Semin Reprod Med 2008; 26(1): 085-092
DOI: 10.1055/s-2007-992928
© Thieme Medical Publishers

Dietary Therapy in Polycystic Ovary Syndrome

Lisa J. Moran1 , 2 , Grant D. Brinkworth3 , Robert J. Norman2
  • 1The Jean Hailes Foundation for Women's Health, Monash Institute for Public Health Research, Monash Medical Centre, Clayton, Victoria, Australia
  • 2Research Centre for Reproductive Health, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
  • 3CSIRO Human Nutrition, Adelaide; Australia
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
08. Januar 2008 (online)

ABSTRACT

Polycystic ovary syndrome (PCOS) is a common condition in women with reproductive age associated with reproductive and metabolic dysfunction. Treatment has traditionally focused on fertility and hormonal therapy. However, obesity, central obesity, and insulin resistance (IR) are strongly implicated in its etiology, and improving these factors has become a treatment target in PCOS. Lifestyle modification programs with an emphasis on behavioral management and dietary and exercise interventions have been successful in reducing the risk of diabetes and the metabolic syndrome in the general population and improving reproductive and metabolic features in PCOS, although as yet there is limited evidence for specific dietary and exercise approaches and guidelines for use in PCOS and requires further investigation. The use of antiobesity pharmacologic agents and bariatric surgery has been recently studied in PCOS and may offer additional treatment options for the future. Future research should focus on the optimal dietary strategies and exercise regimens for PCOS treatment and the relative efficacy and appropriate use of lifestyle management versus antiobesity pharmacologic agents and surgery.

