Michaelann S. Wilke

Purpose: Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder and is associated with a variety of health disorders. The management of PCOS requires a multidisciplinary health care approach. The COVID-19 pandemic affected access and delivery of health care. The aim of this study was to assess the impact of the pandemic on the health and health care experience of those affected by PCOS. Patients and Methods: An online survey was conducted January 2021 to July 2022 in Canada, open to anyone who identified as having PCOS. Data collected in REDCap included questions on demographics, symptoms, and experience of PCOS management during the pandemic. Results: The majority (59%) of respondents (n=194, mean age 34± 8 years) experienced pandemic-related employment changes and self-reported a high stress level (73± 21/100). Of those who reported changes in body weight, 58% gained weight, which they attributed to unhealthy eating habits and a lack of exercise during the pandemic, and 16% lost weight, which they credited to increased physical activity and a shift towards healthier eating habits. The respondents ascribed the impact of COVID-related changes to clinic cancellations, delayed appointments, long wait times for referrals and lab work, lack of access to exercise facilities and insufficient social support. Some respondents voluntarily reduced access to health care services to limit COVID exposure. COVID-19-related health status was perceived as more important than their own PCOS-related symptoms. Virtual appointments via telehealth were regarded as beneficial for 20% of users. Conclusion: Individuals with PCOS reported an overall reduction in COVID-related access to health care and supports. Some adapted to the use of telemedicine, while others experienced increased stress due to a lack of access to health care and an inability to manage their PCOS symptoms. The pandemic further highlighted that those with PCOS often experience a lack of accessibility to multidisciplinary health care and supports needed to manage their condition. Plain Language Summary: Polycystic ovary syndrome (PCOS) is a complex disorder affecting up to 18% of women and can impact overall health and quality of life across the lifespan. It is characterized by irregular menstrual cycles, heavy menstrual bleeding, male-pattern hair growth, and acne due to excess production of male hormones. PCOS is associated with an increased risk of infertility, pregnancy complications, obesity, type 2 diabetes, cardiovascular diseases, and mental health disorders such as anxiety, depression, and negative self-image. Because of its complexity, PCOS requires a multidisciplinary health care approach including endocrinologists, gynecologists, dietician, exercise specialists, and psychologists/psychiatrists. In this paper, we describe the findings of a self-administered survey in those who self-reported having PCOS. The survey explores the patients’ view of the challenges in health care management during the COVID-19 pandemic. The COVID-19 pandemic caused disruptions in the delivery of health care and many patients struggled to find the support they needed. COVID-19 caused unprecedented challenges to the health care system but also presented opportunities for alternative health care delivery models. Our findings highlight the need to incorporate viable individualized and alternative care options for people with chronic conditions such as PCOS, to support self-management and prevent deterioration in health and well-being during times of unforeseen health crises. While the survey is restricted to respondents in Canada, the findings and proposed improvements provide distinct insights that are of international relevance as there is ample evidence of similar experiences regarding health care access and support during the COVID-19 pandemic around the world.

GM3 is implicated in cell signaling, inflammation and insulin resistance. The intestinal mucosa metabolizes ganglioside and provides gangliosides for uptake by peripheral tissues. Gangliosides downregulate acute and chronic inflammatory signals. It is likely that transport of intestinal derived gangliosides to other tissues impact the same signals characteristic of inflammatory change in other chronic conditions such as Type 2 Diabetes (T2DM). The postprandial ceramide composition of GM3 and other gangliosides in plasma and chylomicrons has not been examined in T2DM. The present study assessed if diet or T2DM alters ganglioside components in plasma and chylomicrons secreted from the intestinal mucosa after a meal. GD1, GD3, and GM3 content of chylomicrons and plasma was determined by LC/triple quad MS in non-diabetic (control) and T2DM individuals in the fasting and postprandial state after 2 days of consuming a low or high fat diet in a randomized blinded crossover design. Diet fat level did not alter baseline plasma or chylomicron ganglioside levels. Four hours after the test meal, plasma monounsaturated GD3 was 75% higher, plasma saturated GD3 was 140% higher and plasma polyunsaturated GM3 30% lower in diabetic subjects compared to control subjects. At 4 h, chylomicron GD1 was 50% lower in T2DM compared to controls. The proportion of d34:1 in GD3 was more abundant and d36:1 in GD1 less abundant in T2DM compared to control subjects at 4 h. The present study indicates that T2DM alters ceramide composition of ganglioside available for uptake by peripheral tissues.

The specific effects of individual fatty acids (FA) on plasma cholesterol levels, in the range habitually consumed by humans, is not usually presented by the literature. Conclusions have been made regarding the cholesterolemic effect of individual FA, even though these FA cannot be tested individually. It appears that FA balance of the diet may be more important than individual FA intakes. Variation in plasma cholesterol response to diet is influenced by many factors, such as gene‐nutrient interactions. The effect on human health of current processes used in the food industry that are certain to change dietary fat composition and TG structure is yet to be fully explored. Some of the relevant research regarding dietary fat and plasma cholesterol levels is reviewed.