Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 6/2014

01-12-2014 | Review

Focus on metabolic and nutritional correlates of polycystic ovary syndrome and update on nutritional management of these critical phenomena

Authors: Mariangela Rondanelli, Simone Perna, Milena Faliva, Francesca Monteferrario, Erica Repaci, Francesca Allieri

Published in: Archives of Gynecology and Obstetrics | Issue 6/2014

Login to get access

Abstract

Introduction

Polycystic ovary syndrome (PCOS) is associated with numerous metabolic morbidities (insulin resistance (IR), central obesity) and various nutritional abnormalities (vitamin D deficit, mineral milieu alterations, omega6/omega3 PUFA ratio unbalance).

Methods

We performed a systematic literature review to evaluate the till-now evidence regarding: (1) the metabolic and nutritional correlates of PCOS; (2) the optimum diet therapy for the treatment of these abnormalities. This review included 127 eligible studies.

Results

In addition to the well-recognized link between PCOS and IR, the recent literature underlines that in PCOS there is an unbalance in adipokines (adiponectin, leptin, visfatin) production and in omega6/omega3 PUFA ratio. Given the detrimental effect of overweight on these metabolic abnormalities, a change in the lifestyle must be the cornerstone in the treatment of PCOS patients. The optimum diet therapy for the PCOS treatment must aim at achieving specific metabolic goals, such as IR improvement, adipokines secretion and reproductive function. These goals must be reached through: accession of the patient to hypocaloric dietary program aimed at achieving and/or maintaining body weight; limiting the consumption of sugar and refined carbohydrates, preferring those with lower glycemic index; dividing the food intake in small and frequent meals, with high caloric intake at breakfast; increasing their intake of fish (4 times/week) or taking omega3 PUFA supplements; taking Vitamin D and chromium supplementation, if there are low serum levels.

