Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS)

Contributing factors for pregnancy outcomes in women with PCOS after their first FET treatment: a retrospective cohort study

OBJECTIVE

We aim to explore the contributing factors of clinical pregnancy outcomes in PCOS patients undergoing their first FET treatment.

METHODS

A retrospective analysis was conducted on 574 PCOS patients undergoing their first FET treatment at a private fertility center from January 2018 to December 2021.

RESULTS

During the first FET cycle of PCOS patients, progesterone levels (aOR 0.109, 95% CI 0.018-0.670) and endometrial thickness (EMT) (aOR 1.126, 95% CI 1.043-1.419) on the hCG trigger day were associated with the clinical pregnancy rate. Similarly, progesterone levels (aOR 0.055, 95% CI 0.007-0.420) and EMT (aOR 1.179, 95% CI 1.011-1.376) on the hCG trigger day were associated with the live birth rate. In addition, AFC (aOR 1.179, 95% CI 1.011-1.376) was found to be a risk factor for preterm delivery.

CONCLUSIONS

In women with PCOS undergoing their first FET, lower progesterone levels and higher EMT on hCG trigger day were associated with clinical pregnancy and live birth, and AFC was a risk factor for preterm delivery. During FET treatment, paying attention to the patient's endocrine indicators and follicle status may have a positive effect on predicting and improving the pregnancy outcome of PCOS patients.

Comparison of premenstrual symptoms, psychological well-being, and nutritional status between Palestinian women with and without polycystic ovarian syndrome: a case-control study

BACKGROUND

Polycystic ovarian syndrome (PCOS) is a widely seen reproductive and endocrinological disorder. PCOS can exert substantial effects on many aspects of an individual's life, including reproductive health and psychological well-being. The objective of this study was to assess the nutritional status, premenstrual syndrome, and mental health of women affected by PCOS in comparison to women without PCOS.

METHODOLOGY

A case-control observational study in Palestine included 100 PCOS patients and 200 healthy women. The collected data included socio-demographic information, medical history, premenstrual syndrome, mental health, nutritional status, and lifestyle. Anthropometric measurement and the Mediterranean Diet Adherence Screener (MEDAS) were used to evaluate the nutritional status. The General Health Questionnaire (12-GHQ) was used to evaluate the state of mental health. Premenstrual syndrome (PMS) severity was evaluated using a validated Arabic premenstrual syndrome questionnaire.

RESULTS

The study's findings indicated that there was a statistically significant increase in the three dimensions of PMS among participants with PCOS, p < 0.05. Similarly, PCOS patients demonstrated elevated ratings across all aspects of mental health, p < 0.05. In terms of the other variables, it has been observed that PCOS patients have a notably greater prevalence of perceived sleep disturbances and decreased adherence to the Mediterranean diet. Regression analysis revealed that PCOS is associated with mental health problems indicated by a higher GHQ score (OR: 1.09; 95% CI: 1.03; 1.16, p < 0.05), lower adherence to the MD diet (OR: 0.86; 95% CI: 0.76; 0.98, p < 0.05), and pre-menstrual syndrome, especially the physical symptoms (OR: 1.06; 95% CI: 1.003; 1.12, p < 0.05) after adjusting for age, smoking, waist-hip ratio, and body mass index (BMI).

CONCLUSION

The study has linked polycystic ovary syndrome to negative mental health outcomes and an increased severity of premenstrual syndrome (PMS). Additional investigation is required in order to establish a causal association between polycystic ovary syndrome (PCOS) and lifestyle behaviors within the Palestinian population. Intervention and instructional studies are necessary to investigate the efficacy of management strategies in alleviating the effects of polycystic ovary syndrome (PCOS) on both physical and mental well-being.

Obesity, Dietary Patterns, and Hormonal Balance Modulation: Gender-Specific Impacts

Understanding the intricate relationship between nutrition, hormonal balance, and gender-specific factors is crucial for developing targeted interventions to mitigate obesity-related endocrine disruptions and improve metabolic health. This narrative review examines the impact of various dietary patterns on hormonal regulation in both men and women, focusing on their effects on hormonal balance and metabolic health in the context of obesity. Calorie restriction, the Western diet, high-fat diets, low-CHO diets, plant-based diets, and the Mediterranean diet are analyzed in relation to their influence on obesity-related endocrine disruptions and metabolic health. Future research directions include investigating the specific mechanisms underlying dietary influences on hormonal regulation, addressing the gender-specific metabolic differences and body fat distribution, and exploring the dietary needs of individuals undergoing gender transition. Personalized dietary interventions tailored to individual metabolic and hormonal profiles are essential for optimizing health outcomes across the gender spectrum. By integrating gender-specific considerations into dietary recommendations, healthcare professionals can better support individuals in achieving optimal metabolic health and hormonal balance.

