Original Article Influence of lifestyle guidance and mental care on internal secretion, carbohydrate metabolism and pregnancy in obese patients ...
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Int J Clin Exp Med 2020;13(1):104-111 www.ijcem.com /ISSN:1940-5901/IJCEM0103402 Original Article Influence of lifestyle guidance and mental care on internal secretion, carbohydrate metabolism and pregnancy in obese patients with polycystic ovary syndrome Jiamei Song, Hongxia Wang School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China Received October 11, 2019; Accepted December 9, 2019; Epub January 15, 2020; Published January 30, 2020 Abstract: Objective: We aim to discuss the influence of lifestyle guidance and mental care on internal secretion, carbohydrate metabolism and pregnancy in obese patients with polycystic ovary syndrome (PCOS). Methods: In total, 84 obese PCOS patients were selected as subjects of study for a retrospective analysis and divided into an observation group (44 cases) and a control group (40 cases) according to care methods. The patients of the control group received routine care and those of the observation group received lifestyle guidance and mental care on the basis of routine care. The weight and body mass index (BMI), levels of luteinizing hormone (LH), ratio between LH, follicle-stimulating hormone (LH/FSH), testosterone (T), fasting blood glucose (FBG), fasting insulin (FINS), the homeostasis model assessment of insulin resistance (HOMA-IR),the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were calculated. Results: After care, the weight, BMI, the levels of LH, LH/FSH and T, HOMA- IR and FINS, SDS and SAS scores of the observation group were lower than those of in the control group (P
Influence of lifestyle guidance and mental care on PCOS
_
Table 1. Comparison of general data in two groups [ x ± s, n (%)]
Failure times of in Education level
Average age
Group n vitro fertilization-em- Junior high Senior high school/tech- Junior college
(years old)
bryo transplantation school nical secondary school or above
Observation group 44 28.32±2.46 7 (15.91) 3 (6.82) 12 (27.27) 29 (65.91)
Control group 40 28.56±2.71 5 (12.50) 5 (12.50) 13 (32.50) 22 (55.00)
X2/t 0.426 0.199 1.313
P 0.672 0.656 0.519
were strengthened in obese PCOS patients to distributed and interpreted to instruct patients
observe the influence on internal secretion, to arrange their diets according to guidelines,
carbohydrate metabolism and pregnancy. The mainly focusing on food with high protein, high
report is shown below. fiber and low calories. (3) Self-observation
record: the patients were instructed to record
Material and methods their daily diet and measure and record their
weight weekly. (4) Follow-up visit: the patients
General data were followed over the telephone once a fort-
night so that their questions could be answer-
The clinical data of 84 obese PCOS patients
ed and the problems could be solved. The
who were admitted to our hospital from Fe-
patients returned to the doctor once a month
bruary 2016 to March 2019 were collected for
for analysis in terms of diet, movement and
retrospective analysis. Inclusion criteria: this
weight, etc., as recorded by patients so as to
study included (1) patients in conformity with
adjust the intervention program. The interven-
the diagnostic criteria on obese PCOS pro-
tion lasted for 6 months in succession.
posed by Rotterdam in 2003 [9]; (2) those aged
20-35 years old; (3) those with the body mass The observation group received lifestyle guid-
index (BMI) of 25-35 kg/m2; (4) those without ance and mental care on the basis of routine
childbearing history; (5) those who were able care: (1) dietary instruction: the dietary pro-
to complete the questionnaire independently gram was formulated for patients: the ratio of
without communication barriers; and (6) those
dietary energy was 40%-45% protein, 30%-
who signed the Informed Consent Form willing-
35% lipid and 20%-25% carbohydrate. The food
ly. Exclusion criteria: this study excluded (1)
mainly consisted of plants, such as fresh fruits
patients complicated with severe hypohepatia,
and vegetables and nuts, etc., and cooked with
pulmonary dysfunction, renal insufficiency and
vegetable oil. Greasy food is not recommended
cardiac dysfunction; (2) those complicated with
and sweet and spicy food are decreased. (2)
diseases of adrenal glands and hyperprolac-
Movement instruction: the patients did aerobic
tinemia; (3) those whose mates were infecund;
exercise more than 3 times every week and the
(4) who were infecund due to fallopian tube
most appropriate time was 1 h after breakfast
issues; and (5) those with a history of mental
or 1 h after dinner. They could choose proper
diseases. The patients were divided into a con-
movements according to their own exercise
trol group (n=40) and an observation group
habits and preferences, such as jogging and
(n=44) according to caring methods. The differ-
setting-up exercise, etc. The movement time
ence in general data of two groups had no sta-
was kept between 40 min and 60 min and the
tistical significance (P>0.05), but had compara-
exercise heart rate target was (220-age)×60%.
bility, as shown in Table 1.
