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Year : 2023  |  Volume : 28  |  Issue : 1  |  Page : 12-18

Assessment of relationship between anthropometric measurements and reproductive hormonal profiles, among females of childbearing age at a tertiary health facility in Nigeria

1 Department of Chemical Pathology, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
2 Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
3 Bridge Clinic, Abuja, Nigeria
4 Department of Radiology, Federal Medical Centre, Abeokuta, Ogun State, Nigeria

Date of Submission07-Jun-2022
Date of Decision10-Aug-2022
Date of Acceptance05-Oct-2022
Date of Web Publication13-Dec-2022

Correspondence Address:
Waliu O Oladosu
Department of Chemical Pathology, Federal Medical Centre, Abeokuta, Ogun State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmh.IJMH_47_22

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Background: Increasing prevalence of overweight and obesity has profound impacts on health generally, including the reproductive system. Traditionally, pear body shapes, from narrow waist and wide hip circumferences, have been associated with high fecundability among females. Although this has been scientifically demonstrated by a number of researches only a few of these investigations were conducted with black women in Africa who were of reproductive age. Objectives: The objectives of the study were to compare the mean reproductive hormone levels between the different waist-to-hip ratio (WHR) and body mass index (BMI) categories and also to determine the correlations between the two anthropometric measurements and the reproductive hormones in a black African population. Materials and Methods: It was an analytical cross-sectional study of 180 females of a childbearing age. The WHR and BMI were measured as per standard recommendations. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, day-21 progesterone, and testosterone were assayed. Results: A majority of the research participants were within the age group 21–30 years. Thirty three percent (33%) and 28.9% of participants were overweight and obese, respectively, using BMI compared with 26.7% and 20%, respectively, using WHR. Seventy six point nine percent (76.9%) of participants with an optimal BMI range ovulated with 61.5% having adequate luteal phase support compared with 75% and 54.2%, respectively, using WHR. Day-21 serum progesterone and serum estradiol were significantly negatively correlated with WHR and BMI (P < 0.05). BMI, however, showed a better correlation than WHR (r = -0.535 vs. -0.397; P = 0.001 vs. 0.008, respectively). Gonadotropins were significantly lower among overweight and obese groups for both BMI and WHR (P < 0.05), but only WHR showed moderately positive significant correlation with gonadotropins (LH: r = 0.050 vs. r = 0.215, P = 0.003, respectively; FSH: r = 0.159 vs. r = 0.431, P = 0.001, respectively), same as serum testosterone (r = 0.580 vs. r = 0.611, P = 0.002, respectively). Conclusions: Anthropometric measurements can serve as objective clues to functionality and optimal concentrations of reproductive hormones. Weight control should therefore aid the optimization of reproductive hormones and fertility among females of reproductive age.

Keywords: BMI, females, hormones, waist-to-hip ratio

How to cite this article:
Oladosu WO, Alayo AM, Ahmed AO, Jimoh OS, Olarinoye-Raji ST, Egbeyemi BA, Ajadi TA. Assessment of relationship between anthropometric measurements and reproductive hormonal profiles, among females of childbearing age at a tertiary health facility in Nigeria. Int J Med Health Dev 2023;28:12-8

How to cite this URL:
Oladosu WO, Alayo AM, Ahmed AO, Jimoh OS, Olarinoye-Raji ST, Egbeyemi BA, Ajadi TA. Assessment of relationship between anthropometric measurements and reproductive hormonal profiles, among females of childbearing age at a tertiary health facility in Nigeria. Int J Med Health Dev [serial online] 2023 [cited 2023 Feb 1];28:12-8. Available from: https://www.ijmhdev.com/text.asp?2023/28/1/12/363251

  Introduction Top

The global decline in fertility has been an issue of concern in many settings, imposing significant social and economic implications on a preexisting ageing demographic.[1] The worldwide ongoing rise of overweight and obesity rates, particularly among women of childbearing age, has compounded the problem.[2]

Lower female fecundability (i.e., the cycle probability of conception) has been linked with overweight and obesity, as measured by body mass index (BMI).[3] To a lesser extent, underweight has also been linked to reduced fecundability.[4] Both extremes of BMI are associated with reproductive dysfunctions through an increasing risk of anovulation, alterations in levels of various hormones, and energy metabolism.[5],[6]

There is a strong association between waist-to-hip ratio (WHR) and sex hormones. These sex hormones include follicle stimulating hormones (FSH), luteinizing hormones (LH), estradiol, progesterone, prolactin, and testosterone. Women with a relatively low WHRs had significantly more ovulatory cycles and regular cycles than women with higher WHR.[7],[8] Based on this evidence, a lower WHR among women may indicate a higher likelihood of conception.[9]

Furthermore, WHR has been suggested as a clue to a woman’s reproductive status. Following menopause, females’ WHRs become similar to men’s and much higher than nonpregnant women.[10],[11] Therefore, individual differences in WHR can broadly indicate current reproductive status, pregnancy, and the probability of childbirth.[12]

This study aimed to compare the mean reproductive hormone levels between the different WHR and BMI categories. It also evaluated and compared the correlations between the two anthropometric measurements and reproductive hormones, among black women within the reproductive age group.