High Dietary Inflammatory Index increases the risk of female infertility: An analysis of NHANES 2013-2018

Diet-related inflammation, which can be evaluated using the dietary inflammatory index (DII), is increasingly related to female infertility. However, studies on the association between DII and infertility are limited. In this study, we aim to explore the association between DII and infertility and its dose-effect relationship among women aged 20 to 45 years through a cross-sectional analysis of the National Health and Nutrition Examination Survey 2013-2018. A total of 2613 women aged 20 to 45 years were included and analyzed. The DII was calculated using the first 24-hour dietary recall interview data and divided into quartiles. Weighted multivariable logistic regression and restricted cubic spline analysis were used to explore the relationship between DII and infertility. The odds ratio (OR) (95% confidence interval [CI]) for the association between DII and infertility was 1.06 (0.96-1.19) after multivariable adjustment. Compared with the first quartile (anti-inflammatory diet), the fourth quartile of DII (pro-inflammatory diet) was more strongly associated with an increased risk of infertility, with an OR of 1.61 (95% CI, 1.05-2.47). Restricted cubic splines showed a J-shaped nonlinear association between DII and infertility (P for nonlinear = .003), with a cutoff point of 2.45. When DII was higher than 2.45, the OR for infertility was 1.95 (95% CI, 1.49-2.54). Similar results were observed among the subgroup analyses. In conclusion, this study found high DII (pro-inflammatory diet) increases the risk of female infertility. DII had a J-shaped nonlinear relationship with female infertility, whose cut point is 2.45. Controlling the intake of pro-inflammatory food may be beneficial for female infertility.

High Fat Diet and Polycystic Ovary Syndrome (PCOS) in Adolescence: An Overview of Nutritional Strategies

Polycystic ovary syndrome (PCOS) is a multifaceted and heterogeneous disorder, linked with notable reproductive, metabolic, and psychological outcomes. During adolescence, key components of PCOS treatment involve weight loss achieved through lifestyle and dietary interventions, subsequently pursued by pharmacological or surgical therapies. Nutritional interventions represent the first-line therapeutic approach in adolescents affected by PCOS, but different kinds of dietary protocols exist, so it is necessary to clarify the effectiveness and benefits of the most well-known nutritional approaches. We provided a comprehensive review of the current literature concerning PCOS definition, pathophysiology, and treatment options, highlighting nutritional strategies, particularly those related to high-fat diets. The high-fat nutritional protocols proposed in the literature, such as the ketogenic diet (KD), appear to provide benefits to patients with PCOS in terms of weight loss and control of metabolic parameters. Among the different types of KD studies, very low-calorie ketogenic diets (VLCKD), can be considered an effective dietary intervention for the short-term treatment of patients with PCOS. It rapidly leads to weight loss alongside improvements in body composition and metabolic profile. Even though extremely advantageous, long-term adherence to the KD is a limiting factor. Indeed, this dietary regimen could become unsustainable due to the important restrictions required for ketosis development. Thus, a combination of high-fat diets with more nutrient-rich nutritional regimens, such as the Mediterranean diet, can amplify positive effects for individuals with PCOS.

Effects of dietary intervention on human diseases: molecular mechanisms and therapeutic potential

Diet, serving as a vital source of nutrients, exerts a profound influence on human health and disease progression. Recently, dietary interventions have emerged as promising adjunctive treatment strategies not only for cancer but also for neurodegenerative diseases, autoimmune diseases, cardiovascular diseases, and metabolic disorders. These interventions have demonstrated substantial potential in modulating metabolism, disease trajectory, and therapeutic responses. Metabolic reprogramming is a hallmark of malignant progression, and a deeper understanding of this phenomenon in tumors and its effects on immune regulation is a significant challenge that impedes cancer eradication. Dietary intake, as a key environmental factor, can influence tumor metabolism. Emerging evidence indicates that dietary interventions might affect the nutrient availability in tumors, thereby increasing the efficacy of cancer treatments. However, the intricate interplay between dietary interventions and the pathogenesis of cancer and other diseases is complex. Despite encouraging results, the mechanisms underlying diet-based therapeutic strategies remain largely unexplored, often resulting in underutilization in disease management. In this review, we aim to illuminate the potential effects of various dietary interventions, including calorie restriction, fasting-mimicking diet, ketogenic diet, protein restriction diet, high-salt diet, high-fat diet, and high-fiber diet, on cancer and the aforementioned diseases. We explore the multifaceted impacts of these dietary interventions, encompassing their immunomodulatory effects, other biological impacts, and underlying molecular mechanisms. This review offers valuable insights into the potential application of these dietary interventions as adjunctive therapies in disease management.

Effects of high-protein diets on the cardiometabolic factors and reproductive hormones of women with polycystic ovary syndrome: a systematic review and meta-analysis

The optimal dietary regimen for polycystic ovary syndrome (PCOS) has not been identified. High-protein diets (HPDs) are effective for weight control in individuals with metabolic abnormalities, but no systematic meta-analyses have yet summarised the effects of HPDs on PCOS. Seven electronic databases were searched from inception to 30 April 2023, and studies comparing the effects of HPDs and other diets on the anthropometrics, metabolic factors, and hormonal profiles for PCOS were identified. Data were pooled using random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by Cochrane Collaboration tool. Eight trials involving 300 women with PCOS were included. Compared with isocaloric balanced diets (BDs), HPDs significantly reduced fasting insulin (-2.69 μIU/mL, 95% CI [-3.81, -1.57], P < 0.0001, I2 = 46%) and homoeostatic model assessment for insulin resistance (HOMA-IR-0.41, 95% CI [-0.80, -0.02], P = 0.04, I2 = 94%) in women with PCOS. However, HPDs and BDs had comparable effects on weight loss, abdominal adiposity, lipid profiles, and reproductive hormones (all P ≥ 0.05). HPDs may benefit women with PCOS in terms of improving insulin resistance, supporting for their use as one of the dietary management options for PCOS, however further RCTs in larger and broader settings are required to confirm these observations and investigate the mechanism behind it.

