{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:26:45Z","timestamp":1787585205412,"version":"build-2736575974"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The Zhejiang University (ZJU) index is a novel composite metabolic score incorporating body mass index, fasting glucose, triglycerides, and the alanine aminotransferase\/aspartate aminotransferase ratio. This study aimed to evaluate whether baseline ZJU index is associated with reproductive outcomes in women with polyendocrine metabolic ovarian syndrome (PMOS) undergoing fertility treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This\n                      <jats:italic>post-hoc<\/jats:italic>\n                      analysis is based on the Polycystic Ovary Syndrome Acupuncture and Clomiphene Trial (PCOSAct). Participants were stratified into tertiles based on baseline ZJU index levels. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for ovulation, conception, clinical pregnancy, and live birth, adjusting for potential confounders. Restricted cubic spline (RCS) analyses assessed nonlinear associations, and sensitivity analyses evaluated the robustness of the findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Women in the highest ZJU tertile had significantly lower rates of ovulation, conception, clinical pregnancy, and live birth compared with the lowest tertile (all P &amp;lt; 0.05). In the primary adjusted model (Model 2), each one-unit increase in ZJU was associated with reduced odds of ovulation (OR 0.94, 95% CI 0.91\u20130.97), conception (OR 0.96, 95% CI 0.93\u20130.99), clinical pregnancy (OR 0.95, 95% CI 0.92\u20130.98), and live birth (OR 0.95, 95% CI 0.92\u20130.99). No significant non\u2013linearity was observed (all\n                      <jats:italic>P<\/jats:italic>\n                      for non-linearity &amp;gt; 0.05). For the continuous ZJU associations, point-estimate E-values ranged from 1.17 to 1.22, and the corresponding confidence-limit E-values ranged from 1.09 to 1.15, indicating limited robustness to unmeasured confounding. Associations between the ZJU index and reproductive outcomes remained consistent across sensitivity analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A higher baseline ZJU index was associated with poorer reproductive outcomes in women with PMOS undergoing fertility treatment. The ZJU index may serve as a metabolic marker associated with reproductive outcomes in women with PMOS. However, its ability to predict individual reproductive outcomes and any clinically applicable threshold require further evaluation in dedicated prediction studies with external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1892813","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:42:28Z","timestamp":1787582548000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of the Zhejiang University (ZJU) index with reproductive outcomes in women with polyendocrine metabolic ovarian syndrome: a post-hoc analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Yang","family":"Liu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]},{"name":"Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Gong","sequence":"additional","affiliation":[{"name":"Beilun District People's Hospital, Beilun Branch of the First Affiliated Hospital of Zhejiang University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Ge","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]},{"name":"Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]},{"name":"Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Yu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]},{"name":"Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxing","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Hu","sequence":"additional","affiliation":[{"name":"Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"He","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingshu","family":"Gao","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoke","family":"Wu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e0332082","DOI":"10.1371\/journal.pone.0332082","article-title":"Trends and projections of polycystic ovary syndrome burden in China: Insights from the global burden of disease study 2021","volume":"20","author":"Qin","year":"2025","journal-title":"PLoS ONE."},{"key":"B2","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1186\/s12884-021-04015-w","article-title":"Alterations of brain metrics in fetuses of women with polycystic ovary syndrome : a retrospective study based on fetal magnetic resonance imaging","volume":"21","author":"Bao","year":"2021","journal-title":"BMC Pregnancy Childbirth."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1514250","DOI":"10.3389\/fpubh.2025.1514250","article-title":"Global burden of polycystic ovary syndrome among women of childbearing age, 1990-2021: a systematic analysis using the global burden of disease study 2021","volume":"13","author":"Meng","year":"2025","journal-title":"Front Public Health."