Journal of Psychosomatic Obstetrics & Gynecology

ISSN: 0167-482X (Print) 1743-8942 (Online) Journal homepage: http://www.tandfonline.com/loi/ipob20

Comparison of myo-inositol and metformin on

mental health parameters and biomarkers of
oxidative stress in women with polycystic ovary
syndrome: a randomized, double-blind, placebo-
controlled trial

Hamidreza Jamilian, Mehri Jamilian, Fatemeh Foroozanfard, Faraneh Afshar

Ebrahimi, Fereshteh Bahmani & Zatollah Asemi

To cite this article: Hamidreza Jamilian, Mehri Jamilian, Fatemeh Foroozanfard, Faraneh Afshar
Ebrahimi, Fereshteh Bahmani & Zatollah Asemi (2017): Comparison of myo-inositol and metformin
on mental health parameters and biomarkers of oxidative stress in women with polycystic ovary
syndrome: a randomized, double-blind, placebo-controlled trial, Journal of Psychosomatic
Obstetrics & Gynecology, DOI: 10.1080/0167482X.2017.1383381

To link to this article: http://dx.doi.org/10.1080/0167482X.2017.1383381

Published online: 05 Oct 2017.

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 JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY, 2017
https://doi.org/10.1080/0167482X.2017.1383381

ORIGINAL ARTICLE

Comparison of myo-inositol and metformin on mental health parameters

and biomarkers of oxidative stress in women with polycystic ovary
syndrome: a randomized, double-blind, placebo-controlled trial
Hamidreza Jamiliana, Mehri Jamilianb, Fatemeh Foroozanfardc, Faraneh Afshar Ebrahimic,
Fereshteh Bahmanid and Zatollah Asemid
a
Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran; bEndocrinology and Metabolism Research Center,
Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran; cDepartment of
Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran; dResearch Center for
Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran

ABSTRACT ARTICLE HISTORY

Downloaded by [University of Connecticut] at 06:36 06 October 2017

Introduction: Data on comparison of myo-inositol and metformin on mental health parameters Received 7 July 2017
and biomarkers of oxidative stress in subjects with polycystic ovary syndrome (PCOS) are scarce. Revised 3 September 2017
This purpose of this study was to compare of myo-inositol and metformin on mental health Accepted 15 September 2017
parameters and biomarkers of oxidative stress in subjects with PCOS.
Methods: This randomized controlled trial was conducted among 60 subjects diagnosed with KEYWORDS
PCOS according to the Rotterdam criteria. Subjects were randomly assigned into two groups to Myo-inositol; metformin;
intake either myo-inositol (n ¼ 30) or metformin (n ¼ 30) for 12 weeks. Parameters of mental polycystic ovary syndrome;
health were recorded at baseline and after the 12-week intervention. Fasting blood samples mental health; oxidative
were obtained at baseline and the end of the study to determine biomarkers of biomarkers of stress
oxidative stress.
Results: After the 12-week intervention, changes in beck depression inventory total score
(1.0 ± 1.7 vs. 0.3 ± 0.7, p ¼ 0.03), general health questionnaire scores (1.7 ± 2.9 vs. 0.5 ± 1.2,
p ¼ 0.02), depression anxiety and stress scale scores (3.9 ± 6.4 vs. 0.9 ± 1.9, p ¼ 0.01) and
plasma total antioxidant capacity (TAC) concentrations (þ106.1 ± 69.6 vs. þ2.1 ± 132.4 mmol/L,
p < 0.001) in the myo-inositol group were significantly different from the changes in these indi-
cators in the metformin group. Myo-inositol supplementation for 12 weeks among patients with
PCOS did not affect plasma glutathione and malondialdehyde levels.
Conclusions: Overall, our data supported that myo-inositol supplementation for 12 weeks among
patients with PCOS had favorable effects on parameters of mental health and plasma TAC levels.