Conclusion

Lifestyle intervention remains the optimal treatment strategy for PCOS women. A relatively small weight loss (5 %) can improve IR, hyperandrogenism, menstrual function, fertility.
Literature
1.
Calvo AM, San Millan RM, Sancho JL, Avila SJ, Escobar-Morreale HF (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 85:2434–2438PubMed
2.
Dunaif A (1997) Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 18:774–800PubMed
3.
Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R (2011) Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol 7:219–231PubMed
4.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2003) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47
5.
Ehrmann DA (2005) Polycystic ovary syndrome. N Engl J Med 352:1223–1236PubMed
6.
Solomon CG (1999) The epidemiology of polycystic ovary syndrome. Prevalence and associated disease risks. Endocrinol Metab Clin North Am 28:247–263PubMed
7.
Dunaif A, Graf M, Mandeli J, Laumas V, Dobrjansky A (1987) Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J Clin Endocrinol Metab 65:499–507PubMed
8.
Jakubowicz DJ, Nestler JE (1997) 17 alpha-hydroxyprogesterone responses to leuprolide and serum androgens in obese women with and without polycystic ovary syndrome offer dietary weight loss. J Clin Endocrinol Metab 82:556–560PubMed
9.
Plymate SR, Matej LA, Jones RE, Friedl KE (1998) Inhibition of sex hormone-binding globulin production in the human hepatoma (Hep G2) cell line by insulin and prolactin. J Clin Endocrinol Metab 67:460–464
10.
Nestler JE, Powers LP, Matt DW et al (1991) A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 72:83–89PubMed
11.
Utsunomiya T, Taniguchi I, Sadanaga A, Iwasato K, Mizoguchi Y, Terawaki S (1993) Insulin resistance in non-obese patients with polycystic ovary syndrome. Jpn J Fertil Steril 38:77–81
12.
Rosenfield RL, Barnes RB, Ehrmann DA (1994) Studies of the nature of 17-hydroxyprogesterone hyperresponsiveness to gonadotropin-releasing hormone agonist challenge in functional ovarian hyperandrogenism. J Clin Endocrinol Metab 79:1686–1692PubMed
13.
Egger M, Smith GD, Altman DG (2001) Systematic reviews in health care: meta-analysis in context. BMJ 2001:3–68
14.
Yildiz BO, Knochenhauer ES, Azziz R (2008) Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab 93:162–168PubMedCentralPubMed
15.
Apridonidze T, Essah PA, Iuorno MJ, Nestler JE (2005) Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 90:1929–1935PubMed
16.
Peppard HR, Marfori J, Iuorno MJ, Nestler JE (2001) Prevalence of polycystic ovary syndrome among premenopausal women with type 2 diabetes. Diabetes Care 24:1050–1052PubMed
17.
Lim SS, Norman RJ, Davies MJ, Moran LJ (2013) The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev 14:25–109
18.
Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R (2002) Obesity and the polycystic ovary syndrome. Int J Obes Metab Disord 26:883–896
19.
DeUgarte CM, Bartolucci AA, Azziz R (2005) Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril 83:1454–1460PubMed
20.
Carmina E, Lobo RA (2004) Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertil Steril 82:661–665PubMed
21.
Azziz R, Carmina E, Dewailly D et al (2009) The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 91:456–488PubMed
22.
Carmina E, Bucchieri S, Esposito A (2007) Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab 92:2500–2505PubMed
23.
Diamanti-Kandarakis E (2006) Insulin resistance in PCOS. Endocrine 30:13–17PubMed
24.
Geisthövel F (2010) Novel systematics of nomenclature and classification of female functional androgenization (including polycystic ovary syndrome and non-classic congenital adrenal hyperplasia). J Reprod Med Endokrinol 7:6–26
25.
Goverde AJ, van Koert AJ, Eijkemans MJ, Knauff EA, Westerveld HE, Fauser BC, Broekmans FJ (2009) Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod 24:710PubMed
26.
Lord JM, Flight IH, Norman RJ (2003) Insulin sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev 3:CD003053PubMed
27.
Palomba S, Orio F Jr, Falbo A, Manguso F, Russo T, Cascella T, Tolino A, Carmina E, Colao A, Zullo F (2005) Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab 90(7):4068–4074PubMed
28.
Palomba S, Orio F Jr, Nardo LG, Falbo A, Russo T, Corea D, Doldo P, Lombardi G, Tolino A, Colao A, Zullo F (2004) Metformin administration versus laparoscopic ovarian diathermy in clomiphene citrate-resistant women with polycystic ovary syndrome: a prospective parallel randomized double-blind placebo-controlled trial. J Clin Endocrinol Metab 89(10):4801–4809PubMed
