BACKGROUND Levels of anti-Müllerian hormone (AMH) are known to be associated with lifestyle determinants such as smoking and oral contraception (OC) use. When measuring AMH in clinical practice, it is essential to know which factors may influence circulating levels or ovarian reserve in general. OBJECTIVE AND RATIONALE To date, there is no systematic review or summarizing consensus of the nature and magnitude of the relation between AMH and modifiable lifestyle factors. The purpose of this review was to systematically assess the evidence on association of lifestyle behaviors with circulating AMH levels. SEARCH METHODS We performed a pre-registered systematic review of publications in Embase and PubMed on the lifestyle factors BMI, smoking, OC use, alcohol consumption, caffeine consumption, physical activity, and waist-hip ratio (WHR) in relation to circulating AMH levels up to 1 November 2023. The search strategy included terms such as 'Anti-Mullerian hormone', 'lifestyle', and 'women'. Studies were considered eligible if the association between at least one of the lifestyle factors of interest and AMH was assessed in adult women. The quality of included studies was assessed using the Study Quality Assessment Tools of the National Heart, Lung, and Blood Institute. The results were presented as ranges of the most frequently used association measure for studies that found a significant association in the same direction. OUTCOMES A total of 15 072 records were identified, of which 65 studies were eligible for inclusion, and 66.2% of the studies used a cross-sectional design. The majority of studies investigating BMI, smoking, OC use, and physical activity reported significant inverse associations with AMH levels. For WHR, alcohol, and caffeine use, the majority of studies did not find an association with AMH. For all determinants, the effect measures of the reported associations were heterogeneous. The mean difference in AMH levels per unit increase in BMI ranged from -0.015 to -0.2 ng/ml in studies that found a significant inverse association. The mean difference in AMH levels for current smokers versus non-smokers ranged from -0.4 to -1.1 ng/ml, and -4% to -44%, respectively. For current OC use, results included a range in relative mean differences in AMH levels of -17% to -31.1%, in addition to a decrease of 11 age-standardized percentiles, and an average decrease of 1.97 ng/ml after 9 weeks of OC use. Exercise interventions led to a decrease in AMH levels of 2.8 pmol/l to 13.2 pmol/l after 12 weeks in women with polycystic ovary syndrome or a sedentary lifestyle. WIDER IMPLICATIONS Lifestyle factors are associated with differences in AMH levels and thus should be taken into account when interpreting individual AMH measurements. Furthermore, AMH levels can be influenced by the alteration of lifestyle behaviors. While this can be a helpful tool for clinical and lifestyle counseling, the nature of the relation between the observed differences in AMH and the true ovarian reserve remains to be assessed. REGISTRATION NUMBER PROSPERO registration ID: CRD42022322575.

中文翻译：

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关于可改变的生活方式因素与循环抗苗勒管激素之间关联的系统评价。


背景 已知抗苗勒管激素 （AMH） 的水平与吸烟和口服避孕药 （OC） 使用等生活方式决定因素有关。在临床实践中测量 AMH 时，必须了解哪些因素可能影响循环水平或卵巢储备。客观和基本原理 迄今为止，还没有关于 AMH 与可改变的生活方式因素之间关系的性质和程度的系统评价或总结共识。本综述的目的是系统评估生活方式行为与循环 AMH 水平相关的证据。检索方法我们对 Embase 和 PubMed 上的出版物进行了预先注册的系统评价，内容涉及截至 2023 年 11 月 1 日与循环 AMH 水平相关的生活方式因素 BMI、吸烟、OC 使用、饮酒、咖啡因消耗、身体活动和腰臀比 （WHR）。检索策略包括 “Anti-Mullerian hormone”、“lifestyle” 和 “women” 等术语。如果在成年女性中评估了至少一个感兴趣的生活方式因素与 AMH 之间的关联，则认为研究符合条件。使用美国国家心肺血液研究所的研究质量评估工具评估纳入研究的质量。结果表示为发现在同一方向上显着关联的研究的最常用关联测量的范围。结果 共确定了 15 072 条记录，其中 65 项研究符合纳入标准，66.2% 的研究使用横断面设计。大多数调查 BMI、吸烟、OC 使用和身体活动的研究报告称与 AMH 水平呈显著负相关。 对于 WHR、酒精和咖啡因的使用，大多数研究未发现与 AMH 相关。对于所有决定因素，报告的关联的效果测量是异质的。在发现显著负关联的研究中，BMI 每增加单位 AMH 水平的平均差异范围为 -0.015 至 -0.2 ng/ml。当前吸烟者与非吸烟者 AMH 水平的平均差异分别为 -0.4 至 -1.1 ng/ml 和 -4% 至 -44%。对于当前的 OC 使用，结果包括 AMH 水平的相对平均差异范围为 -17% 至 -31.1%，此外还减少了 11 个年龄标准化百分位数，OC 使用 9 周后平均下降了 1.97 ng/ml。运动干预导致患有多囊卵巢综合征或久坐不动的生活方式的女性在 12 周后 AMH 水平下降 2.8 pmol/l 至 13.2 pmol/l。更广泛的影响 生活方式因素与 AMH 水平的差异相关，因此在解释个体 AMH 测量值时应予以考虑。此外，AMH 水平会受到生活方式行为改变的影响。虽然这可能是临床和生活方式咨询的有用工具，但观察到的 AMH 差异与真实卵巢储备之间关系的性质仍有待评估。注册号 PROSPERO 注册 ID：CRD42022322575。