Hypocaloric Diet Helpful in Polycystic Ovary Syndrome

Laurie Barclay, MD

March 25, 2004

March 25, 2004 -- A hypocaloric diet may allow significant weight loss and improvement in the reproductive and metabolic abnormalities of polycystic ovary syndrome (PCOS), according to the results of a randomized, short-term trial published in the March issue of Fertility and Sterility.

"PCOS is frequently associated with obesity, which exacerbates the metabolic and reproductive abnormalities associated with this disorder," write Kelly Stamets, from the Pennsylvania State College of Medicine in Hershey, and colleagues. "Women with PCOS are uniquely insulin resistant, and the degree of resistance approaches that of women with Type 2 diabetes. This has led to the adaptation of methods that improve insulin sensitivity (from Type 2 diabetes) as the primary treatment approach in women with PCOS."

For one month, 35 obese women with infertility and PCOS received one of two energy-restricted diets. The high-protein diet contained 30% protein, 40% carbohydrate, and 30% fat, and the high-carbohydrate diet contained 15% protein, 55% carbohydrate, and 30% fat. The primary outcome measure was weight loss, and the secondary measures were biometric, hormonal, lipid, and lipoprotein, and markers of glucose homeostasis and energy metabolism.

Of 26 women who completed the study, both diets resulted in comparable weight loss (-3.7 ± 1.9 kg for the high-protein diet and -4.4 ± 1.5 kg for the high-carbohydrate diet). There were also no differences between groups in circulating androgens, measures of glucose metabolism, and leptin.

Compared with baseline, however, the group of women who maintained either hypocaloric diet for one month had a decrease in circulating androgens ( P = .03), fasting and area under the curve (AUC) insulin ( P < .05) on a three-hour oral glucose tolerance test (OGTT), and fasting and AUC leptin levels ( P < .0001). Menstrual bleeding occurred during the trial in 14 of 26 patients.

Study limitations include a drop-out rate of 26%, short-term intervention, lack of monitoring for ovulation, and reliance on self-reports.

"Those who completed the short-term hypocaloric diet had a significant weight loss and a significant improvement in their reproductive and metabolic abnormalities," the authors write. "There was no increased benefit to a high-protein diet. Future diet studies evaluating the ideal composition of a hypocaloric diet in women with PCOS will require a large study population, and will most likely require a multicenter trial."

The National Institutes of Health helped support this study.

Fertil Steril. 2004;81:630-637

Reviewed by Gary D. Vogin, MD

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