REFERENCES

  • 1 Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome.  Best Pract Res Clin Obstet Gynaecol. 2004;  18 671-683
  • 2 Talbott E O, Guzick D S, Sutton-Tyrrell K et al.. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women.  Arterioscler Thromb Vasc Biol. 2000;  20 2414-2421
  • 3 Pirwany I R, Fleming R, Greer I A, Packard C J, Sattar N. Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters.  Clin Endocrinol (Oxf). 2001;  54 447-453
  • 4 Cussons A J, Stuckey B G, Watts G F. Cardiovascular disease in the polycystic ovary syndrome: new insights and perspectives.  Atherosclerosis. 2006;  185 227-239
  • 5 Legro R S, Kunselman A R, Dodson W C, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women.  J Clin Endocrinol Metab. 1999;  84 165-169
  • 6 Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study.  Clin Endocrinol (Oxf). 2000;  52 595-600
  • 7 Laitinen J, Taponen S, Martikainen H et al.. Body size from birth to adulthood as a predictor of self-reported polycystic ovary syndrome symptoms.  Int J Obes Relat Metab Disord. 2003;  27 710-715
  • 8 Balen A H, Conway G S, Kaltsas G et al.. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients.  Hum Reprod. 1995;  10 2107-2111
  • 9 Glueck C J, Dharashivkar S, Wang P et al.. Obesity and extreme obesity, manifest by ages 20-24 years, continuing through 32-41 years in women, should alert physicians to the diagnostic likelihood of polycystic ovary syndrome as a reversible underlying endocrinopathy.  Eur J Obstet Gynecol Reprod Biol. 2005;  122 206-212
  • 10 Pasquali R, Casimirri F, Cantobelli S et al.. Insulin and androgen relationships with abdominal body fat distribution in women with and without hyperandrogenism.  Horm Res. 1993;  39 179-187
  • 11 Rebuffe-Scrive M, Cullberg G, Lundberg P A, Lindstedt G, Bjorntorp P. Anthropometric variables and metabolism in polycystic ovarian disease.  Horm Metab Res. 1989;  21 391-397
  • 12 Yildirim B, Sabir N, Kaleli B. Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome.  Fertil Steril. 2003;  79 1358-1364
  • 13 Ehrmann D A, Liljenquist D R, Kasza K, Azziz R, Legro R S, Ghazzi M N. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome (PCOS).  J Clin Endocrinol Metab. 2006;  91 48-53
  • 14 Hoeger K. Obesity and weight loss in polycystic ovary syndrome.  Obstet Gynecol Clin North Am. 2001;  28 85-97
  • 15 Marsh K, Brand-Miller J. The optimal diet for women with polycystic ovary syndrome?.  Br J Nutr. 2005;  94 154-165
  • 16 Anderson J W, Konz E C, Frederich R C, Wood C L. Long-term weight-loss maintenance: a meta-analysis of US studies.  Am J Clin Nutr. 2001;  74 579-584
  • 17 NHMRC .Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults. Canberra, Australia; Australian Government Publishing Service 2003
  • 18 Wadden T A, Butryn M L. Behavioral treatment of obesity.  Endocrinol Metab Clin North Am. 2003;  32 981-1003
  • 19 Andersen P, Seljeflot I, Abdelnoor M et al.. Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with polycystic ovary syndrome.  Metabolism. 1995;  44 611-616
  • 20 Kiddy D S, Hamilton-Fairley D, Bush A et al.. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome.  Clin Endocrinol (Oxf). 1992;  36 105-111
  • 21 Moran L J, Noakes M, Clifton P M, Tomlinson L, Norman R J. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2003;  88 812-819
  • 22 Crosignani P G, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet.  Hum Reprod. 2003;  18 1928-1932
  • 23 Huber-Buchholz M M, Carey D G, Norman R J. Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone.  J Clin Endocrinol Metab. 1999;  84 1470-1474
  • 24 Clark A M, Thornley B, Tomlinson L, Galletley C, Norman R J. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment.  Hum Reprod. 1998;  13 1502-1505
  • 25 Van Dam E W, Roelfsema F, Veldhuis J D et al.. Increase in daily LH secretion in response to short-term calorie restriction in obese women with PCOS.  Am J Physiol Endocrinol Metab. 2002;  282 E865-E872
  • 26 Gambineri A, Patton L, De Iasio R et al.. Efficacy of octreotide-LAR in dieting women with abdominal obesity and polycystic ovary syndrome.  J Clin Endocrinol Metab. 2005;  90 3854-3862
  • 27 Stamets K, Taylor D S, Kunselman A, Demers L M, Pelkman C L, Legro R S. A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome.  Fertil Steril. 2004;  81 630-637
