes improving IR and reducing circulating insulin and preventing the risk of developing type 2 diabetes mellitus and cardiovascular diseases. The major factor contributing to insulin resistance in PCOS individual is inositol deficiency. Inositol plays an important role in improving the action of insulin, growth, and differentiation of cells and may help in reducing the metabolic abnormalities and menstrual/ovulatory abnormalities by improving the gut health of the individuals.[9] [Table 2] shows the inositol interventions which were carried to improve the hormonal and gut abnormalities till date.{Table 2}

Effects of resistant starch supplementation in polycystic ovary syndrome

Gut imbalance is one of the abnormalities observed in individuals with PCOS. Understanding and correlating the pathophysiology of PCOS has led to the idea of improving the gut health of the individuals with PCOS.[16] Resistant starch is known to be one of the micronutrients that helps in improving the gut health and was also proven to be beneficial in weight maintenance/weight loss, menstrual irregularities, and insulin resistance. Resistant starch was supplemented in women with PCOS in several clinical trials and its beneficial effects in improving their gut health were determined.[17] [Table 3] shows the interventions carried out with resistant starch till date.{Table 3}

Conclusion

The review concludes that the conducted studies have observed a direct association of nutrient supplementation such as inositol, chromium, and resistant starch in PCOS. They are proven to be beneficial in improving menstrual abnormalities, improving insulin resistance and play a significant role in weight reduction by improving the gut health of the individuals. Therefore, maintaining a balanced dietary habit and incorporating these nutrients as a part of the daily diet is essential in combatting PCOS, proper dietary habits, and lifestyle should be adapted to alleviate the symptoms related to PCOS.

Strengths and limitations of the study

Nutrition intervention in PCOS has become a major topic that has been focussed on the recent timesThis review has been focussed on observing whether the interventions that have been carried out with resistant starch and micro minerals such as inositol, chromium has helped in alleviating the diverse symptoms of PCOS and it can be considered as the strength of the studyThe major limitation of this study is that not many studies have been carried out with these micro minerals and micronutrient interventions such as Vitamin D and calcium have only been focused on a wide range of studies in accordance with PCOS.

Acknowledgment

I would like to thank Dr. V. Supriya, M.Sc., M.Phil., RD., Ph.D., Associate Professor, Department of Clinical Nutrition, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India, for her unflinching support in preparing the final draft of this manuscript.

Limitation of study

Not applicable.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[25]