Cardiovascular Disease and the Mediterranean Diet: Insights into Sex-Specific Responses

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes.

Association of dietary inflammatory index with C-reactive protein and interleukin-6 in women with and without polycystic ovarian syndrome

Considering that interventions related to lifestyle, especially nutrition have been proposed as the first line of prevention and treatment of polycystic ovarian syndrome (PCOS), and regarding the proven relationship between PCOS and inflammation, the present study was designed to find out the possible association of Diet Inflammatory Index (DII) with the inflammatory markers like C-reactive protein (CRP) and Interleukin-6 (IL-6), and compare the obtained results in PCOS and non-PCOS women. This case-control study was conducted on 45 PCOS and 40 non-PCOS women. Food intake and DII were measured using a 147-item Food Frequency Questionnaire. All participants were tested for the serum levels of IL-6 and CRP. Finally, the obtained results were compared between the two groups of PCOS and non-PCOS women. Significant differences were observed between the two groups in terms of age, menstrual status and number of pregnancies (P < 0.05). Comparison of DII values showed no significant difference between the two groups of women (P = 0.68), but IL-6 was significantly higher in the PCOS group than in the control group (4.94 ± 1.97 vs. 3.48 ± 1.77, P < 0.001). Also in terms of CRP, no significant difference was observed between the two groups (P > 0.05). The difference of DII between the case and control groups were not significant and Pearson's correlation test did not show a significant correlation between DII and IL-6 (P˃0.05). This result can be due to the influence of several factors affecting the determination of DII such as education level, health status, physical activity level, age, and calorie intake. It seems that diet, especially consumption of more carbohydrates plays a role in causing chronic inflammation, as well as the occurrence and exacerbation of PCOS.

Effects of AIDiet intervention to improve diet quality, immuno-metabolic health in normal and overweight PCOS girls: a pilot study

This study was conducted in two groups of girls with PCOS (polycystic ovary syndrome) categorized as slim (group N) and overweight-to-obese (group Ov/Ob). The study's primary outcome was to assess the impact of a 12-week anti-inflammatory diet (AIDiet) intervention, without energy deficit, on daily diet quality improvement, evaluated according to the KIDMED index. The secondary outcome was improving inflammatory, redox, hormonal, and metabolic statuses. In the study, which was completed by 13 girls from the Ov/Ob group and 19 girls from the N group, a significant improvement in the mean KIDMED score was obtained. Moreover, the intervention significantly improves concentration of total antioxidant capacity (TAC), fasting insulin, and the homeostatic model assessment for insulin resistance (HOMA-IR) index, in the Ov/Ob group, while both groups experienced a reduction in the concentration of interleukin (IL)-1 and IL-6, tumour necrosis factor (TNF-α), and androstenedione. The AIDiet intervention effectively improved the quality of the subjects' diets, which was associated with the improvement of hormonal and immuno-metabolic markers. However, these changes in normal-weight patients were observed regardless of body weight reduction. ClinicalTrials.gov Identifier NCT04738409.

The effect of the female genital tract and gut microbiome on reproductive dysfunction

Microorganisms are ubiquitous in the human body; they are present in various areas including the gut, mouth, skin, respiratory tract, and reproductive tract. The interaction between the microbiome and reproductive health has become an increasingly compelling area of study. Disruption of the female genital tract microbiome can significantly impact the metabolism of amino acids, carbohydrates, and lipids, increasing susceptibility to reproductive tract diseases such as vaginitis, chronic endometritis, endometrial polyps, endometriosis, and polycystic ovary syndrome. The gut microbiome, considered an endocrine organ, plays a crucial role in the reproductive endocrine system by interacting with hormones like estrogen and androgens. Imbalances in the gut microbiome composition can lead to various diseases and conditions, including polycystic ovary syndrome, endometriosis, and cancer, although research on their mechanisms remains limited. This review highlights the latest advancements in understanding the female genital tract and gut microbiomes in gynecological diseases. It also explores the potential of microbial communities in the treatment of reproductive diseases. Future research should focus on identifying the molecular mechanisms underlying the association between the microbiome and reproductive diseases to develop new and effective strategies for disease prevention, diagnosis, and treatment related to female reproductive organs.

Role of Mediterranean diet in endocrine diseases: a joint overview by the endocrinologist and the nutritionist

PURPOSE

The purpose of this review is to examine the current evidence on the potential role of Mediterranean diet (MD) in the prevention and management of endocrine disorders and to highlight the importance of interdisciplinary collaboration between endocrinologists and nutritionists.

METHODS

A literature search was conducted using PubMed and Google Scholar databases to identify relevant studies published in English. Studies were selected based on their relevance to the role of MD in the prevention and management of endocrine disorders. The search terms included "Mediterranean diet," "endocrine disorders," "thyroid disorders," "gonadal disorders," and "neuroendocrine tumors".

RESULTS

The studies reviewed suggest that MD may have a beneficial effect in the prevention and management of various endocrine disorders, including thyroid disorders, gonadal disorders, and neuroendocrine tumors. MD has been associated with decreased risk of nodular thyroid disease and thyroid cancer, improved male and female reproductive health, and a potential role in the management of neuroendocrine tumors. MD's anti-inflammatory and antioxidant properties, as well as its high levels of phytochemicals, may play a role in its beneficial effects.