Introduction To treat the long-term health consequences among

Polycystic ovary syndrome (PCOS) is one of the most
common hyperandrogenic and dysmetabolic disorder
of reproductive-aged women [1]. The prevalence of
PCOS is ranging from 5.5% to 16%, depending on the
diagnostic criteria used [2]. Prior studies have shown
that PCOS women suffer from impaired emotional
well-being, including anxiety and depression [3], and
reduced quality of life [4]. However, the relationship
between the biochemical features of PCOS and the
severity of the psychological disorders remains unclear.
Nonetheless, the role of physical appearance, such as
hirsutism and obesity [5], and acne [6] has been rela-
tively well-established in psychological dysfunction in
PCOS patients.
PCOS women, in addition to lifestyle changes [7], the
use of insulin-sensitizers [8] has been proposed.
However, metformin intake may have metabolic and
reproductive benefits, such as weight reduction,
improved androgen levels, restoration of a normal
menstrual cyclicity and ovulation [9], the consumption
of it in PCOS women may be limited by gastrointes-
tinal side effects [10]. Unlike with metformin, no side
effects have been reported following the intake of
myo-inositol [11]. Inositol is a precursor in the phos-
phatidyl-inositol secondary messenger pathway acti-
vated by several neurotransmitters [12]. In the last two
decades, inositols were found to have important
effects in the treatment of disease associated to insulin

CONTACT Zatollah Asemi asemi_r@yahoo.com Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical
Sciences, Kashan, Iran
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
 2 H. JAMILIAN ET AL.
resistance such as PCOS, gestational diabetes, and
metabolic syndrome [13–14]. In addition, other studies
underlined the importance of two inositol isoforms,
myo- and D-chiro-, in metabolism and ovarian function
in PCOS women [15,16]. In a study by Chengappa
et al. [17] it observed that inositol intake at a dosage
of 12 g/day for six weeks in patients with bipolar
depression improved Hamilton Depression Rating
Scale and Clinical Global Improvement scores. In add-
ition, the beneficial effects of folate supplementation
on biomarkers of oxidative stress in patients with
PCOS [18] and type 2 diabetes mellitus [19] have pre-
viously reported.
Although there is evidence to indicate that myo-
inositol intake may improve mental health parameters
and biomarkers of oxidative stress in PCOS women,
Downloaded by [University of Connecticut] at 06:36 06 October 2017
the beneficial effects of myo-inositol intake in PCOS
women on these variables compared with the metfor-
min, to our knowledge, has not yet been firmed.
Therefore, we hypothesized that myo-inositol intake
might improve mental health parameters and bio-
markers of oxidative stress of PCOS women. The pur-
pose of this study was to compare myo-inositol and
metformin on mental health parameters and bio-
markers of oxidative stress among women with PCOS.
Subjects and methods
Trial design
The current study was a prospective randomized con-
trolled trial.
Participants
The current study was carried out at the Kosar clinic
affiliated to Arak University of Medical Sciences
(AUMS), Arak, Iran between July 2016 and December
2016. Inclusion criteria were women with PCOS accord-
ing to the Rotterdam criteria [20] and aged
25–65 years. Smokers, the intake of folate supplements
within the last 3 months, pregnant women, individuals
with metabolic diseases, thyroid disease, hyperprolacti-
nemia and hypercortisolemia were excluded in the
study.
Ethics statements
This study was conducted in accordance with the
Declaration of Helsinki and Good Clinical Practice
guidelines as well as written informed consent were
obtained from all participants. The study was
approved by the research ethics committee of AUMS
and was recorded in the Iranian website for registra-
tion of clinical trials (http://www.irct.ir:
IRCT201706065623N118).
Study design
Participants were randomly assigned into two groups
to intake either 500 mg of metformin three times a
day (n ¼ 30) or myo-inositol containing 2 g of myo-
inositol plus 200 mg of folate twice a day (n ¼ 30) for
12 weeks. Myo-inositol and metformin were manufac-
tured by LO.LI. Pharma (Rome, Italy) and Tehran Darou
Pharma (Tehran, Iran), respectively. Participants were
asked not to alter their routine physical activity or
usual dietary intakes during the study and not to con-
sume any supplements and medications that might
influence related markers during the study or the pre-
vious three months (wash-out). All participants pro-
vided three-day dietary records and three physical
activity records. Both dietary records and physical
activity were taken at baseline, weeks of 3, 6, 9 and 12
of the intervention. To obtain information on partici-
pant nutrient intake based on these three-day food
diaries, we used Nutritionist IV software (First
Databank, San Bruno, CA, USA) modified for Iranian
foods.
Treatment adherence
To evaluate the compliance, participants were asked
to bring the medication container. In addition, partici-
pants received a daily reminder message on their cell
phones to take their supplements regularly.
Assessment of anthropometric measures
Weight and height of participants were determined in
an overnight fasting status using a standard scale
(Seca, Hamburg, Germany) at the onset of the study
and after the 12-week intervention. BMI was calculated
as weight in kg divided by height in meters squared.
Assessment of outcomes
Parameters of mental health were considered as the
primary outcome and biomarkers of oxidative stress
were considered as the secondary outcomes.
Assessment of mental health
Mental health was judged with beck depression inven-
tory (BDI), general health questionnaire-28 (GHQ-28)
and depression anxiety and stress scale (DASS) at