  Materials and Methods Top

Ethical approval for this study was obtained from the Federal Medical Centre, Abeokuta Ethical Research Committee (FMCA/470/HRE/10-2015). Written informed consent was obtained from all research participants. The study was conducted at the Department of Obstetrics and Gynaecology and the Department of Chemical Pathology, Federal Medical Centre, Abeokuta, Southwestern Nigeria. The center is 250-bedded and receives referral for gynecological and obstetrics cases from Ogun State and neighboring states. The gynecological clinic holds four times per week.

It was an analytical cross-sectional study among 180 females between the childbearing ages of 15 and 49 years, as defined by WHO. The sampling method was simple random. Nonconsenting individuals, pregnant women, breastfeeding mothers, women on oral contraceptives or hormonal replacement, as well as patients already on medical treatment for overweight or obesity, were excluded from this study.

The anthropometric measurements were taken by trained individuals. Heights were measured with the participants standing erect and without shoes, recorded to the nearest half centimeter. Weight was also measured by a digital calibrated weighting scale, with the participants wearing light clothing or underwear, recorded to the nearest 100 g. The waist circumference was measured at the narrowest part between the lower rib and the iliac crest (the natural waist) or, in case of an indeterminable waist narrowing, halfway between the lower rib and the iliac crest and was recorded to the nearest half centimeter. Hip circumference was measured over the widest part of the buttocks and was recorded to the nearest half centimeter.[13]

Participants were asked to fast for 10–12 h overnight on day 3 of their menstrual cycles, and blood samples were collected to determine serum FSH, LH, prolactin, estradiol, and testosterone levels. The same process was repeated on day 21 of their cycle for serum progesterone where 5 mL of venous blood samples was collected from participants in plain vacutainer tubes. Samples were allowed to clot and then centrifuged for 20 min at 3000 revolutions per minute. Serum samples were separated and stored at -20°c till the required sample numbers were obtained. Then respective samples were analyzed for FSH, LH, prolactin, testosterone, estradiol, and progesterone (day 21), using Calbiotech Enzyme Linked Immunosorbent Assay (ELISA) kits.

Reference values

Statistical analysis

Statistical analysis was done with the Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). Normally distributed data were expressed as mean ± standard deviation (SD) whereas parameters displaying P < 0.05 were considered statistically significant. One-way ANOVA test was used to compare quantitative data between groups. The relationships between variables were assessed using Pearson’s correlation analysis.

  Results Top

The majority of our research participants were within the reproductive age group 21–30 years, whereas 8.9%, 28.9%, 33.3%, and 28.9% of the research participants were underweight, were within normal range, overweight, and obese, respectively. Also, 53.3%, 26.7%, and 20% of participants had WHR within the desired group, moderate-, and high-risk groups, respectively [Table 1] and [Table 2].
Table 1: Anthropometric measurement and age distribution

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Table 2: Mean and SD of the study parameters

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Comparison of day-21 serum progesterone values and the participant’s BMI showed that 46.7% and 53.8% of participants that were in the overweight and obese categories, respectively, were anovulatory compared with 23.1% in the desirable BMI range. Also, 76.9% of research participants within the optimal BMI category (BMI: 18.9–24.9 kg/m2) were ovulatory, with 61.5% of them having ovulatory cycle with adequate luteal phase support, whereas 15.4% ovulated with luteal phase insufficiency, compared with 26.7% and 15.4% in the overweight and obese categories, respectively, as shown in [Table 3].
Table 3: Cross-tabulation of BMI and progesterone

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Also, 75% of the participants within the desired WHR range of <0.80 were ovulating (54.2% with adequate luteal phase support and 20.8% with luteal phase insufficiency) compared to participants with WHR of 0.81–0.85 and >0.85, with 50% and 44.4% ovulatory cycles among the participants, respectively [Table 4].
Table 4: Cross-tabulation between WHR and progesterone

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BMI and WHR showed a significant negative correlation with serum levels of day-21 progesterone, with BMI having a better correlation than WHR (r = -0.535 vs. -0.397; P = 0.001 vs. 0.008, respectively), as shown in [Table 7].