CONCLUSION

Interdisciplinary collaboration between endocrinologists and nutritionists is essential for the optimal management of endocrine disorders, including the potential role of MD in their prevention and management. While further research is needed, the current evidence suggests that MD may have a protective effect against endocrine disorders, and its incorporation into dietary recommendations may be beneficial.

The Effects of Different Types of Diets on Steroid Hormone Concentrations

The great popularity of various diets in recent years has led us to reflect on their suitability for our health. The aim of this communication is to review current knowledge on the influence of the most well-known diets on the concentrations of the main steroids and to consider possible mechanisms. The influence of diet on hormone concentrations is expected, but the literature data on this topic are inconsistent and yield conflicting results. The main problem in evaluating these influences is the change in weight that a change in diet induces. This effect needs to be filtered out in order to discover interesting associations between diet and steroid hormones. This is illustrated by the example of the effects of ketogenic diets on testosterone levels in men, where the direct effect of the diet is to reduce testosterone levels, but a number of papers have described increases that are due to diet-related weight loss and the modification of obesity-induced changes. A second major driver is the change in circadian rhythm, and it is necessary to assess hormonal changes induced by changing the time of day of the diet. Such shifts within the circadian rhythm rather than due to a particular type of diet itself are documented by changes in the circadian rhythm of cortisol.

Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder experienced by women. PCOS is a lifelong condition associated with reproductive, metabolic, and psychological presentations. PCOS is also linked with increased prevalence of cardiometabolic risk factors. While an association between body weight and PCOS has been noted, cardiometabolic risk factors are prevalent in individuals with PCOS across body weights. Currently, no consensus exists as to the most appropriate lifestyle strategy for mitigating cardiometabolic risk in PCOS. A large proportion of the literature is focused on weight loss for individuals with PCOS who are overweight or experience obesity, despite PCOS being prevalent across body sizes. The aim of this narrative review is to assess dietary and lifestyle interventions aimed at reducing cardiometabolic risk in individuals with PCOS across body sizes. A total of 51 articles are included in this review. Overall, randomized controlled trials are limited and most studies focus on weight loss, excluding individuals classified within a healthy body weight range. Studies that modified the dietary pattern without an energy deficit saw improvements in cardiometabolic risk. Thus, less restrictive dietary approaches may be effective at reducing cardiometabolic risk in this population. This review also highlights the need for more sustainable lifestyle interventions that meet the needs of individuals with PCOS of varying body weights.

Polycystic ovary syndrome: Current scenario and future insights

Polycystic ovary syndrome (PCOS) prevails in approximately 33% of females of reproductive age globally. Although the root cause of the disease is unknown, attempts are made to clinically manage the disturbed hormone levels and symptoms arising due to hyperandrogenism, a hallmark of PCOS. This review presents detailed insights on the etiology, risk factors, current treatment strategies, and challenges therein. Medicinal agents currently in clinical trials and those in the development pipeline are emphasized. The significance of the inclusion of herbal supplements in PCOS and the benefits of improved lifestyle are also explained. Last, emerging therapeutic targets for treating PCOS are elaborated. The present review will assist the research fraternity working in the concerned domain to access significant knowledge associated with PCOS.

Mediterranean diet and female reproductive health over lifespan: a systematic review and meta-analysis

OBJECTIVE

We conducted a systematic review and meta-analysis of the effects of Mediterranean diet on female reproductive health outcomes over the life-course.

DATA SOURCES

We searched PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov to identify eligible studies published till February 2022. Eligible references from identified studies and review articles were also considered.

STUDY ELIGIBILITY CRITERIA

Randomized controlled trials, prospective cohort studies, or nested case-control studies examining Mediterranean diet and major female reproductive outcomes over the lifespan, including clinical outcomes from childhood to adulthood (menarche, polycystic ovary syndrome, endometriosis, and outcomes related to fertility, pregnancy, and menopause), were included for review.

METHODS

Two independent reviewers screened and performed data extraction and risk-of-bias assessment. We performed random-effects meta-analysis to obtain summary relative risks and 95% confidence intervals for major female reproductive outcomes. Subgroup analyses were performed for several pregnancy outcomes according to timing of the interventions for randomized controlled trials and timing of the dietary assessment for observational studies.

RESULTS

Thirty-two studies (9 randomized controlled trials, 22 prospective cohort studies, and 1 nested case-control study) involving 103,204 predominantly White women (>95%) were included. The pooled relative risk (95% confidence interval) comparing randomization to Mediterranean diet vs a control diet based on 7 randomized controlled trials was 0.74 (0.55-0.99) for gestational diabetes mellitus, 0.45 (0.26-0.76) for preterm birth, 0.71 (0.51-1.00) for gestational hypertension, and 0.82 (0.54-1.22) for preeclampsia; the effect sizes for preterm birth were greater in randomized controlled trials that initiated the interventions in first trimester vs after first trimester (P heterogeneity=.02). We observed inverse associations for all the above-mentioned pregnancy outcomes based on 9 cohort studies. There was suggestive evidence of favorable associations between Mediterranean diet adherence with fertility and gestational weight management. Limited studies suggested associations between higher Mediterranean diet adherence and later time to menarche and fewer vasomotor menopausal symptoms, null associations for polycystic ovary syndrome-like phenotype and pregnancy loss, and positive associations for luteal phase deficiency.

CONCLUSION

Adherence to Mediterranean diet may lower risks of adverse pregnancy outcomes among predominantly White populations. For fertility-related outcomes, available evidence supporting potential beneficial effects is suggestive yet limited. For other reproductive outcomes across the lifespan, data remains sparse.