baseline and the end of treatment. BDI is a self-com-
piled questionnaire of 21 items in multiple choice for-
mat [21]. The GHQ-28 comprises 28-item consisting of
four subscales: somatic symptoms, anxiety and insom-
nia, social dysfunction and severe depression [22].
DASS questionnaire consists of three 14-item self-
report scales that measure depression, anxiety and
stress [23].
Biochemical assessment
Ten milliliters fasting blood samples were taken at
baseline and after the 12-week intervention at Arak
reference laboratory, Arak, Iran. Serum high sensitivity
C-reactive protein (hs-CRP) levels were assessed using
available ELISA kits (LDN, Nordhorn, Germany).
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Spectrophotometric methods were used to assess
nitric oxide (NO) [24]. Plasma total antioxidant capacity
(TAC) by the method of ferric reducing antioxidant
power developed by Benzie and Strain [25], total
glutathione (GSH) using the method of Beutler et al.
[26] and malondialdehyde (MDA) concentrations by
the thiobarbituric acid reactive substances spectro-
photometric test [27] were determined.
Sample size
Considering the following values: effect size ¼ 0.5,
a ¼ 0.05, b ¼ 0.20, to the power of 80% and using a
formula suggested for clinical trials, the sample size
was estimated at 25 subjects in each group.
Considering the possible losses, the sample size was
set at 30 subjects in each group finally.
Randomization
Randomization assignment was conducted using com-
puter-generated random numbers. At the time of ran-
domization, sequentially numbered, sealed envelopes
were opened. Allocation to study group was concealed
until consent was obtained and inclusion/exclusion cri-
teria verified. Allocation of the subjects was conducted
by a trained staff at the gynecology clinic that was
blinded to the randomization schedule. Because com-
mercially available myo-inositol and metformin were
used, there was no blinding after randomization; con-
sequently, researchers and participants could identify
the actual treatment.
Statistical methods
The Kolmogorov–Smirnov test was applied to control
the normal distribution of variables. Independent
JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY 3
sample t-test was used to establish changes in
anthropometric measures and dietary intakes between
the two groups. To compare the effects of myo-inosi-
tol and metformin on mental health and oxidative
stress parameters, we used one-way repeated meas-
ures analysis of variance. Adjustment for changes in
baseline values of biochemical parameters, age and
baseline BMI was conducted by analysis of covariance.
p < 0.05 were considered statistically significant. All
statistical analyzes conducted using the Statistical
Package for Social Science version 18 (SPSS Inc.,
Chicago, IL, USA).
Results
Thirty participants in both groups completed the trial
out of 65 subjects which were recruited in our study
(five subjects were excluded from the study because
of not meeting inclusion criteria) (Figure 1). On aver-
age, higher than 90% of myo-inositol and metformin
were taken in both groups.
Mean age, height, weight and BMI at baseline and
end-of-trial were not statistically different between the
two groups (Table 1).
Considering the three-day dietary records obtained
at baseline, weeks of 3, 6, 9 and 12 of the intervention,
there was no statistically significant difference in terms
of dietary macro- and micro-nutrient intakes between
myo-inositol and metformin groups (data not shown).
After the 12-week intervention, compared with met-
formin, myo-inositol supplementation led to significant
improvements in BDI score (1.0 ± 1.7 vs. 0.3 ± 0.7,
p ¼ 0.03), GHQ scores (1.7 ± 2.9 vs. 0.5 ± 1.2, p ¼ 0.02)
and DASS scores (3.9 ± 6.4 vs. 0.9 ± 1.9, p ¼ 0.01)
(Table 2). In addition, change in plasma TAC concentra-
tions (þ106.1 ± 69.6 vs. þ2.1 ± 132.4 mmol/L, p < 0.001)
in myo-inositol group were significantly different from
the change in this indicator in metformin group. Myo-
inositol supplementation for 12 weeks among patients
with PCOS did not affect plasma GSH and MDA levels.
Baseline levels of MDA (p ¼ 0.01) were significantly
different between the two groups. Therefore, we con-
trolled the analyzes for the baseline values of bio-
chemical parameters, age and baseline BMI. When we
adjusted the analysis for baseline values of biochem-
ical variables, age and baseline BMI, BDI scores
(p ¼ 0.05) and GHQ scores (p ¼ 0.06) became non-sig-
nificant, and other findings did not alter (Table 3).
Discussion
In this study, we compared the effects of myo-inositol
and metformin on mental health parameters and
 4 H. JAMILIAN ET AL.