  • 28 Glazer N L, Hendrickson A F, Schellenbaum G D, Mueller B A. Weight change and the risk of gestational diabetes in obese women.  Epidemiology. 2004;  15 733-737
  • 29 Galletly C, Clark A, Tomlinson L, Blaney F. A group program for obese, infertile women: weight loss and improved psychological health.  J Psychosom Obstet Gynaecol. 1996;  17 125-128
  • 30 Moran L J, Noakes M, Clifton P M, Wittert G A, Williams G, Norman R J. Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome.  Am J Clin Nutr. 2006;  84 77-87
  • 31 Moran L J, Noakes M, Clifton P M, Wittert G, Belobradjic D, Norman R. C-reactive protein before and after weight loss in overweight women with and without polycystic ovary syndrome.  J Clin Endocrinol Metab. 2007;  92 2944-2953
  • 32 Gambineri A, Patton L, Vaccina A et al.. Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study.  J Clin Endocrinol Metab. 2006;  91 3970-3980
  • 33 Knowler W C, Barrett-Connor E, Fowler S E et al.. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med. 2002;  346 393-403
  • 34 Orchard T J, Temprosa M, Goldberg R et al.. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial.  Ann Intern Med. 2005;  142 611-619
  • 35 Pirozzo S, Summerbell C, Cameron C, Glasziou P. Advice on low-fat diets for obesity.  Cochrane Database Syst Rev. 2002;  CD003640
  • 36 Reaven G M. The insulin resistance syndrome: definition and dietary approaches to treatment.  Annu Rev Nutr. 2005;  25 391-406
  • 37 Poppitt S D, McCormack D, Buffenstein R. Short-term effects of macronutrient preloads on appetite and energy intake in lean women.  Physiol Behav. 1998;  64 279-285
  • 38 Skov A R, Toubro S, Ronn B, Holm L, Astrup A. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity.  Int J Obes Relat Metab Disord. 1999;  23 528-536
  • 39 Lejeune M P, Westerterp K R, Adam T C, Luscombe-Marsh N D, Westerterp-Plantenga M S. Ghrelin and glucagon-like peptide 1 concentrations, 24-h satiety, and energy and substrate metabolism during a high-protein diet and measured in a respiration chamber.  Am J Clin Nutr. 2006;  83 89-94
  • 40 Tappy L. Thermic effect of food and sympathetic nervous system activity in humans.  Reprod Nutr Dev. 1996;  36 391-397
  • 41 Krieger J W, Sitren H S, Daniels M J, Langkamp-Henken B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1.  Am J Clin Nutr. 2006;  83 260-274
  • 42 Due A, Toubro S, Skov A R, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial.  Int J Obes Relat Metab Disord. 2004;  28 1283-1290
  • 43 McAuley K A, Smith K J, Taylor R W, McLay R T, Williams S M, Mann J I. Long-term effects of popular dietary approaches on weight loss and features of insulin resistance.  Int J Obes (Lond). 2006;  30 342-349
  • 44 Nordmann A J, Nordmann A, Briel M et al.. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials.  Arch Intern Med. 2006;  166 285-293
  • 45 Stern L, Iqbal N, Seshadri P et al.. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.  Ann Intern Med. 2004;  140 778-785
  • 46 Cardillo S, Seshadri P, Iqbal N. The effects of a low-carbohydrate versus low-fat diet on adipocytokines in severely obese adults: three-year follow-up of a randomized trial.  Eur Rev Med Pharmacol Sci. 2006;  10 99-106
  • 47 Brand J C, Colagiuri S, Crossman S, Allen A, Roberts D C, Truswell A S. Low-glycemic index foods improve long-term glycemic control in NIDDM.  Diabetes Care. 1991;  14 95-101
  • 48 Luscombe N D, Noakes M, Clifton P M. Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM.  Eur J Clin Nutr. 1999;  53 473-478
  • 49 McMillan-Price J, Petocz P, Atkinson F et al.. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial.  Arch Intern Med. 2006;  166 1466-1475
  • 50 Ludwig D S. Dietary glycemic index and obesity.  J Nutr. 2000;  130 280S-283S
  • 51 Carels R A, Darby L A, Douglass O M, Cacciapaglia H M, Rydin S. Education on the glycemic index of foods fails to improve treatment outcomes in a behavioral weight loss program.  Eat Behav. 2005;  6 145-150
  • 52 Hays J H, DiSabatino A, Gorman R T, Vincent S, Stillabower M E. Effect of a high saturated fat and no-starch diet on serum lipid subfractions in patients with documented atherosclerotic cardiovascular disease.  Mayo Clin Proc. 2003;  78 1331-1336