(3) Care in heart rate: such symptoms as obe-
Methods sity, hypertrichosis and infertility caused by
being obese with PCOS could increase the
The control group received routine care: (1) mental pressure of patients and make them
health education: the patients were taught have anxiety and depression, which affected
knowledge related to being obese with PCOS their enthusiasm in cooperating with interven-
and relevant daily precautions, etc. (2) General tion programs. Therefore, medical workers pro-
dietary instruction: the dietary guidelines were vide psychological counseling, actively listen to
105 Int J Clin Exp Med 2020;13(1):104-111Influence of lifestyle guidance and mental care on PCOS
patients, analyze the psychological problems tion); 16. I have to empty my bladder often
and offer persuasion and guidance, and even (ascheturesis); 17. My hands are usually dry
invite psychologists to provide professional and warm (hidrosis); 18. My face gets hot and
psychological guidance if necessary. The inter- blushes (facial flushing); 19. I fall asleep easily
vention lasted for 6 months in succession. and get a good night’s rest (sleep disorders);
20. I have nightmares (nightmares). The 20
Evaluation criteria items of SDS included: 1. I feel down hearted
and blue (melancholy); 2. Morning is when I feel
(1) The weight and body mass index (BMI) were the best (serious in the morning and mild at
measured in the two groups. (2) Internal secre- night); 3. I have crying spells or feel like it (cry-
tion: the venous blood of patients was collec- ing easily); 4. I have trouble sleeping at night
ted during 2-4 d of their menstrual period and (sleep disorders); 5. I eat as much as I used to
centrifuged for 10 min at the speed of 3,000 r/ (anorexia); 6. I still enjoy sex (sexual interest
min. Roche Cobas E602 Analyzer was used to decreased); 7. I notice that I am losing weight
measure luteinizing hormone (LH), ratio bet- (loss of weight); 8. I have trouble with constipa-
ween LH and follicle-stimulating hormone (LH/ tion (constipation); 9. My heart beats faster
FSH) and testosterone (T) level. (3) Carbohy- than usual (palpitation); 10. I get tired for no
drate metabolism: the venous blood was col- reason (fatigue); 11. My mind is not as clear as
lected on empty stomach before and after it used to be (difficulty thinking); 12. I do not
nursing. The glucose oxidase method was us- find it easy to do the things I used to (ability
ed to measure the fasting blood glucose (FBG) decreased); 13. I am restless and can’t keep
with kits purchased from Guangzhou Jinde still (uneasiness); 14. I do not feel hopeful
Biotechnology Co., Ltd. and chemiluminescen- about the future (desperation); 15. I am more
ce was used to measure the fasting insulin irritable than usual (irritability); 16. I do not find
(FINS) with kits purchased from Beijing Ke- it easy to make decisions (decision difficult); 17.
meidongya Biotechnology Co., Ltd. The compu- I do not feel that I am useful and needed (feel-
tational formula of HOMA-IR=FBG (mmol/L)× ing of uselessness); 18. My life is not full (feel-
FINS (mIU/L)/22.5 was used to calculate the ing empty in life); 19. I feel that others would be
homeostasis model assessment of insulin better off if I were dead (unworthiness); 20. I do
resistance (HOMA-IR). (4) Mental states: the not enjoy the things I used to do (loss of inter-
self-rating anxiety scale (SAS) and self-rating est). It is divided into 4 grades, and the scores
depression scale (SDS) designed by Zung in of each item are added together to get a score,
America were used to evaluate the mental which is then converted into a standard score.
states of patients before and after nursing. The total standard score is 25-100 points. The
There were 20 items in each scale. The 20 lower the scores were, the better the mental
items of SAS included: 1. I feel more nervous states of anxiety and depression was. (5) Pre-
and anxious than usual (anxiety); 2. I feel afraid gnancy situation: The human chorionic gona-
for no reason at all (afraid); 3. I get upset easily dotrophin was positive.
or feel panicky (panic); 4. I feel like I’m falling
Statistical analysis
apart and going to pieces (insane); 5. I feel that
everything is all right and nothing bad will hap- SPSS 25.0 statistical software was used for
pen (unfortunate presentiment); 6. My arms analysis. The measurement data were expres-
and legs shake and tremble (trembling arms sed as mean ± standard deviation. The t test
and legs); 7. I am bothered by headaches neck of two independent samples was used to co-
and back pain (body pain); 8. I feel weak and mpare the mean between the two groups.
get tired easily (fatigue); 9. I feel calm and can Paired t test was used to compare the mean
sit still easily (akathisia); 10. I can feel my heart before and after intervention in the same
beating fast (palpitation); 11. I am bothered by group. Univariate analysis of variance was used
dizzy spells (dizziness); 12. I have fainting to compare the mean between groups. Pairwise
spells or feel like I’m going to faint (sense of comparison of homogeneity of variance was
syncope); 13. I can breathe in and out easily performed using LSD method, while heteroge-
(dyspnea); 14. I get feelings of numbness and neity of variance was used Dennett T3 test.
tingling in my fingers and toes (tingling in fin- Comparison of rates was performed by Chi-
gers and toes); 15. I am bothered by stomach square test. PInfluence of lifestyle guidance and mental care on PCOS
_
Figure 1. Comparison of weigh and BMI level in two groups ( x ± s). Notes: ***PInfluence of lifestyle guidance and mental care on PCOS
Figure 2. Comparison
_ of internal secretion level in
two groups ( x ± s). Notes: ***PInfluence of lifestyle guidance and mental care on PCOS
_
Figure 4. Comparison of mental states in two groups ( x ± s). Notes: ***PInfluence of lifestyle guidance and mental care on PCOS
pocyte factors on ovary and adrenal gland will 121001, Liaoning, China. Tel: +86-0416-4673073;
be inhibited to reduce the secretion of andro- E-mail: envwxzz@163.com
gens and avoid ovarian hyperthecosis caus-
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