The effects of intermittent fasting diet alone or in combination with probiotic supplementation in comparison with calorie-restricted diet on metabolic and hormonal profile in patients with polycystic ovary syndrome: study protocol for a randomized clinical trial

INTRODUCTION

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in females characterized by ovulatory dysfunction, hyperandrogenism, and other metabolic disorders. Both intermittent fasting and specific probiotics have been suggested to help improve patients with PCOS through changes in gut microbial composition, circadian clock, and metabolic regulation. Therefore, the present study aims to investigate the effects of intermittent fasting alone or in combination with probiotic supplementation compared to the calorie-restricted (CR) diet on anthropometric measures, metabolic status, inflammation, and oxidative stress in women with PCOS.

METHODS

We will carry out a randomized clinical trial for 8 weeks. Participants will be randomly assigned (1:1:1) to one of the three groups: (1) a 14:10 early time-restricted feeding (TRF) diet with probiotic supplementation (n = 30); (2) a 14:10 early TRF diet with placebo supplementation (n = 30); (3) a CR diet (energy-restricted 25% of required calories) with placebo supplementation as a control group (n = 30). The primary outcomes will be changes in body weight and insulin resistance. However, glycemic control, lipid profile, metabolic parameters, sex hormone-binding globulin, dehydroepiandrosterone, anti-Mullerian hormone, free androgen index, hirsutism, acne, antioxidant and oxidant status, inflammation, anthropometric measures, mental health, sleep quality, appetite, eating behavior, food craving, and blood pressure are secondary outcomes. All outcomes of this study will be evaluated in pre- and post-intervention.

DISCUSSION

We hypothesized that 10-h TRE administered alone or in combination with probiotic supplementation to overweight and obese PCOS subjects would lead to weight loss and improved metabolic, hormonal, inflammatory, and antioxidant markers compared to control subjects following a standard 3-meal-per-day CR diet.

ETHICAL ASPECTS

The current trial received approval from the Medical Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (IR.TUMS.MEDICNE.REC.1401.425).

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20121110011421N5. Registered on 3 October 2022.

Endocrine factors associated with infertility in women: an updated review

INTRODUCTION

Infertility is defined as the inability to conceive after unprotected sexual intercourse for at least 12 consecutive months. Our objective is to present an updated narrative review on the endocrine causes of infertility in women.

AREAS COVERED

A comprehensive review was conducted using Scielo, Scopus, and EMBASE databases, comprising 245 articles. The pathophysiology of infertility in women was described, including endocrinopathies such as hypothalamic amenorrhea, hyperprolactinemia, polycystic ovary syndrome, primary ovarian insufficiency, obesity, thyroid dysfunction, and adrenal disorders. The diagnostic approach was outlined, emphasizing the necessity of hormonal studies and ovarian response assessments. Additionally, the treatment plan was presented, commencing with non-pharmacological interventions, encompassing the adoption of a Mediterranean diet, vitamin supplementation, moderate exercise, and maintaining a healthy weight. Subsequently, pharmacological treatment was discussed, focusing on the management of associated endocrine disorders and ovulatory dysfunction.

EXPERT OPINION

This comprehensive review highlights the impact of endocrine disorders on fertility in women, providing diagnostic and therapeutic algorithms. Despite remaining knowledge gaps that hinder more effective treatments, ongoing research and advancements show promise for improved fertility success rates within the next five years. Enhanced comprehension of the pathophysiology behind endocrine causes and the progress in genetic research will facilitate the delivery of personalized treatments, thus enhancing fertility rates.

Pathophysiology and Nutritional Approaches in Polycystic Ovary Syndrome (PCOS): A Comprehensive Review

PURPOSE OF REVIEW

Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder in women of reproductive age worldwide. This disease causes menstrual, metabolic, and biochemical abnormalities such as hyperandrogenism, oligo-anovulatory menstrual cycles, polycystic ovary, hyperleptinemia, insulin resistance (IR), and cardiometabolic disorders, often associated with overweight or obesity and visceral adiposity.

RECENT FINDINGS

The etiology and pathophysiology of PCOS are not yet fully understood, but insulin seems to play a key role in this disease. PCOS shares an inflammatory state with other chronic diseases such as obesity, type II diabetes, and cardiovascular diseases; however, recent studies have shown that a healthy nutritional approach can improve IR and metabolic and reproductive functions, representing a valid therapeutic strategy to ameliorate PCOS symptomatology. This review aimed to summarize and collect evidence about different nutritional approaches such as the Mediterranean diet (MedDiet) and the ketogenic diet (KD), as well as bariatric surgery and nutraceutical supplementation as probiotics, prebiotics, and synbiotics, among the others, used in patients with PCOS.

