Dietary and lifestyle interventions for reducing cardiometabolic risk in PCOS

By Neha MathurDec 13 2023Reviewed by Lily Ramsey, LLM

In a recent narrative review published in Nutrients Journal, researchers summarize dietary and lifestyle interventions that might help reduce cardiometabolic risk in women with polycystic ovary syndrome (PCOS) and varying body compositions.

Study: Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS). Image Credit: MMD Creative/Shutterstock.com

Background

Anovulatory infertility occurs in ~75% of women with PCOS, and much of the literature has discussed strategies to improve reproductive outcomes in these women.

However, PCOS is a lifelong condition also associated with metabolic/psychological manifestations and comorbidities, such as dyslipidemia, obesity, hypertension, chronic inflammation, and impaired glucose tolerance.

Thus, PCOS may also be a significant risk factor for cardiovascular diseases (CVDs) regardless of the weight and BMI of the affected individual.

Indeed, weight, BMI, or energy intake alone cannot completely elucidate the higher prevalence of cardiometabolic risk in women with PCOS.

Improvement in the overall dietary and lifestyle patterns of PCOS cases is, thus, vital for its management, for which, currently, there is no consensus. Furthermore, the understanding of PCOS management in women with different BMIs is limited.

Study methodology

Researchers thoroughly searched the PubMed and CINAHL databases to identify original intervention research done on human subjects and published between 1989 and 2023 in English. They used search terms with Boolean functions, e.g., “polycystic ovary syndrome” AND “diet” OR “exercise.”

These studies examined the relationship between diet/lifestyle and cardiometabolic risk factors in individuals with PCOS.

Furthermore, selected studies included at least one anthropometric measure (e.g., BMI), as well as one biochemical (lipid profile) or clinical (blood pressure) marker in their outcomes.

The team classified all identified studies into solely dietary interventions or lifestyle interventions. 

Results

Of 37 and 14 studies based on dietary and lifestyle interventions, only 13 and six were randomized interventions, respectively.

They utilized widely varying dietary strategies, spanning from interventions modifying different diet components, including energy intake, macronutrient composition, dietary pattern, and eating behavior, to modifications of the diets without energy restrictions. 

Likewise, identified studies utilized varying lifestyle interventions plus additional behavioral modifications (e.g., structured/unstructured exercise and cognitive behavior therapy). Notably, most of the included studies (55%) used the Rotterdam criteria to diagnose PCOS.

Only 11 studies on dietary and one on lifestyle interventions covered participants within a healthy BMI range. Studies that modified dietary patterns without a caloric restriction observed improvements in cardiometabolic parameters.

The attrition rates in studies using weight loss interventions (or calorie restriction) were higher, indicating poor sustainability in real-world scenarios.

Thus, focusing on dietary interventions, such as altering eating behavior, modifying caloric intake timing, meals per day, lowering carbohydrate intake, and increasing protein intake, might prove more beneficial among individuals with PCOS across BMI ranges.

Moreover, the study analysis highlighted the need to prioritize research recruitment outside medical centers, as these sites may have more individuals with worse clinical presentations.

Furthermore, they emphasized more robust screening to determine metabolic risk among individuals classified into a healthy BMI category, as even they could be metabolically unhealthy. The authors recommended using serum anti-Mullerian hormone (AMH) in tandem with the existing diagnostic algorithm for PCOS diagnosis.

Additionally, the lifestyle recommendations for individuals with PCOS should address its psychological aspects as they might also contribute to the raised risk of CVDs.

Conclusions

A higher weight and BMI are only one indicator of health in women with PCOS; however, many other factors may be at play.

The care of individuals with PCOS should be holistic and consider a plethora of factors, including an individual’s cardiometabolic risk profile, disordered eating history, central adiposity, failed attempts to lose weight, lifestyle behaviors, dietary preferences, and weight cycling effects.

There is ample research on the topic, but its quality and interventions vary, hindering robust conclusions. Nonetheless, there is no one-size-fits-all approach to managing PCOS. 

Future research should use pooled analyses and collaboration to fill in missing gaps. To start with, they may use the international evidence-based guidelines for the assessment and management of PCOS.

To conclude, this study underscores the need for more sustainable and realistic lifestyle/dietary interventions that meet the needs of PCOS-affected women with varying body weights. 

The focus should be improving cardiometabolic risk factors and PCOS management through approaches that consider and integrate all psychological, biological, and social aspects of this condition.