29.
Maciel GA, Soares Júnior JM, Alves da Motta EL, Abi Haidar M, de Lima GR, Baracat EC (2004) Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin. Fertil Steril 81(2):355–360PubMed
30.
Kumari AS, Haq A, Jayasundaram R, Abdel-Wareth LO, Al Haija SA, Alvares M (2005) Metformin monotherapy in lean women with polycystic ovary syndrome. Reprod Biomed Online 10(1):100–104PubMed
31.
Tan S, Hahn S, Benson S, Dietz T, Lahner H, Moeller LC, Schmidt M, Elsenbruch S, Kimmig R, Mann K, Janssen OE (2007) Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance. Eur J Endocrinol 157(5):669–676PubMed
32.
Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, Boivin J, Petraglia F, Wijeyeratne CN, Norman RJ, Dunaif A, Franks S, Wild RA, Dumesic D, Barnhart K (2012) Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 97:28–38PubMed
33.
Panidis D, Tziomalos K, Chatzis P, Papadakis E, Delkos D, Tsourdi EA, Kandaraki EA, Katsikis I (2013) Association between menstrual cycle irregularities and endocrine and metabolic characteristics of the polycystic ovary syndrome. Eur J Endocrinol 168(2):145–152PubMed
34.
Robinson S, Kiddy D, Gelding SV, Willis D, Niththyananthan R, Bush A, Johnston DG, Franks S (1993) The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin Endocrinol (Oxf) 39(3):351–355
35.
Gill S, Taylor AE, Martin KA, Welt CK, Adams JM, Hall JE (2001) Specific factors predict the response to pulsatile gonadotropin-releasing hormone therapy in polycystic ovarian syndrome. J Clin Endocrinol Metab 86(6):2428–2436PubMed
36.
Cupisti S, Kajaia N, Dittrich R, Duezenli H, Beckmann M W, Mueller A (2008) Body mass index and ovarian function are associated with endocrine and metabolic abnormalities in women with hyperandrogenic syndrome. Eur J Endocrinol 158(5):711–719. doi:10.​1530/​EJE-07-0515 PubMed
37.
Strowitzki T, Capp E, von Eye Corleta H (2010) The degree of cycle irregularity correlates with the grade of endocrine and metabolic disorders in PCOS patients. Eur J Obstet Gynecol Reprod Biol 149(2):178–181. doi:10.​1016/​j.​ejogrb.​2009.​12.​024 PubMed
38.
Wang JX, Davies MJ, Norman RJ (2001) Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum Reprod 16(12):2606–2609PubMed
39.
40.
Eppig JJ, O’Brien MJ, Pendola FL, Watanabe S (1998) Factors affecting the developmental competence of mouse oocytes grown in vitro: follicle-stimulating hormone and insulin. Biol Reprod 59(6):1445–1453PubMed
41.
Galal A, Mitwally MF (2009) Insulin sensitizers for women with polycystic ovarian syndrome. Expert Rev Endocrinol Metab 4:183–192
42.
Dumesic DA, Schramm RD, Peterson E, Paprocki AM, Zhou R, Abbott DH (2002) Impaired developmental competence of oocytes in adult prenatally androgenized female rhesus monkeys undergoing gonadotropin stimulation for in vitro fertilization. J Clin Endocrinol Metab 87(3):1111–1119PubMed
43.
Tao Z, Yan L (2005) Luteinizing hormone and insulin inducing earlier and excess expression of luteinizing hormone receptor messenger ribonucleic acids in granulosa cells of polycystic ovary syndrome. Fertil Steril 84(Suppl):S426–S427
44.
Diamanti-Kandarakis E (2008) Polycystic ovarian syndrome: pathophysiology, molecular aspects and clinical implications. Expert Rev Mol Med 10:e3PubMed
45.
Jabara S, Coutifaris C (2003) In vitro fertilization in the PCOS patient: clinical considerations. Semin Reprod Med 21(3):317–324PubMed
46.
Cano F, García-Velasco JA, Millet A, Remohí J, Simón C, Pellicer A (1997) Oocyte quality in polycystic ovaries revisited: identification of a particular subgroup of women. J Assist Reprod Genet 14(5):254–261PubMedCentralPubMed
47.
Kezele PR, Nilsson EE, Skinner MK (2002) Insulin but not insulin-like growth factor-1 promotes the primordial to primary follicle transition. Mol Cell Endocrinol 192(1–2):37–43PubMed
48.
Wood JR, Dumesic DA, Abbott DH, Strauss JF (2007) Molecular abnormalities in oocytes from women with polycystic ovary syndrome revealed by microarray analysis. J Clin Endocrinol Metab 92:705–713. doi:10.​1210/​jc.​2006-2123 PubMed
49.
González F, Rote NS, Minium J, Kirwan JP (2006) Increased activation of nuclear factor kB triggers inflammation and insulin resistance in polycystic ovary syndrome. J Clin Endocrinol Metab 91:1508–1512PubMed