  • 53 Mavropoulos J C, Yancy W S, Hepburn J, Westman E C. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study.  Nutr Metab. 2005;  2 35
  • 54 Cornier M A, Donahoo W T, Pereira R et al.. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women.  Obes Res. 2005;  13 703-709
  • 55 Pittas A G, Das S K, Hajduk C L et al.. A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial.  Diabetes Care. 2005;  28 2939-2941
  • 56 Ebbeling C B, Leidig M M, Feldman H A, Lovesky M M, Ludwig D S. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial.  JAMA. 2007;  297 2092-2102
  • 57 Pittas A G, Roberts S B. Dietary composition and weight loss: can we individualize dietary prescriptions according to insulin sensitivity or secretion status?.  Nutr Rev. 2006;  64 435-448
  • 58 Shaw K, Gennat H, O'Rourke P, Del Mar C. Exercise for overweight or obesity.  Cochrane Database Syst Rev. 2006;  CD003817
  • 59 Jakicic J M, Winters C, Lang W, Wing R R. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial.  JAMA. 1999;  282 1554-1560
  • 60 Carroll S, Dudfield M. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome.  Sports Med. 2004;  34 371-418
  • 61 Poehlman E T, Dvorak R V, DeNino W F, Brochu M, Ades P A. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial.  J Clin Endocrinol Metab. 2000;  85 2463-2468
  • 62 Ross R, Dagnone D, Jones P J et al.. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial.  Ann Intern Med. 2000;  133 92-103
  • 63 Randeva H S, Lewandowski K C, Drzewoski J et al.. Exercise decreases plasma total homocysteine in overweight young women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2002;  87 4496-4501
  • 64 Vigorito C, Giallauria F, Palomba S et al.. Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2007;  92 1379-1384
  • 65 Cuff D J, Meneilly G S, Martin A, Ignaszewski A, Tildesley H D, Frohlich J J. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes.  Diabetes Care. 2003;  26 2977-2982
  • 66 McAuley K A, Williams S M, Mann J I et al.. Intensive lifestyle changes are necessary to improve insulin sensitivity: a randomized controlled trial.  Diabetes Care. 2002;  25 445-452
  • 67 Medicine ACoS .Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2000
  • 68 Harborne L R, Sattar N, Norman J E, Fleming R. Metformin and weight loss in obese women with polycystic ovary syndrome: comparison of doses.  J Clin Endocrinol Metab. 2005;  90 4593-4598
  • 69 Lord J M, Flight I H, Norman R J. Metformin in polycystic ovary syndrome: systematic review and meta-analysis.  BMJ. 2003;  327 951-953
  • 70 Sabuncu T, Harma M, Nazligul Y, Kilic F. Sibutramine has a positive effect on clinical and metabolic parameters in obese patients with polycystic ovary syndrome.  Fertil Steril. 2003;  80 1199-1204
  • 71 Jayagopal V, Kilpatrick E S, Holding S, Jennings P E, Atkin S L. Orlistat is as beneficial as metformin in the treatment of polycystic ovarian syndrome.  J Clin Endocrinol Metab. 2005;  90 729-733
  • 72 Curioni C, Andre C. Rimonabant for overweight or obesity.  Cochrane Database Syst Rev. 2006;  CD006162
  • 73 DeMaria E J. Bariatric surgery for morbid obesity.  N Engl J Med. 2007;  356 2176-2183
  • 74 Sjostrom L, Lindroos A K, Peltonen M et al.. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.  , [see comment] N Engl J Med. 2004;  351 2683-2693
  • 75 Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Statement.  Am J Clin Nutr. 1992;  55 615S-619S
  • 76 Deitel M, Stone E, Kassam H A, Wilk E J, Sutherland D J. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery.  J Am Coll Nutr. 1988;  7 147-153
  • 77 Martin L F, Finigan K M, Nolan T E. Pregnancy after adjustable gastric banding.  Obstet Gynecol. 2000;  95 927-930
  • 78 Eid G M, Cottam D R, Velcu L M et al.. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass.  Surg Obes Relat Dis. 2005;  1 77-80
  • 79 Escobar-Morreale H F, Botella-Carretero J I, Alvarez-Blasco F, Sancho J, San Millan J L. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery.  J Clin Endocrinol Metab. 2005;  90 6364-6369

Lisa J MoranPh.D. 

The Jean Hailes Foundation for Women's Health, Monash Institute for Public Health Research, Monash Medical Centre

Locked bag 29, Clayton Road, Clayton, Victoria, 3168, Australia

eMail: lisa.moran@yahoo.com.au