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e000548","DOI":"10.1136\/bmjmed-2023-000548","article-title":"Polycystic ovary syndrome: pathophysiology and therapeutic opportunities","volume":"2","author":"Dong","year":"2023","journal-title":"BMJ Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1097\/MOP.0000000000000945","article-title":"Current concepts of polycystic ovary syndrome pathogenesis","volume":"32","author":"Rosenfield","year":"2020","journal-title":"Curr Opin Pediatr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"104381","DOI":"10.1016\/j.rbmo.2024.104381","article-title":"Pharmacological and non-pharmacological interventions for improving endometrial receptivity in infertile patients with polycystic ovary syndrome: a comprehensive review of the available evidence","volume":"49","author":"Palomba","year":"2024","journal-title":"Reprod Biomed Online."},{"key":"B7","doi-asserted-by":"publisher","first-page":"5591","DOI":"10.1038\/s41467-024-49749-1","article-title":"Systematic review and meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome","volume":"15","author":"Bahri Khomami","year":"2024","journal-title":"Nat Commun."},{"key":"B8","doi-asserted-by":"publisher","first-page":"j1","DOI":"10.1136\/bmj.j1","article-title":"Obesity and pregnancy: Mechanisms of short term and long term adverse consequences for mother and child","volume":"356","author":"Catalano","year":"2017","journal-title":"BMJ"},{"key":"B9","doi-asserted-by":"publisher","first-page":"16494","DOI":"10.1038\/srep16494","article-title":"ZJU index: a novel model for predicting nonalcoholic fatty liver disease in a Chinese population","volume":"5","author":"Wang","year":"2015","journal-title":"Sci Rep."},{"key":"B10","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1007\/s00592-017-1024-8","article-title":"The ZJU index is a powerful index for identifying NAFLD in the general Chinese population","volume":"54","author":"Li","year":"2017","journal-title":"Acta Diabetol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1340644","DOI":"10.3389\/fendo.2024.1340644","article-title":"Association between the ZJU index and risk of new-onset non-alcoholic fatty liver disease in non-obese participants: a Chinese longitudinal prospective cohort study","volume":"15","author":"Zheng","year":"2024","journal-title":"Front Endocrinol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1007\/s00592-016-0878-5","article-title":"The ZJU index: a useful indicator for recognizing insulin resistance in the Chinese general population","volume":"53","author":"Ji","year":"2016","journal-title":"Acta Diabetol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.2147\/IJWH.S527967","article-title":"Relationship between the ZJU index and infertility risk in reproductive-aged US women: an analysis of NHANES 2013-2018","volume":"17","author":"Tian","year":"2025","journal-title":"Int J Womens Health."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2502","DOI":"10.1001\/jama.2017.7217","article-title":"Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial","volume":"317","author":"Wu","year":"2017","journal-title":"JAMA"},{"key":"B15","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/humrep\/deh098","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)","volume":"19","year":"2004","journal-title":"Hum Reprod"},{"key":"B16","doi-asserted-by":"publisher","first-page":"34348","DOI":"10.1038\/s41598-025-16845-1","article-title":"The mediating effect of serum total testosterone in the association between the ZJU index and PCOS","volume":"15","author":"Yin","year":"2025","journal-title":"Sci Rep."},{"key":"B17","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.steroids.2011.12.003","article-title":"Inflammation in polycystic ovary syndrome: underpinning of insulin resistance and ovarian dysfunction","volume":"77","author":"Gonz\u00e1lez","year":"2012","journal-title":"Steroids."},{"key":"B18","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.bpobgyn.2016.03.008","article-title":"Polycystic ovary syndrome: endometrial markers","volume":"37","author":"Piltonen","year":"2016","journal-title":"Best Pract Res Clinic Obstet Gynaecol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1570771","DOI":"10.3389\/fnut.2025.1570771","article-title":"ZJU index as a predictive biomarker of gestational diabetes mellitus: a prospective cohort analysis","volume":"12","author":"Xu","year":"2025","journal-title":"Front Nutr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1186\/s12944-025-02760-x","article-title":"Associations of the Zhejiang University (ZJU) index with cardiovascular diseases and mortality among US adults: a national cohort study","volume":"24","author":"Mo","year":"2025","journal-title":"Lipids Health Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"289","DOI":"10.7570\/jomes24035","article-title":"Obesity and polycystic ovary syndrome","volume":"33","author":"Kim","year":"2024","journal-title":"J Obes Metab Syndr."},{"key":"B22","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1210\/clinem\/dgad356","article-title":"Adipose tissue dysfunction in polycystic ovary syndrome","volume":"109","author":"Bril","year":"2023","journal-title":"J Clin Endocrinol Metab."