50.
Piotrowski PC, Rzepczynska IJ, Kwintkiewicz J, Duleba AJ (2005) Oxidative stress induces expression of CYP11A, CYP17, STAR and 3bHSD in rat theca-interstitial cells. J Soc Gynecol Invest 12(2 Suppl):319A
51.
González F, Minium J, Rote NS, Kirwan JP (2005) Hyperglycemia alters tumor necrosis factor-a release from mononuclear cells in women with polycystic ovary syndrome. J Clin Endocrinol Metab 90:5336–5342PubMed
52.
González F, Rote NS, Minium J, Kirwan JP (2006) In vitro evidence that hyperglycemia stimulates tumor necrosis factor-a release in obese women with polycystic ovary syndrome. J Endocrinol 188:521–529PubMed
53.
González F, Rote NS, Minium J, Kirwan JP (2006) Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome. J Clin Endocrinol Metab 91:336–340PubMed
54.
González F, Rote NS, Minium J, Kirwan JP (2009) Evidence of proatherogenic inflammation in polycystic ovary syndrome. Metabolism 58:954–962PubMedCentralPubMed
55.
Chazenbalk G, Trivax BS, Yildiz BO (2010) Regulation of adiponectin secretion by adipocytes in the polycystic ovary syndrome: role of tumor necrosis factor-{alpha}. J Clin Endocrinol Metab 95:935–942PubMedCentralPubMed
56.
Carmina E, Orio F, Palomba S (2005) Evidence for altered adipocyte function in polycystic ovary syndrome. Eur J Endocrinol 152:389–394PubMed
57.
Chen X, Jia X, Qiao J, Guan Y, Kang J (2013) Adipokines in reproductive function: a link between obesity and polycystic ovary syndrome. J Mol Endocrinol 50:21–37
58.
Carmina E (2013) Obesity, adipokines and metabolic syndrome in polycystic ovary syndrome. Front Horm Res 40:40–50PubMed
59.
Chabrolle C, Tosca L, Ramé C, Lecomte P, Royère D, Dupont J (2009) Adiponectin increases insulin-like growth factor l-induced progesterone and estradiol secretion in human granulosa cells. Fertil Steril 92:1988–1996PubMed
60.
Pusalkar M, Meherji P, Gokral J, Savardekar L, Chinnaraj S, Maitra A (2010) Obesity and polycystic ovary syndrome: association with androgens, leptin and its genotypes. Gynecol Endocrinol 26:874–882PubMed
61.
Comim FV, Hardy K, Franks S (2013) Adiponectin and its receptors in the ovary: further evidence for a link between obesity and hyperandrogenism in polycystic ovary syndrome. PLoS ONE 18(8):e80416
62.
Panidis D, Kourtis A, Farmakiotis D, Mouslech T, Rousso D, Koliakos G (2003) Serum adiponectin levels in women with polycystic ovary syndrome. Hum Reprod 18:1790–1796PubMed
63.
Ardawi MS, Rouzi AA (2005) Plasma adiponectin and insulin resistance in women with polycystic ovary syndrome. Fertil Steril 83:1708–1716PubMed
64.
Escobar-Morreale HF, Villuendas G, Botella-Carretero JI, Alvarez-Blasco F, Sanchón R, Luque-Ramírez M, San Millán JL (2006) Adiponectin and resistin in PCOS: a clinical, biochemical and molecular genetic study. Hum Reprod 21(9):2257–2265PubMed
65.
Pinhas-Hamiel O, Singer S, Pilpel N, Koren I, Boyko V, Hemi R, Pariente C, Kanety H (2009) Adiponectin levels in adolescent girls with polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) 71(6):823–827. doi:10.​1111/​j.​1365-2265.​2009.​03604.​x
66.
Mannerås-Holm L, Leonhardt H, Kullberg J, Jennische E, Odén A, Holm G et al (2011) Adipose tissue has aberrant morphology and function in PCOS: enlarged adipocytes and low serum adiponectin, but not circulating sex steroids, are strongly associated with insulin resistance. J Clin Endocrinol Metab 96(2):E304–E311. doi:10.​1210/​jc.​2010-1290 PubMed
67.
68.
69.
Toulis KA, Gouli DG, Farmakiotis D, Georgopoulos NA, Katsikis I, Tarlatzis BC, Papadima I, Panidis D (2009) Adiponectin levels in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Hum Reprod Update 15:297–307. doi:10.​1093/​humupd/​dmp006 PubMed
70.
Yamauchi T, Kamon J, Ito Y et al (2003) Cloning of adiponectin receptors that mediate antidiabetic metabolic effects. Nature 423:762–769PubMed
71.
Hossam OH (2013) Role of adiponectin and its receptor in prediction of reproductive outcome of metformin treatment in patients with polycystic ovarian syndrome. J Obstet Gynaecol Res 39:1596–1603
72.
Considine RV, Caro JF (1997) Leptin and the regulation of body weight. Int J Biochem Cell Biol 29:1255–1272PubMed
73.
Muoio DM, Lynis DG (2002) Peripheral metabolic actions of leptin. Best Pract Res Clin Endocrinol Metab 16:653–666PubMed
74.
Bjorbaek C, Kahn BB (2004) Leptin signaling in the central nervous system and the periphery. Recent Prog Horm Res 59:305–331