Assessed for eligibility (n=65)

Enrollment
Excluded (n=5)
- Not meeting inclusion criteria (n=5)

Randomized (n=60)
Allocation

Allocated to placebo (n=30) Allocated to intervention (n=30)

Follow-up

Lost to follow-up (n=0) Lost to follow-up (n=0)

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Analysis

Analyzed (n=30) Analyzed (n=30)

Figure 1. Summary of patient flow.

significantly associated with improved insulin sensitiv-

Table 1. General characteristics of study participants. ity [33]. In addition, D-chiro-inositol supplementation
Metformin Myo-inositol for 6 months among patients with PCOS was effective
group group
(n ¼ 30) (n ¼ 30) pa in improving ovarian function and metabolic factors,
Age (y) 27.7 ± 3.4 28.5 ± 4.7 0.43 including total testosterone, free testosterone, 4-andro-
Height (cm) 160.7 ± 5.4 160.6 ± 3.5 0.95 stenedione, prolactin, and insulin resistance [34]. In
Weight at study baseline (kg) 72.5 ± 16.0 71.3 ± 11.9 0.74
Weight at end-of-trial (kg) 72.2 ± 16.5 70.7 ± 11.5 0.69 another study, both the isoforms of inositol were
Weight change (kg) 0.3 ± 1.1 0.5 ± 1.6 0.44 effective in improving ovarian function and metabolic
BMI at study baseline (kg/m2) 28.1 ± 6.4 27.6 ± 4.2 0.71
BMI at end-of-trial (kg/m2) 28.0 ± 6.5 27.4 ± 4.1 0.66 factors in subjects with PCOS, although myo-inositol
BMI change (kg/m2) 0.1 ± 0.4 0.2 ± 0.6 0.49 showed the most marked effect on the metabolic pro-
Data are means ± SDs. files, whereas D-chiro-inositol decreased hyperandro-
a
Obtained from independent t-test.
genism better [35]. Interestingly, it has been
documented that in PCOS women metformin improves
biomarkers of oxidative stress in subjects with PCOS. insulin action at least in part by increasing insulin-
Our data documented that myo-inositol supplementa- mediated release of D-chiro-inositol phosphoglycan
tion for 12 weeks among patients with PCOS had [36].
beneficial effects on parameters of mental health, and We found that myo-inositol supplementation
plasma TAC levels, but did not affect GSH and MDA among PCOS women for 12 weeks resulted in a signifi-
concentrations. To our knowledge, this study is the cant improvement in mental health parameters com-
first report of the effects of myo-inositol and metfor- pared with the metformin. However, few studies have
min intake on mental health parametres and bio- evaluated the effects of myo-inositol intake on mental
markers of oxidative stress in patients with PCOS. health parameters among patients without PCOS; data
Subjects with PCOS are susceptible to mental health on the effects of myo-inositol supplementation, com-
disorders [28,29] and increased biomarkers of oxidative pared with metformin, on mental health parameters in
stress [30,31]. During the last decades, inositol admin- PCOS women are scarce. Two previous studies of
istration has gained as novel promising treatment for adjunctive inositol yielded conflicting results. One
a wide range of pathological conditions namely gyne- study has randomized subjects with bipolar depression
cological diseases, insulin resistance, psychiatric illness, to receive 12 g of inositol or placebo for six weeks
and even cancer [32]. It has been shown that in PCOS [17]. Patients receiving inositol had at least a 50%
patients, the increased release of D-chiro-inositol is improvement in depressive symptoms, as well as
 JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY 5