Glycemic Index and Glycemic Load Estimates in the Dietary Approach of Polycystic Ovary Syndrome

Polycystic ovary syndrome is a common endocrine disorder characterized by hormonal imbalances and various metabolic abnormalities linked to insulin resistance via a vicious cycle. Genetic and environmental factors underlie its pathogenesis and evolution. Nutrition, in terms of nutrient composition, dietary patterns, endocrine-disrupting chemicals, and food processing and preparation, has gained significant attention in the pathogenesis and the therapeutic approach of polycystic ovary syndrome. Carbohydrate intake seems to be a critical point in the diet assignment. Glycemic index and glycemic load constitute indexes of the impacts of dietary carbohydrates on postprandial glucose levels. Numerous studies have indicated that a high glycemic index and glycemic load diet may exacerbate insulin resistance, a key feature of the syndrome, and offer a risk for its development and its complications. Conversely, low-glycemic index and low-glycemic load diets seem to improve insulin sensitivity, regulate menstrual cycles, and mitigate the risk of comorbidities associated with polycystic ovary syndrome, such as obesity, alterations in body composition, type 2 diabetes, cardiovascular disease, and quality of life. This comprehensive review aims to explore the relevance of nutrition and more specifically, the association of glycemic index and glycemic load with the various aspects of polycystic ovary syndrome, as well as to assess the potential benefits of manipulating those indexes in the dietary approach for the syndrome.

The Effects of Plant-Derived Phytochemical Compounds and Phytochemical-Rich Diets on Females with Polycystic Ovarian Syndrome: A Scoping Review of Clinical Trials

Polycystic ovarian syndrome (PCOS) is an endocrine condition that impacts nutritional status, metabolic, and hormonal function in females of reproductive age. This condition is associated with increased androgen production (hyperandrogenism) and decreased insulin sensitivity, which often leads to insulin resistance and hyperinsulinemia. This increase in androgen production and insulin resistance is strongly associated with a high incidence of obesity, type-2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and certain types of gonad-related cancers among females who suffer from this condition. As research continues to grow, it has been demonstrated that PCOS is a complex condition, and some of its characteristics vary among the females that have this disorder. However, it has been suggested that oxidative stress and low-grade chronic inflammation could play an important role in the development of PCOS. Current evidence suggest that phytochemicals could potentially help with weight-loss by reducing oxidative stress and low-grade inflammation, as well as aid in metabolic and hormonal regulation due to their antioxidant properties. Some of the bioactive compounds found in plants that have shown positive effects in the attenuation of PCOS include flavonoids, polyphenols, phytoestrogen, and polyunsaturated fatty acids (PUFAs). Thus, a review of the current literature published on PCOS and phytochemicals was conducted in PubMed, Google Scholar, and the Academy of Nutrition and Dietetics databases for articles published between 2013 and 2023 with a study duration of 1 to 3 months and adequate sample sizes. The main purpose of this review of literature was to investigate the metabolic effects of phytochemical compounds and phytochemical-rich diets on females with PCOS by comparing the results of several randomized clinical trials.

The PCOS puzzle: putting the pieces together for optimal care

Polycystic ovary syndrome (PCOS) is a multifaceted hormonal disorder that has significant ramifications for both women's reproductive and metabolic well-being. This analysis aims to offer a thorough comprehension of PCOS by investigating the various contributing factors that are crucial for its effective management. We delve into the topic of hormonal imbalances, such as elevated androgens and disrupted estrogen-progesterone dynamics, and their effects on reproductive and metabolic health. Furthermore, we explore the intricate connection between insulin resistance, hyperinsulinemia, and PCOS, highlighting their pivotal role in metabolic dysfunction. Additionally, we examine fertility challenges, irregular menstrual patterns, and metabolic complications while also reviewing current treatment methodologies. Moreover, we address the latest research concerning genetic, environmental, and epigenetic influences on PCOS. By piecing together these essential elements, healthcare professionals can attain a comprehensive understanding of PCOS and deliver optimal care for those affected by the condition.

Ziziphus mauritiana Leaves Normalize Hormonal Profile and Total Cholesterol in Polycystic Ovarian Syndrome Rats

In the present study, the beneficial effect of leaves of Ziziphus mauritiana on testosterone, estradiol, progesterone, LH hormones, blood glucose, and total cholesterol levels in the experimentally induced polycystic ovaries of female Sprague Dawley rats were evaluated. Letrozole was used to induce PCOS in rats, and clomiphene citrate was used as a standard control. This study was carried out in vivo on 30 female rats where group I received normal saline and group II to V were treated with letrozole (1 mg/kg/day), which was dissolved in normal saline orally for 21 days to induce PCOS. After PCOS induction, test groups III and IV were orally treated with ZMME at a dose of 100 mg/kg and 200 mg/kg for 14 days, respectively, and group V was treated with clomiphene citrate (2 mg/kg) orally for 14 days. At the end of the experimental period, the animals were sacrificed by cervical dislocation, and blood samples were collected by cardiac puncture. After blood collection, the ovaries were removed and weighed. The results showed that Ziziphus mauritiana normalized all hormones and total cholesterol levels. The HPTLC profile showed the presence of gallic acid, rutin, quercetin, and ursolic acid. Many studies have reported that quercetin is effective against PCOS and its complications; it suppresses insulin resistance and reduces testosterone and LH levels. The present study showed an improvement in the inflammatory microenvironment of the ovarian tissue in the PCOS rat model. This research concluded that the leaves of Ziziphus mauritiana have potential efficacy in the treatment of PCOS by normalizing abnormal hormones and total cholesterol levels, which could be due to the presence of quercetin in the leaves.

New Insights and Potential Therapeutic Interventions in Metabolic Diseases

Endocrine homeostasis and metabolic diseases have been the subject of extensive research in recent years. The development of new techniques and insights has led to a deeper understanding of the mechanisms underlying these conditions and opened up new avenues for diagnosis and treatment. In this review, we discussed the rise of metabolic diseases, especially in Western countries, the genetical, psychological, and behavioral basis of metabolic diseases, the role of nutrition and physical activity in the development of metabolic diseases, the role of single-cell transcriptomics, gut microbiota, epigenetics, advanced imaging techniques, and cell-based therapies in metabolic diseases. Finally, practical applications derived from this information are made.