75.
Margetic S, Gazzola C, Pegg GG, Hill RA (2002) Leptin: a review of its peripheral actions and interactions. Int J Obes Relat Metab Disord 26:1407–1433PubMed
76.
Brzechffa PR, Jakimiuk AJ, Agarwal SK, Weitsman SR, Buyalos RP, Magoffin DA (1996) Serum immunoreactive leptin concentrations in women with polycystic ovary syndrome. J Clin Endocrinol Metab 81(11):4166–4169PubMed
77.
Vicennati V, Gambineri A, Calzoni F, Casimirri F, Macor C, Vettor R, Pasquali R (1998) Serum leptin in obese women with polycystic ovary syndrome is correlated with body weight and fat distribution but not with androgen and insulin levels. Metabolism 47(8):988–992PubMed
78.
Pehlivanov B, Mitkov M (2009) Serum leptin levels correlate with clinical and biochemical indices of insulin resistance in women with polycystic ovary syndrome. Eur J Contracept Reprod Health Care 14(2):153–159. doi:10.​1080/​1362518080254996​2 PubMed
79.
Yildizhan R, Ilhan GA, Yildizhan B, Kolusari A, Adali E, Bugdayci G (2011) Serum retinol binding protein 4, leptin, and plasma asymmetric dimethylarginine levels in obese and non-obese young women with polycystic ovary syndrome. Fertil Steril 96:246–250PubMed
80.
Chapman IM, Wittert GA, Norman RJ (1997) Circulating leptin concentrations in polycystic ovary syndrome: relation to anthropometric and metabolic parameters. Clin Endocrinol (Oxf) 46(2):175–181
81.
Rouru J, Anttila L, Koskinen P, Penttilä TA, Irjala K, Huupponen R, Koulu M (1997) Serum leptin concentrations in women with polycystic ovary syndrome. J Clin Endocrinol Metab 82(6):1697–1700PubMed
82.
Gennarelli G, Holte J, Wide L, Berne C, Lithell H (1998) Is there a role for leptin in the endocrine and metabolic aberrations of polycystic ovary syndrome? Hum Reprod 13(3):535–541PubMed
83.
Carmina E, Bucchieri S, Mansueto P, Rini G, Ferin M, Lobo RA (2009) Circulating levels of adipose products and differences in fat distribution in the ovulatory and anovulatory phenotypes of polycystic ovary syndrome. Fertil Steril 1(4 Suppl):1332–1335. doi:10.​1016/​j.​fertnstert.​2008.​03.​007
84.
Wang P, Holst C, Astrup A et al (2012) Blood profiling of proteins and steroids during weight maintenance with manipulation of dietary protein level and glycaemic index. Br J Nutr 107:106–119PubMed
85.
86.
Stofkova A (2010) Resistin and visfatin: regulators of insulin sensitivity, inflammation and immunity. Endocr Regul 44:25–36PubMed
87.
Tan BK, Chen J, Digby JE, Keay SD, Kennedy CR, Randeva HS (2006) Increased visfatin messenger ribonucleic acid and protein levels in adipose tissue and adipocytes in women with polycystic ovary syndrome: parallel increase in plasma visfatin. J Clin Endocrinol Metab 91(12):5022–5028PubMed
88.
Chan TF, Chen YL, Chen HH, Lee CH, Jong SB, Tsai EM (2007) Increased plasma visfatin concentrations in women with polycystic ovary syndrome. Fertil Steril 88(2):401–405PubMed
89.
Kowalska I, Straczkowski M, Nikolajuk A, Adamska A, Karczewska-Kupczewska M, Otziomek E, Wolczynski S, Gorska M (2007) Serum visfatin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome. Hum Reprod 22(7):1824–1829PubMed
90.
Panidis D, Farmakiotis D, Rousso D, Katsikis I, Delkos D, Piouka A, Gerou S, Diamanti-Kandarakis E (2008) Plasma visfatin levels in normal weight women with polycystic ovary syndrome. Eur J Intern Med 19(6):406–412. doi:10.​1016/​j.​ejim.​2007.​05.​014 PubMed
91.
92.
93.
Seow KM, Hwang JL, Wang PH, Ho LT, Juan CC (2011) Expression of visfatin mRNA in peripheral blood mononuclear cells is not correlated with visfatin mRNA in omental adipose tissue in women with polycystic ovary syndrome. Hum Reprod 26(10):2869–2873. doi:10.​1093/​humrep/​der267 PubMed
94.
Spanos N, Tziomalos K, Macut D, Koiou E, Kandaraki EA, Delkos D, Tsourdi E, Panidis D (2012) Adipokines, insulin resistance and hyperandrogenemia in obese patients with polycystic ovary syndrome: cross-sectional correlations and the effects of weight loss. Obes Facts 5(4):495–504. doi:10.​1159/​000341579 PubMed
95.
96.
97.
Olszanecka-Glinianowicz M, Madej P, Zdun D, Bożentowicz-Wikarek M, Sikora J, Chudek J, Skałba P (2012) Are plasma levels of visfatin and retinol-binding protein 4 (RBP4) associated with body mass, metabolic and hormonal disturbances in women with polycystic ovary syndrome? Eur J Obstet Gynecol Reprod Biol 162(1):55–61. doi:10.​1016/​j.​ejogrb.​2012.​01.​026 PubMed
98.
