Abstract
ObjectiveDiet has been reported as the first-line management of polycystic ovary syndrome (PCOS). However, the relationship between diet and fertility in PCOS is still controversial. This meta-analysis aimed to evaluate whether diet could promote reproductive health in women with PCOS while providing evidence-based nutrition advice for clinical practice.MethodsSeven databases, including Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, and some Chinese database, were searched up to January 31, 2021. Randomized controlled trials evaluating the effects of diet in women with PCOS were included. Based on a preregistered protocol (PROSPERO CRD42019140454), the systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two reviewers made study selection, data extraction and bias assessment independently. Risk ratios and mean difference with 95% confidence intervals were assessed by a random-effects model. Statistical heterogeneity within comparisons was evaluated by Cochran’s Q test and quantified by the I-squared (I2 ) statistic.ResultsTwenty RCTs with 1113 participants were included. Results showed diet significantly related to improved fertility outcomes (increasing clinical pregnancy, ovulation and menstrual regularity rate; reducing miscarriage rate), reproductive endocrine [increasing sex hormone-binding globulin (SHBG); decreasing Anti-Müllerian Hormone (AMH), free androgen index (FAI), total testosterone (T)] and clinical hyperandrogenism (hirsutism assessed by Ferriman-Gallwey score) in PCOS. Specifically, subgroup analyses indicated low-carbohydrate diets were superior in optimizing reproductive outcomes and calorie restriction was critical in ameliorating hyperandrogenism. Additionally, the positive effects were associated with the treatment duration. The longer the duration, the greater the improvement was.ConclusionOverall, diet is an effective intervention for improving fertility health, thus professional and dynamic dietary advice should be offered to all PCOS patients, based on the changeable circumstances, personal needs and expectations of the individuals.
Highlights
Polycystic ovary syndrome (PCOS) characterized by irregular cycles, ovulatory dysfunction, hyperandrogenism and polycystic ovarian morphology (PCOM) is one of the most common endocrine disorders in women of reproductive age, and is prone to increased risks of complications such as diabetes, cardiovascular disease and endometrial cancer in the long term [1,2,3]
Except for the trial conducted by Gower et al [34], all of them were parallel-design and single-canter RCTs conducted in China [40, 42,43,44,45,46,47], Iran [35, 36, 39, 41], the United States [30, 34], Australia [29, 32], the United Kingdom [31], Canada [48], Denmark [33], Egypt [37] and Mexico [38] between 2003 and 2020
The diagnosis of PCOS in the analysis could be divided into four categories: twelve trials under the Rotterdam Consensus [31, 33, 35, 36, 38,39,40,41, 43, 44, 46, 47], six trials following the NIH diagnostic criteria [29, 30, 32, 34, 37, 45], and the remaining two confirmed by the AE–PCOS [48] and China Medical Association [42] diagnostic criteria, respectively
Summary
Polycystic ovary syndrome (PCOS) characterized by irregular cycles, ovulatory dysfunction, hyperandrogenism and polycystic ovarian morphology (PCOM) is one of the most common endocrine disorders in women of reproductive age, and is prone to increased risks of complications such as diabetes, cardiovascular disease and endometrial cancer in the long term [1,2,3]. PCOS is associated with the risk of infertility and adverse pregnancy outcomes [6, 7]. It has been reported as the most common cause of ovulatory dysfunction, accounting for 80% of women suffering from anovulatory infertility [8]. With the increased rates of weight gain and prevalence of excess weight in women with PCOS (up to 88%) [9, 10], reproductive health is further exacerbated, which adversely affects the condition and poses a major public health challenge mandating both prevention and treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