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e776","DOI":"10.1016\/S2468-2667(24)00188-9","article-title":"Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: a Swedish population-based cohort study","volume":"9","author":"Shirvanifar","year":"2024","journal-title":"Lancet Public Health."},{"key":"B24","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1093\/humupd\/dmz011","article-title":"Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis","volume":"25","author":"Sermondade","year":"2019","journal-title":"Hum Reprod Update."},{"key":"B25","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1186\/s40001-025-03123-z","article-title":"Impact of BMI on pregnancy outcomes in PCOS patients undergoing ultralong GnRH\u2014a protocol with blastocyst transfer","volume":"30","author":"Su","year":"2025","journal-title":"Eur J Med Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"5294","DOI":"10.1111\/dom.70736","article-title":"Non-linear association between maternal body mass index and clinical outcomes in single euploid embryo transfer: a retrospective cohort study of 4235 cycles","volume":"28","author":"Cheng","year":"2026","journal-title":"Diabet Obes Metab."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2489","DOI":"10.1016\/S0140-6736(24)00538-5","article-title":"Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial","volume":"403","author":"Samarasinghe","year":"2024","journal-title":"Lancet."},{"key":"B28","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s13048-025-01606-5","article-title":"Immune imbalance in the pre-ovulatory follicular microenvironment of overweight and obese women during IVF","volume":"18","author":"Liu","year":"2025","journal-title":"J Ovarian Res."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e48005","DOI":"10.1097\/MD.0000000000048005","article-title":"Mediating role of the systemic immune-inflammation index in obesity-induced glycolipid dysmetabolism and compromised IVF\/ICSI outcomes in polycystic ovary syndrome: a retrospective cohort study","volume":"105","author":"Zhang","year":"2026","journal-title":"Medicine."},{"key":"B30","doi-asserted-by":"publisher","first-page":"3454","DOI":"10.3390\/nu13103454","article-title":"The impact of gestational weight gain on the risks of adverse maternal and infant outcomes among normal BMI women with high triglyceride levels during early pregnancy","volume":"13","author":"Jiang","year":"2021","journal-title":"Nutrients."},{"key":"B31","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s13048-024-01416-1","article-title":"The association between triglyceride glucose-body mass index and in vitro fertilization outcomes in women with polycystic ovary syndrome: A cohort study","volume":"17","author":"Li","year":"2024","journal-title":"J Ovarian Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e47184","DOI":"10.1097\/MD.0000000000047184","article-title":"Adverse effects of dyslipidemia on embryo quality and reproductive outcomes in specific subgroups undergoing first IVF\/ICSI cycles: a case\u2013control study","volume":"105","author":"Luo","year":"2026","journal-title":"Medicine."},{"key":"B33","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/hep.27379","article-title":"A screen in mice uncovers repression of lipoprotein lipase by microRNA-29a as a mechanism for lipid distribution away from the liver","volume":"61","author":"Mattis","year":"2015","journal-title":"Hepatology."},{"key":"B34","doi-asserted-by":"publisher","first-page":"634","DOI":"10.5534\/wjmh.250083","article-title":"The influence of high-normal fasting blood glucose on semen quality, embryonic development, and pregnancy outcomes","volume":"44","author":"Wang","year":"2025","journal-title":"World J Mens Health."},{"key":"B35","doi-asserted-by":"publisher","first-page":"2615","DOI":"10.1007\/s10815-024-03191-w","article-title":"Effects of high-normal fasting blood glucose on ART outcomes of frozen-thawed single blastocyst transfer in women with normal BMI","volume":"41","author":"Wang","year":"2024","journal-title":"J Assist Reprod Genet."},{"key":"B36","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1080\/09513590.2022.2122430","article-title":"Higher baseline alanine aminotransferase level is associated with lower live birth rate after freeze-thawed embryo transfer","volume":"38","author":"Zhang","year":"2022","journal-title":"Gynecol Endocrinol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1093\/humupd\/dmn015","article-title":"Follicle dynamics and anovulation in polycystic ovary syndrome","volume":"14","author":"Franks","year":"2008","journal-title":"Hum Reprod Update"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1892813\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:42:29Z","timestamp":1787582549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1892813\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":37,"alternative-id":["10.3389\/fnut.2026.1892813"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1892813","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1892813"}}