Kasim-Karakas SE, Almario RU, Cunningham W (2009) Effects of protein versus simple sugar intake on weight loss in polycystic ovary syndrome (according to the National Institutes of Health criteria). Fertil Steril 92:262–270PubMed
99.
Moran LJ, Noakes M, Clifton PM, Wittert GA, Belobrajdic DP, Norman RJ (2007) C-reactive protein before and after weight loss in overweight women with and without polycystic ovary syndrome. J Clin Endocrinol Metab 92:2944–2951PubMed
100.
Stamets K, Taylor DS, Kunselman A, Demers LM, Pelkman CL, Legro RS (2004) 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 81:630–637PubMed
101.
Van Dam EW, Roelfsema F, Veldhuis JD, Helmerhorst FM, Frolich M, Meinders AE, Krans HM, Pijl H (2002) Increase in daily LH secretion in response to short-term calorie restriction in obese women with PCOS. Am J Physiol Endocrinol Metab 282:E865–E872PubMed
102.
Laughlin GA, Morales AJ, Yen SS (1997) Serum leptin levels in women with polycystic ovary syndrome: the role of insulin resistance/hyperinsulinemia. J Clin Endocrinol Metab 82:1692–1696PubMed
103.
Mantzoros CS, Dunaif A, Flier JS (1997) Leptin concentrations in the polycystic ovary syndrome. J Clin Endocrinol Metab 82:1687–1691PubMed
104.
Muneyvirci-Delale O, Nacharaju VL, Altura BM, Altura BT (1998) Sex steroid hormones modulate serum ionized magnesium and Ca levels throughout the menstrual cycle in women. Fertil Steril 69:958–962PubMed
105.
Rumawas ME, McKeown NM, Rogers G, Meigs JB, Wilson PWF, Jacques PF (2006) Magnesium intake is related to improved insulin homeostasis in the Framingham offspring cohort. J Am Coll Nutr 25:486–492PubMed
106.
Chakraborty P, Ghosh S, Goswami SK, Syed NK, Baidyanath C, Kuladip J (2013) Altered trace mineral milieu might play an aetiological role in the pathogenesis of polycystic ovary syndrome. Biol Trace Elem Res 152:9–15PubMed
107.
Kauffman RP, Tullar PE, Nipp RD, Castracane VD (2011) Serum magnesium concentrations and metabolic variables in polycystic ovary syndrome. Acta Obstet Gynecol Scand 90:452–458PubMed
108.
109.
Kelly CC, Lyall H, Petrie JR, Gould GW, Connell JMC, Sattar N (2001) Low grade chronic inflammation in women with polycystic ovary syndrome. J Clin Endocrinol Metab 86:2453–2455PubMed
110.
Slesinski RS, Clarke JJ, San RH, Gudi R (2005) Lack of mutagenicity of chromium picolinate in the hypoxanthine phosphoribosyltransferase gene mutation assay in Chinese hamster ovary cells. Mutat Res 585:86–95PubMed
111.
Cefalu WT, Hu FB (2004) Role of chromium in human health and in diabetes. Diabetes Care 11:2741–2751
112.
Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg GR, Bruce-Robertson A (1977) Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. Am J Clin Nutr 30:531–538PubMed
113.
Mertz W (1998) Chromium research from a distance: from 1959 to 1980. J Am Coll Nutr 17:544–547PubMed
114.
Davis CM, Vincent JB (1997) Chromium oligopeptide activates insulin receptor tyrosine kinase activity. Biochemistry 36:4382–4385PubMed
115.
Vincent JB (1999) Mechanisms of chromium action: low-molecular-weight chromium-binding substance. J Am Coll Nutr 18:6–12PubMed
116.
Morris BW, MacNeil S, Hardisty CA, Heller S, Burgin C, Gray TA (1999) Chromium homeostasis in patients with type II (NIDDM) diabetes. J Trace Elem Med Biol 13:57–61PubMed
117.
Lydic ML, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M (2006) Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 86:243–246PubMed
118.
Verstuyf A, Carmeliet G, Bouillon R, Mathieu C (2010) Vitamin D: a pleiotropic hormone. Kidney Int 78:140–145PubMed
119.
Alvarez JA, Ashraf A (2010) Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol 2010:351–385
120.
Ngo DT, Chan WP, Rajendran S et al (2011) Determinants of insulin responsiveness in young women: impact of polycystic ovarian syndrome, nitric oxide, and vitamin D. Nitric Oxide 25:326–330PubMed
121.
Ortlepp JR, Metrikat J, Albrecht M, von Korff A, Hanrath P, Hoffmann R (2003) The vitamin D receptor gene variant and physical activity predicts fasting glucose levels in healthy young men. Diabet Med 20:451–454PubMed
122.
Bourlon PM, Billaudel B, Faure-Dussert A (1999) Influence of vitamin D3 deficiency and 1, 25 dihydroxyvitamin D3 on de novo insulin biosynthesis in the islets of the rat endocrine pancreas. J Endocrinol 160:87–95PubMed
123.
Chiu KC, Chu A, Go VL, Saad MF (2004) Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 79:820–825PubMed