Comparison of other hormonal parameters with participants’ BMI showed that levels of gonadotropins (LH and FSH) were significantly lower among the overweight and obese groups compared with the optimal BMI group. Mean serum estradiol levels decrease with increasing BMI among participants, whereas the participants in the obese group showed the highest mean serum testosterone levels compared with the other groups [Table 5].
Table 5: Comparing the means of the hormonal profiles with BMI

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Similarly, mean serum gonadotropins levels were also found to be lowest among participants with the highest WHR compared to the group with optimal WHR of ≤0.80, with a statistically significant difference, whereas mean serum estradiol was found to be decreasing with increasing WHR, similar to findings in the BMI. No statistically significant difference was observed in mean serum prolactin across the three WHR categories. Serum testosterone, however, showed statistically significant differences across the WHR categories, with WHR ≥0.85 category showing the highest mean serum testosterone, similar to what was obtained with BMI, as shown in [Table 6].
Table 6: Comparing the means of the hormonal profiles with WHR

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Correlation analysis of BMI, WHR, and reproductive hormones showed a significant positive correlation between both anthropometric measurements and serum total testosterone to almost equal extent (r = 0.580 vs. 0.611). Both anthropometric measurements showed a significant negative correlation with serum estradiol levels; BMI however correlated better than WHR (r = -0.508 vs. -0.278). BMI was found to be only weakly positively correlated with FSH levels (r = 0.159) and not correlated with LH (r = 0.050) compared to WHR that was significantly positively correlated with FSH (r = 0.431) and weakly positively correlated with LH (r = 0.217). Serum prolactin was not significantly correlated with BMI (r = 0.086), whereas there was a weak significant positive correlation with WHR (r = 0.330) [Table 7].
Table 7: Correlation between hormonal profiles and BMI and WHR

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  Discussion Top

Our study evaluated the relationship between anthropometric measurements of obesity (BMI and WHR) and reproductive hormones among African women within reproductive age group. This assisted in the generation of relevant data in this part of the world where limited or no study of this type has been carried out. Thus the data can be compared to data in other parts of the world and aid a holistic global perspectives of reproductive medicine.

Although 28.9% of our patients were within the optimal BMI range of 18.5–24.9 kg/m2, 53.3% of them were in the optimal WHR range of <0.85. Even when the number of underweight participants (8.9%) was added to the optimal BMI participants, 37.8% obtained was still far lesser than that obtained for desirable WHR.

We found that a majority of participants within the optimal BMI and desirable WHR range were ovulating adequately. However, more participants with optimal BMI were more associated with ovulatory cycles with adequate luteal phase support compared with desirable WHR group, whereas anovulatory cycles were more associated with obesity in both anthropometric measurements. Both anthropometric measurements were negatively correlated with day-21 serum progesterone; however, BMI was more significantly correlated. These are similar to findings in other studies where obesity has been associated with longer time to pregnancy and WHR was established, as a reliable cue to female reproductive history.[15],[16] There are, however, other studies that got contrary findings that rather positively associated desirable anthropometric measurement with infertility.[17] This may be due to racial, environmental, and geographical variations of participants in the various researches. A meta-analysis or systematic reviews of these similar studies will be useful in finding a consensus.

Lower mean serum gonadotropins levels were associated with obesity in this study for BMI and WHR, similar to findings in several other studies.[18],[19] This has been attributed to the inhibitory effect of the body mass and fat on the hypothalamo-pituitary axis.[20] WHR showed relatively better positive correlations with gonadotropins compared to BMI. Serum estradiol was found to be negatively correlated with both BMI and WHR in our study, with BMI showing relatively a better correlation than WHR, similar to findings in some studies.[20],[21] The reduction in serum estradiol levels in obesity has been attributed to reduction in sex hormone binding globulin (SHBG) levels from hyperinsulinemia; this in turn is associated with excessive body fat. The reduction in SHBG causes increased serum-free estradiol levels, whereas serum total estradiol becomes reduced from increase loss.[22],[23],[24] A critical review of studies associating higher serum estradiol to higher BMI and WHR in obesity showed that serum-free estradiol rather than serum total estradiol was assayed. It is therefore imperative to state specifically the forms of reproductive hormones measured in studies, either the total or the free forms, to ensure correct comparison and prevent avoidable confusion.[20],[25],[26]

Elevated serum total testosterone was positively associated with increasing BMI and WHR, and both anthropometric measurements were significantly positively correlated with serum total testosterone; however, WHR showed a better correlation than BMI. Obesity, especially the visceral subtype, has been associated with functional hyperandrogenism. This has been attributed to hyperinsulinemia from insulin resistance found in obesity.[27] Hyperinsulinemia causes ovarian hyperandrogenism by stimulating ovarian stromal and thecal testosterone and androstenedione synthesis.[28] Hyperandrogenism in obesity has also been attributed to the pathogenesis of polycystic ovarian syndrome.[29]

Serum prolactin had a weak positively significant correlation only with WHR, not BMI. Some studies have also demonstrated a significantly high prevalence of obesity among patients with hyperprolactinemia, irrespective of the degree of obesity and the causes of the hyperprolactinemia.[30],[31] The proposed mechanism is either the stimulation of lipogenesis or the disruption of central nervous system dopaminergic response.[32]

  Conclusions Top

Anthropometric measurements are objective cues to functionality and optimal concentrations of reproductive hormones among black female Africans within reproductive age group, though optimal BMI appears to be more associated with ovulatory cycles and adequate luteal phase support compared to WHR. Weight control should therefore aid the optimization of reproductive hormones and fertility among females of reproductive age.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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