Effect of High Fat Diet on Disease Development of Polycystic Ovary Syndrome and Lifestyle Intervention Strategies

Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder that affects premenopausal women. The etiology of PCOS is multifaceted, involving various genetic and epigenetic factors, hypothalamic-pituitary-ovarian dysfunction, androgen excess, insulin resistance, and adipose-related mechanisms. High-fat diets (HFDs) has been linked to the development of metabolic disorders and weight gain, exacerbating obesity and impairing the function of the hypothalamic-pituitary-ovarian axis. This results in increased insulin resistance, hyperinsulinemia, and the release of inflammatory adipokines, leading to heightened fat synthesis and reduced fat breakdown, thereby worsening the metabolic and reproductive consequences of PCOS. Effective management of PCOS requires lifestyle interventions such as dietary modifications, weight loss, physical activity, and psychological well-being, as well as medical or surgical interventions in some cases. This article systematically examines the pathological basis of PCOS and the influence of HFDs on its development, with the aim of raising awareness of the connection between diet and reproductive health, providing a robust approach to lifestyle interventions, and serving as a reference for the development of targeted drug treatments.

Physical exercise alleviates oxidative stress in brown adipose tissue and causes changes in body composition and nutritional behavior in rats with polycystic ovary syndrome

AIM

Polycystic Ovary Syndrome (PCOS) is a very common endocrine disorder in women. We investigate the effect of physical exercise on body composition, nutritional parameters, and oxidative stress in rats with PCOS.

METHODS

Female rats were into three groups: Control, PCOS, and PCOS + Exercise. PCOS was induced by letrozole (1 mg/kg via p.o.) for 21 days consecutively. Physical exercise was swimming, for 21 consecutive days, 1 h/day with 5 % load. In all groups, we assessed the nutritional and murinometric parameters, body composition, thermography, and oxidative stress in brown adipose tissue (BAT) and peri-ovarian adipose tissue (POAT).

KEY FINDINGS

In PCOS we observed an increase (P < 0.05) in body weight vs. the Control group. But, the PCOS + Exercise group prevent this weight gain (P < 0.05). The temperature in BAT, decrease (P < 0.05) in the PCOS group vs. Control group. PCOS + Exercise prevented this reduction (P < 0.05) in BAT temperature vs. PCOS groups. We observed decreases (P < 0.05) in Lee Index and BMI in POS + Exercise vs. PCOS group. In PCOS rats, we observed an increase (P < 0.05) in murinometric (SRWG, EI, and FE) and body composition parameters (TWB, ECF, ICF, and FFM) vs. the Control group. The PCOS + Exercise prevents (P < 0.05) these changes in all groups, compared with PCOS. Regarding the BAT, we observe an increase (P < 0.05) in MPO and MDA levels in the PCOS vs. Control group. PCOS + Exercise prevents (P < 0.05) these increases vs. the PCOS group.

SIGNIFICANCE

PCOS modifies body composition, and nutritional parameters, and induces changes in oxidative stress in BAT. Physical exercise prevented these alterations.

Adherence to the Mediterranean Diet in Women and Reproductive Health across the Lifespan: A Narrative Review

The Mediterranean diet (MD) has been previously proven to have various health-related benefits; however, its effect on women's reproductive health over a lifespan is yet to be summarized. This study aimed to summarize the evidence-based knowledge regarding the association between the MD and selected reproductive health outcomes. By searching PubMed, ScienceDirect, and Google Scholar databases, as well as reference lists, 21 studies were included in this narrative review. The available evidence was very limited; however, there is some suggestion that higher adherence to the MD may be positively associated with a lower risk of early age menarche (1 study) and shorter menstrual cycles (1 study), but is unrelated to dysmenorrhea (1 study). Moreover, no study to date has examined the relationship between the MD and the onset age of natural menopause. Considering reproductive health diseases, there was limited evidence that a higher adherence to the MD was associated with a lower risk of premenstrual syndrome (1 study), an improvement in sexual health and a lower prevalence of sexual dysfunction (3 studies), and an improvement in the general condition of with endometriosis and the pain they can experience (1 study). The largest number of studies were found for polycystic ovarian syndrome (PCOS; 7 studies) and infertility (6 studies). Results showed that a higher adherence to the MD was associated with a lower risk of infertility, while results for PCOS were unclear, but mostly indicated a beneficial trend. Further investigations are necessary to establish the role of adherence to the MD in reproductive health maintenance and its possible role in the prevention and treatment of reproductive health diseases in women.

Liraglutide and polycystic ovary syndrome: is it only a matter of body weight?