Table 2. Parameters of mental health and biomarkers of oxidative stress at baseline and after the 12-week intervention in sub-
jects with polycystic ovary syndrome that received either myo-inositol or metformina.
Metformin group (n ¼ 30) Myo-inositol group (n ¼ 30)
Baseline End-of-trial Change p b
Baseline End-of-trial Change pb pc
BDI total scores 15.1 ± 3.9 14.8 ± 3.9 0.3 ± 0.7 0.04 15.4 ± 5.2 14.4 ± 5.1 1.0 ± 1.7 0.004 0.03
GHQ scores 49.7 ± 8.4 49.2 ± 8.6 0.5 ± 1.2 0.02 50.2 ± 6.2 48.5 ± 6.6 1.7 ± 2.9 0.004 0.04
DASS scores 86.6 ± 15.7 85.7 ± 15.7 0.9 ± 1.9 0.01 89.1 ± 16.6 85.2 ± 15.8 3.9 ± 6.4 0.002 0.01
TAC (mmol/L) 823.0 ± 152.0 825.1 ± 166.0 2.1 ± 132.4 0.93 868.5 ± 56.2 974.6 ± 60.6 106.1 ± 69.6 <0.001 <0.001
GSH (mmol/L) 586.5 ± 112.9 591.6 ± 143.4 5.1 ± 138.5 0.84 631.3 ± 79.9 663.9 ± 88.0 32.7 ± 80.1 0.03 0.35
MDA (mmol/L) 2.5 ± 0.6 2.8 ± 1.2 0.3 ± 1.4 0.21 2.8 ± 0.3 2.7 ± 0.3 0.1 ± 0.4 0.11 0.10
a
Data are means ± SDs.
b
Obtained from paired-samples t-test.
c
p Values represent the time  group interaction (computed by analysis of the one-way repeated measures ANOVA).
BDI: beck depression inventory; DASS: depression anxiety and stress scale; GHQ: general health questionnaire; GSH: total glutathione; MDA: malondialde-
hyde; TAC: total antioxidant capacity.

Table 3. Mean adjusted changes in parameters of mental
health and biomarkers of oxidative stress in patients with
polycystic ovary syndrome that received either myo-inositol or
metformina.
Downloaded by [University of Connecticut] at 06:36 06 October 2017
psychological disturbances [44,45]. Inositol intake may
improve mental health parameters through to control
intracellular calcium concentration and modulates

