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Dear Editor,
It is an interesting article by Asemi et al.1 published in this journal in December 2015. The authors investigated the impact of Ramadan fasting in women with polycystic ovary syndrome (PCOS) with respect to their metabolic status. This study is very valuable for muslim women suffering from PCOS. Nevertheless, there are numerous important points which remain unclear regarding the results.
PCOS is the most common endocrine disorders affecting women in reproductive age.2 It is defined as a syndrome of PCO (polycystic ovaries)-diagnosed by ultrasonography, as well as at least one symptom of hyperandrogenism. 3 Scientific evidence suggests that PCOS has a significant association with inflammation,4 dyslipidemia, insulin resistance,5 both type 2 and gestational diabetes mellitus, and cardiovascular disease.6
In the article published by Asemi et al., the authors observed that FPG (fasting plasma glucose) changed insignificantly before and after Ramadan, which were 97.55 ± 6.36 and 95.03 ± 9.74, respectively, describing that the majority of samples had considerably nonnal FPG levels (prediabetes category 100-125 mg/dL).7 From our point of view, the insignificant result is probably due to the nonnal glucose metabolism of patients involved in the study. In fact, not all women with PCOS in reproductive age have abnonnalities in glucose metabolism. Koh et al. reported that few women with PCOS were considered as nonnal FPG (<100 mg/ dL); even they, however, found that over one third of study samples were undetected by FPG measurement although the samples were found to have abnonnalities in glucose tolerance assessed by oral glucose tolerance test.8
In addition, the article's result showed the insignificant alterations of lipid parameters, which are cholesterol and a variety of fatty acids, between pre- and post-ramadan fasting. In fact, the association between insulin resistance, hyperandrogenism, obesity in PCOS has been established and each of these parameters independently affects dyslipidemia, although this theory is still less understood.9 However, it seems that the result might show a relationship between lipid parameters and FPG concentration and the...