124.
Thomson RL, Spedding S, Buckley JD (2012) Vitamin D in the aetiology and management of polycystic ovary syndrome. Clin Endocrinol 7:343–350
125.
Homburg R, Amsterdam A (1998) Polycystic ovary syndrome—loss of the apoptotic mechanism in the ovarian follicles? J Endocrinol Invest 21:552–557PubMed
126.
127.
Shoelson SE, Herrero L, Naaz A (2007) Obesity, inflammation, and insulin resistance. Gastroenterology 132:2169–2180PubMed
128.
Yildizhan R, Kurdoglu M, Adali E et al (2009) Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Arch Gynecol Obstet 280:559–563PubMed
129.
Pal L, Berry A, Coraluzzi L (2012) Therapeutic implications of vitamin D and calcium in overweight women with polycystic ovary syndrome. Gynecol Endocrinol 28:965–968PubMedCentralPubMed
130.
Wehr E, Pieber TR, Obermayer-Pietsch B (2011) Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: a pilot study. J Endocrinol Invest 34:757–763PubMed
131.
Selimoglu H, Duran C, Kiyici S, Ersoy C, Guclu M, Ozkaya G, Tuncel E, Erturk E, Imamoglu S (2010) The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome. J Endocrinol Invest 33:234–238PubMed
132.
Kasim-Karakas SE, Almario RU, Gregory L, Wong R, Todd H, Lasley BL (2004) Metabolic and endocrine effects of a polyunsaturated fatty acid-rich diet in polycystic ovary syndrome. J Clin Endocrinol Metab 89:615–620PubMed
133.
Oh R (2005) Practical applications of fish oil (Omega-3 fatty acids) in primary care. J Am Board Fam Pract 18:28–36PubMed
134.
Ebbesson SO, Risica PM, Ebbesson LO, Kennish JM, Tejero ME (2005) Omega-3 fatty acids improve glucose tolerance and components of the metabolic syndrome in Alaskan Eskimos: the Alaska Siberia project. Int J Circumpolar Health 64:396–408PubMed
135.
Rafraf M, Mohammadi E, Asghari-Jafarabadi M, Farzadi L (2012) Omega-3 fatty acids improve glucose metabolism without effects on obesity values and serum visfatin levels in women with polycystic ovary syndrome. J Am Coll Nutr 31:361–368PubMed
136.
Kratz M, Swarbrick MM, Callahan HS, Matthys CC, Havel PJ, Weigle DS (2008) Effect of dietary n-3 polyunsaturated fatty acids on plasma total and high-molecular-weight adiponectin concentrations in overweight to moderately obese men and women. Am J Clin Nutr 87:347–353PubMedCentralPubMed
137.
Mohammadi E, Rafraf M, Farzadi L, Asghari-Jafarabadi M, Sabour S (2012) Effects of omega-3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome. Asia Pac J Clin Nutr 21(4):511–518PubMed
138.
Gillies CL, Abrams KR, Lambert PC et al (2007) Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 334:299PubMedCentralPubMed
139.
Colberg SR, Albright AL, Blissmer BJ et al (2010) Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 42:2282–2303PubMed
140.
Lee S, Kuk JL, Davidson LE et al (2005) Exercise without weight loss is an effective strategy for obesity reduction in obese individuals with and without Type 2 diabetes. J Appl Physiol 99:1220–1225PubMed
141.
Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ (2009) Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 92:1966–1982PubMed
142.
Bianchi C, Miccoli R, Penno G, Del Prato S (2008) Primary prevention of cardiovascular disease in people with dysglycemia. Diabetes Care 31:208–214
143.
Kiddy DS, Hamilton-Fairley D, Bush A et al (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 36:105–111
144.
Clark AM, Ledger W, Galletly C et al (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 10:2705–2712PubMed
145.
Thomson RL, Buckley JD, Moran LJ, Noakes M, Clifton PM, Norman RJ, Brinkworth GD (2009) The effect of weight loss on anti-Müllerian hormone levels in overweight and obese women with polycystic ovary syndrome and reproductive impairment. Hum Reprod 24:1976–1981PubMed
146.
Holte J, Bergh T, Berne C, Wide L, Lithell H (1995) Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 80:2586–2593PubMed
147.
148.
Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M et al (2013) Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. J Acad Nutr Diet 113(4):520–545. doi:10.​1016/​j.​jand.​2012.​11.​018 PubMed
149.
Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R (2006) Role of diet in the treatment of polycystic ovary syndrome. Fertil Steril 85:679–688PubMedCentralPubMed
150.
Mehrabani HH, Salehpour S, Amiri Z, Farahani SJ, Meyer BJ, Tahbaz F (2012) Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. J Am Coll Nutr 31:117–125PubMed
