Effect of Zinc Supplementation on Insulin Resistance and Clinical Features in Women With Polyendocrine Metabolic Ovarian Syndrome.

Polyendocrine Metabolic Ovarian Syndrome (PMOS) is the most common endocrinopathy in women of reproductive age, and is mechanistically anchored in insulin resistance (IR), and drives the downstream cascade of hyperandrogenism, anovulation, dyslipidaemia and long-term type 2 diabetes risk. South Asian women -including Bangladeshi women - develop IR at lower BMI thresholds than other populations and simultaneously carry one of the world's highest burdens of zinc deficiency (57% of non-pregnant non-lactating women). Zinc is structurally required for pancreatic β-cell insulin synthesis, modulates insulin-receptor signaling and PI3K/Akt-mediated glucose uptake, and acts as a cofactor for Cu/Zn-superoxide dismutase, suppressing the oxidative stress and NF-κB-driven inflammation that perpetuate IR in PMOS. Despite this strong mechanistic rationale, no randomised trial of zinc supplementation in PMOS has been conducted in any South Asian population. To evaluate the effect of 12 weeks of oral zinc supplementation, as adjunct to standard conventional therapy, on insulin resistance (HOMA-IR) and on clinical and biochemical features of PMOS in Bangladeshi women. A randomised, double-blind, placebo-controlled trial will be conducted at the Department of Pharmacology in collaboration with the Department of Obstetrics \& Gynaecology, Bangladesh Medical University (BMU), Dhaka. Seventy four newly diagnosed women with PMOS (Rotterdam / 2023 ESHRE criteria), aged 18-45 years, will be randomised 1:1 to receive elemental zinc 50 mg/day or an identical-appearing placebo, in addition to standard conventional therapy, for 12 weeks. The primary outcome is change in HOMA-IR from baseline to 12 weeks. Secondary outcomes include change in serum zinc, serum triglycderide, biomarker of oxidative stress (serum malondialdehyde), modified Ferriman-Gallwey (mFG) hirsutism score, BMI, and menstrual regularity. Between-arm comparisons will use unpaired t-tests / Mann-Whitney U; within-arm changes by paired t-tests; categorical outcomes by χ²; and the relationship between change in serum zinc and changes in HOMA-IR, mFG and androgen markers by Pearson / Spearman correlation. In conclusion, combining zinc supplementation with the conventional treatment might be potentially have a safe, low cost, substantial impact on insulin resistance, lipid profile, oxidative stress and hormonal measures in patients with PMOS.

Inclusion Criteria: * the updated evidence based Rotterdam Criteria (revised 2023) * newly diagnosed women with PMOS * age above 18 years upto 45 years Exclusion Criteria: * Pregnancy and lactating mother. * diagnosed case of Diabetes mellitus, liver disease, kidney disease, cardiovascular disease * Any acute or chronic infective or inflammatory disease. * Patients receiving Zinc supplementation within the last three months. * Exclusion of PMOS mimicking disease include hyperprolactinemia, adrenal hyperandrogenism, ovarian hyperandrogenism, cushing syndrome, acromegaly etc. * Known allergy to Zinc supplementation. * Those who will not give informed consent