serotonin activity [46]. In addition, folate intake may

Metformin Myo-inositol improve symptoms of depression by S-adenosylme-
group group
(n ¼ 30) (n ¼ 30) pb thionine and healthy red blood cells production [46].
BDI total scores 0.3 ± 0.2 1.0 ± 0.2 0.05 Our study demonstrated that myo-inositol adminis-
GHQ scores 0.5 ± 0.4 1.6 ± 0.4 0.06 tration among patients with PCOS for 12 weeks
DASS scores 1.1 ± 0.8 3.7 ± 0.8 0.02
TAC (mmol/L) 2.2 ± 18.3 110.3 ± 18.3 <0.001 resulted in a significant increase in plasma TAC com-
GSH (mmol/L) 6.9 ± 19.5 44.7 ± 19.5 0.07 pared with metformin, but unchanged GSH and MDA
MDA (mmol/L) 0.1 ± 0.2 0.1 ± 0.2 0.77
a
levels. Oxidative stress plays a clear detrimental role
All values are means ± SEs.
b
Obtained from analysis of ANCOVA adjusted for baseline values þ age on ovarian functions [47]. Accumulating evidence
and baseline BMI. suggests that myo-inositol, in combination with mela-
BDI: beck depression inventory; DASS: depression anxiety and stress scale;
GHQ: general health questionnaire; GSH: total glutathione; MDA: malon- tonin, is able to decrease oxidative stress and conse-
dialdehyde; TAC: total antioxidant capacity. quently improve oocyte quality during assisted
reproductive technologies [48]. In women with PCOS,
significant improvements in their global illness severity there is an increase of the oxidation of thiol groups
[17]. Unlike, another randomized trial of 17 depressed of follicular proteins, related to a progressive eleva-
individuals with bipolar disorder were allocated to tion of the oxidative stress and that the administra-
receive inositol or placebo for six weeks [37]. Results tion of inositol in these patients seems to reduce the
demonstrated a trend for more participants on inositol oxidation of thiol groups, producing a good quality
to show improvement in depressive symptoms, but of oocytes [49]. In a study by Jiang et al. [50] it
inositol could not show more effective than placebo observed that myo-inositol pre-supplementation did
[37]. About folic acid, several studies have demon- block the toxic effects of copper on the antioxidant
strated a high prevalence of folic acid deficiency system in juvenile Jian carp, and therefore protect
among subjects suffering from psychiatric conditions, enterocytes from copper-induced oxidative damage.
including depression, bipolar disorder and cognitive In another study, both 0.05% and 0.1% pinitol admin-
dysfunction disorders [38,39]. Behzadi et al. [40] carried istration in hamsters fed-high fat and high cholesterol
out a preliminary randomized controlled trial of folate significantly improved antioxidant metabolism [51].
added to sodium valproate for three weeks to treat Moreover, two another studies have reported antioxi-
acute mania. Subjects experienced greater improve- dative, anti-inflammatory and anti-aging effects of
ment with adjunct folate, such that symptoms of D-chiro-inositol [52,53]. D-chiro-inositol also prevented
mania (language, thought disorder, irritability and dis- endothelial dysfunction by inhibiting oxidative stress
ruptive–aggressive behavior) significantly improved and mitochondrial fission in an AMP-activated protein
[40]. Prior studies have demonstrated that depression, kinase-dependent manner [54]. In another study, both
bipolar and anxiety disorders, and binge eating dis- D-chiro-inositol and metformin have showed a statis-
order are more frequent among PCOS women com- tically significant positive effect on follicular milieu by
pared with controls [41,42]. PCOS women with decreasing the oxidative damage on follicular fluid
depression may experience sleep disturbances, fatigue proteins, as well as in recovering good quality
[43], decreased sexual satisfaction and increased oocytes [49]. However, in the above-mentioned study,
 6 H. JAMILIAN ET AL.
a natural supplement as D-chiro-inositol and a syn-
thetic drug as metformin had a similar effect on oxi-
dative stress status, these results are really interesting
because it is well known that many subjects treated
with metformin referred serious side effect such as
nausea, vomiting, gastric pain leading to interruption
of therapy, whereas D-chiro-inositol did not have any
adverse consequence. Moreover, the choice of a nat-
ural substance is much more accepted by subjects
and clinicians, who consider metformin only an anti-
diabetic drug and other uses are considered “off
label”. We have previously showed that folate supple-
mentation (5 mg/day) for 12 weeks among subjects
with PCOS increased plasma TAC and GSH concentra-
tions [18]. A significant elevation in serum TAC con-
centrations without any significant effect on
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hydroperoxide levels was also seen following the sup-
plementation of folate (10 mg/day) after six months
among hemodialysis subjects [55]. However, folic acid
supplementation for eight weeks has been found to
not affect markers of oxidant stress among subjects
with type 1 diabetes and microalbuminuria [56].
Increased oxidative stress levels in PCOS women are
correlated with obesity, hyperinsulinemia, hyperandro-
genemia, and chronic inflammation [57,58]. Inositol
intake may decrease the inflammatory response and
oxidative stress decreased CD68 and nuclear factor-jB
expression [59]. The antioxidant effects of folate may
be attributed, in part, to transcriptional regulation of
NADPH oxidase [60].
The present study had few limitations. We did not
evaluate the compliance to myo-inositol intake by
the use of a biomarker. Another limitation was that
we did not assess beneficial effects of myo-inositol
and metformin intake on gene expression related to
oxidative stress. It must be kept in mind that base-
line levels of MDA were significantly different
between the two groups. Therefore, we controlled
the analyzes for the baseline values of biochemical
parameters, age and baseline BMI. Even after control-
ling for these potential confounders, this may repre-
sent of a serious limitation of the study. Therefore,
this should be considered in the interpretation of
our findings.
Overall, our data supported that myo-inositol sup-
plementation for 12 weeks among patients with PCOS
had favorable effects on parameters of mental health
and plasma TAC levels, but did not affect plasma GSH
and MDA levels.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
The present study was supported by a grant from the Vice-
chancellor for Research, AUMS, Iran.
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