151.
Graff SK, Mário FM, Alves BC, Spritzer PM (2013) Dietary glycemic index is associated with less favorable anthropometric and metabolic profiles in polycystic ovary syndrome women with different phenotypes. Fertil Steril 100:1081–1088PubMed
152.
Leidy HJ, Racki EM (2010) The addition of a protein-rich breakfast and its effects on acute appetite control and food intake in ‘breakfast-skipping’ adolescents. Int J Obes 34:1125–1133
153.
Zumoff B, Freeman R, Coupey S, Saenger P, Markowitz M, Kream J (1983) A chronobiologic abnormality in luteinizing hormone secretion in teenage girls with the polycystic-ovary syndrome. N Engl J Med 309:1206–1209PubMed
154.
Prelevic GM, Wurzburger MI, Balint-Peric L (1993) 24-hour serum cortisol profiles in women with polycystic ovary syndrome. Gynecol Endocrinol 7:179–184PubMed
155.
Domecq JP, Prutsky G, Mullan RJ, Hazem A, Sundaresh V, Elamin MB, Phung OJ, Wang A, Hoeger K, Pasquali R, Erwin P, Bodde A, Montori VM, Murad MH (2013) Lifestyle modification programs in polycystic ovary syndrome: Systematic review and meta-analysis. J Clin Endocrinol Metab 98(12):4655–4663. doi:10.​1210/​jc.​2013-2385
156.
Brown AJ, Setji TL, Sanders LL, Lowry KP, Otvos JD, Kraus WE, Svetkey PL (2009) Effects of exercise on lipoprotein particles in women with polycystic ovary syndrome. Med Sci Sports Exerc 41:497–504PubMedCentralPubMed
157.
Guzick DS, Wing R, Smith D, Berga SL, Winters SJ (1994) Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertility, Sterility 61:598–604
158.
Hoeger KM, Kochman L, Wixom N, Craig K, Miller RK, Guzick DS (2004) A randomized, 48-week, placebo-controlled trial of intensive lifestyle modification and/or metformin therapy in overweight women with polycystic ovary syndrome: a pilot study. Fertil Steril 82:421–429PubMed
159.
Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS (2008) The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab 93:4299–4306PubMedCentralPubMed
160.
Karimzadeh MA, Javedani M (2010) An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate-metformin in patients with polycystic ovary syndrome. Fertil Steril 94:216–220PubMed
161.
Palomba S, Falbo A, Giallauria F, Russo T, Rocca M, Tolino A, Zullo F, Orio F (2010) Six weeks of structured exercise training and hypocaloric diet increases the probability of ovulation after clomiphene citrate in overweight and obese patients with polycystic ovary syndrome: a randomized controlled trial. Hum Reprod 25:2783–2791PubMed
162.
Qublan HS, Yannakoula EK, Al-Qudah MA, El-Uri FI (2007) Dietary intervention versus metformin to improve the reproductive outcome in women with polycystic ovary syndrome. A prospective comparative study. Saudi Med J 28:1694–1699PubMed
163.
Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB (2009) Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol 297:R387–R395PubMed
164.
Vigorito C, Giallauria F, Palomba S, Cascella T, Manguso F, Lucci R, De Lorenzo A, Tafuri D, Lombardi G, Colao A, Orio F (2007) 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 92:1379–1384
Metadata
Title
Focus on metabolic and nutritional correlates of polycystic ovary syndrome and update on nutritional management of these critical phenomena
Authors
Mariangela Rondanelli
Simone Perna
Milena Faliva
Francesca Monteferrario
Erica Repaci
Francesca Allieri
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 6/2014
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-014-3433-z

Other articles of this Issue 6/2014

Archives of Gynecology and Obstetrics 6/2014 Go to the issue

Case Report

An unusual long-term complication of transobturator polypropylene mesh

General Gynecology

Outcomes and complications of trans-vaginal mesh repair using the Prolift™ kit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre

General Gynecology

Patient-reported quality-of-life and sexual-function outcomes after laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): a prospective, questionnaire-based follow-up study in 915 patients

Maternal-Fetal Medicine

MR angiography demonstrates a positive correlation between placental blood vessel volume and fetal size

General Gynecology

Identification of differentially expressed proteins in the ovaries of menopausal women

News and Views

Preterm infants, kidney, rickets and vitamin D intake: is it time for rewriting the history?