References

1	Che X, Chen Z, Liu M, Mo Z. Dietary intervention: A promising treatment for polycystic ovary syndrome. Ann Nutr Metab 2021;77:313-23.
2	Bulsara J, Patel P, Soni A, Acharya S. A review: Brief insight into polycystic ovarian syndrome. Endocr Metab Sci 2021;3:100085.
3	Rashed AA, Saparuddin F, Rathi DG, Nasir NN, Lokman EF. Effects of resistant starch interventions on metabolic biomarkers in pre-diabetes and diabetes adults. Front Nutr 2021;8:793414.
4	Yonggang H, Xiaosheng L, Zhaoxia H, Yilu C, Jiqiang L, Huina Z. Effects of human chorionic gonadotropin combined with clomiphene on Serum E(2), FSH, LH and PRL levels in patients with polycystic ovarian syndrome. Saudi J Biol Sci 2017;24:241-5.
5	Zhao X, Jiang Y, Xi H, Chen L, Feng X. Exploration of the relationship between gut microbiota and polycystic ovary syndrome (PCOS): A review. Geburtshilfe Frauenheilkd 2020;80:161-71.
6	Basharat S, Qureshi K, Chishti K, Jaffar HM, Ali M, Saleem A, et al. Role of chromium in polycystic ovarian syndrome. Asian J Health Sci 2022;7:ID25.
7	Amiri Siavashani M, Zadeh Modarres S, Mirhosseini N, Aghadavod E, Salehpour S, Asemi Z. The effects of chromium supplementation on gene expression of insulin, lipid, and inflammatory markers in infertile women with polycystic ovary syndrome candidate for in vitro fertilization: A Randomized, Double-Blinded, Placebo-Controlled Trial. Front Endocrinol (Lausanne) 2018;9:726.
8	Fazelian S, Rouhani MH, Bank SS, Amani R. Chromium supplementation and polycystic ovary syndrome: A systematic review and meta-analysis. J Trace Elem Med Biol 2017;42:92-6.
9	Aversa A, La Vignera S, Rago R, Gambineri A, Nappi RE, Calogero AE, et al. Fundamental concepts and novel aspects of polycystic ovarian syndrome: Expert consensus resolutions. Front Endocrinol (Lausanne) 2020;11:516.
10	Rackerby B, Kim HJ, Dallas DC, Park SH. Understanding the effects of dietary components on the gut microbiome and human health. Food Sci Biotechnol 2020;29:1463-74.
11	Caputo M, Bona E, Leone I, Samà MT, Nuzzo A, Ferrero A, et al. Inositols and metabolic disorders: From farm to bedside. J Tradit Complement Med 2020;10:252-9.
12	Kamenov Z, Gateva A. Inositols in PCOS. Molecules 2020;25:5566.
13	Merviel P, James P, Bouée S, Le Guillou M, Rince C, Nachtergaele C, et al. Impact of myo-inositol treatment in women with polycystic ovary syndrome in assisted reproductive technologies. Reprod Health 2021;18:13.
14	Barriga P, Roque A, Aparicio MD, Berroa JL. Role of myo-inositol in polycystic ovary syndrome. Gynecol Reprod Endocrinol Metab 2020;04:204-7.
15	Bevilacqua A, Bizzarri M. Inositols in insulin signaling and glucose metabolism. Int J Endocrinol 2018;2018:1968450.
16	Guo J, Tan L, Kong L. Impact of dietary intake of resistant starch on obesity and associated metabolic profiles in human: A systematic review of the literature. Crit Rev Food Sci Nutr 2021;61:889-905.
17	DeMartino P, Cockburn DW. Resistant starch: Impact on the gut microbiome and health. Curr Opin Biotechnol 2020;61:66-71.
18	Moore SA, Ai Y, Chang F, Jane JL. Effects of alpha-amylase reaction mechanisms on analysis of resistant-starch contents. Carbohydr Polym 2015;115:465-71.
19	Bojarczuk A, Skaspka A, Mousavi K, Marszalek K. Health benefits of resistant starch: A review of the literature. J Funct Foods 2022;93:105094.
20	Jyothsna E, Hymavathi TY. Resistant Starch Importance, Categories, Food Sources and Physiological Effects. Research Gate; January, 2017. Available from: https://www.phytojournal.com/archives/2017/vol6issue2/PartA/6-5-188-903.pdf. [Last accessed on 2023 Jan 31].
21	Dobranowski PA, Stintzi A. Resistant starch, microbiome, and precision modulation. Gut Microbes 2021;13:1926842.
22	He Y, Shi L, Qi Y, Wang Q, Zhao J, Zhang H, et al. Butylated starch alleviates polycystic ovary syndrome by stimulating the secretion of peptide tyrosine-tyrosine and regulating faecal microbiota. Carbohydr Polym 2022;287:119304.
23	Liyanage GS, Inoue R, Fujitani M, Ishijima T, Shibutani T, Abe K, et al. Effects of soy isoflavones, resistant starch and antibiotics on polycystic ovary syndrome (PCOS)-like features in letrozole-treated rats. Nutrients 2021;13:3759.
24	Teichmann J, Cockburn DW. In vitro fermentation reveals changes in butyrate production dependent on resistant starch source and microbiome composition. Front Microbiol 2021;12:640253.
25	Kellow N, Ellery S. Effect of a Dietary Resistant Starch Supplement on Menstrual Associated Pain, Gastrointestinal and Emotional Symptoms: A Randomised Controlled Trial; 01 December, 2021. Available from: https://research.monash.edu/en/organisations/hudson-institute-department-of-molecular-and-translational-scienc. [Last accessed on 2023 Jan 31].