Despite Polycystic Ovary Syndrome (PCOS) is a very prevalent disorder among women of reproductive age, there is widespread agreement that until now, no pharmacological options are available to tackle the entire spectrum of clinical manifestations encountered in the clinical practice. Obesity and insulin resistance, which commonly characterized this syndrome, prompted the design of studies investigating the effects of glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RA) in PCOS. Indeed, a very impressive number of randomized controlled clinical trials (RCTs) and systematic reviews provided robust evidence on the effectiveness of GLP-1RA in PCOS as a new, appealing approach, producing both satisfactory and permanent weight loss, and improvement of insulin resistance at the same time. However, most of the subjects included in the RCTs are PCOS patients with obesity/overweight, whereas a portion of PCOS women, which can even reach 50%, might present a lean phenotype. Moreover, some benefits on clinical and metabolic features of PCOS may not have fully emerged due to the low or medium doses employed in the vast majority of the current studies. Thus, pitfalls in the methodology of these studies have led sometimes to misleading results. In addition, some aspects of GLP-1 beyond weight loss, such as preclinical evidence on GLP-1 effects in directly modulating the hypothalamus-pituitary-gonadal axis, or the effects of GLP-1RA on clinical and biochemical expression of hyperandrogenism, still deserve a greater insight, especially in light of a possible therapeutic use in PCOS women independently of obesity. Aim of this review is to further unravel the possible role of GLP-1 in PCOS pathogenesis, tempting to provide additional supports to the rationale of treatment with GLP-1RA in the management of PCOS also independent of weight loss. For this purpose, the outcomes of RCTs investigating in PCOS the anthropometric and metabolic changes have been treated separately to better underpin the effects of GLP-1 RA, in particular liraglutide, beyond weight loss.

n-3 PUFA Promotes Ferroptosis in PCOS GCs by Inhibiting YAP1 through Activation of the Hippo Pathway

Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by hyperandrogenemia with multiple suspended sinus follicles, thickened cortical tissue, and excessive proliferation of ovarian granulosa cells that severely affects the fertility and quality of life of women. The addition of n-3 PUFA to the diet may slightly reduce body weight and greatly alleviate disturbed blood hormone levels in PCOS mice. We treated KGN as a cell model for n-3 PUFA addition and showed that n-3 PUFA inhibited the proliferation of GCs and promoted ferroptosis in ovarian granulosa cells. We used CCK-8, fluorescence quantitative transmission electron microscopy experiments and ferroptosis marker gene detection and other methods. Furthermore, n-3 PUFA was found to promote YAP1 exocytosis by activating Hippo and weakening the cross-talk between YAP1 and Nrf2 by activating the Hippo signaling pathway. In this study, we found that n-3 PUFA inhibited the over proliferation of granulosa cells in ovarian follicles by activating Hippo, promoting YAP1 exocytosis, weakening the cross-talk between YAP1 and Nrf2, and ultimately activating the ferroptosis sensitivity of ovarian granulosa cells. We demonstrate that n-3 PUFA can alleviate the hormonal and estrous cycle disorder with PCOS by inhibiting the YAP1-Nrf2 crosstalk that suppresses over proliferating ovarian granulosa cells and promotes iron death in GCs. These findings reveal the molecular mechanisms by which n-3 PUFA attenuates PCOS and identify YAP1-Nrf2 as a potential therapeutic target for regulation granulosa cells in PCOS.

Molecular mechanism of modified Huanglian Wendan decoction in the treatment of polycystic ovary syndrome

To investigate the mechanism of modified Huanglian Wendan decoction in the intervention of polycystic ovary syndrome (PCOS) by network pharmacology and molecular docking. The ingredients and targets of modified Huanglian Wendan decoction were retrieved from the traditional Chinese medicine Systems Pharmacology database. Related targets of PCOS were screened by Comparative Toxicogenomics Database database. Cytoscape 3.7.2 (https://cytoscape.org/) was used to draw the target network diagram of "traditional Chinese medicine - ingredient - PCOS," STRING database was used to construct the target protein interaction network. NCA tool of Cystoscape 3.7.2 was used to carried out topology analysis on PPI network, core components and key targets were obtained. Gene ontology and Kyoto encyclopedia of genes and genomes enrichment analysis were carried out for the intersection targets by David database. AutoDockTools 1.5.6 software (https://autodock.scripps.edu/) was used to conduct molecular docking verification of key components and key targets. Ninety-one ingredients of the modified Huanglian Wendan decoction and 23,075 diseases targets were obtained, 155 Intersection targets of the drug and disease were obtained by R language, Veen plot was drawn. Gene ontology enrichment analysis obtained 432 biological processes, 67 cell components, 106 molecular functions. Fifty-four Kyoto encyclopedia of genes and genomes enrichment pathways (P < .05) including tumor necrosis factor, hypoxia-induced factors-1, calcium, and drug metabolism-cytochrome P450 signaling pathway. Molecular docking showed quercetin, luteolin, kaempferol, and baicalein were stable in docking with core targets. Network pharmacology and molecular docking were used to preliminarily study the mechanism of action of modified Huanglian Wendan decoction in the treatment of PCOS, which laid foundation for future experimental research and clinical application.

Short-time effects of ketogenic diet or modestly hypocaloric Mediterranean diet on overweight and obese women with polycystic ovary syndrome

INTRODUCTION

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during reproductive age. It is characterized clinically by oligo-ovulation or anovulation, hyper-androgenism, and the presence of polycystic ovaries. Often comorbid with insulin resistance, dyslipidemia, and obesity, it also carries significant risk for the development of cardio-vascular and metabolic sequelae, including diabetes and metabolic syndrome. In light of these evidences, the most therapeutic option prescribed to PCOS women with obesity, regardless of the phenotype from the severity of clinical expression, is lifestyle correction by diet and physical activity.

PURPOSE

The aim of this study was to evaluate the association between PCOS with KD in overweight and/or obese women with PCOS, and evaluate the possible beneficial effects on metabolic and endocrine parameters, compared to a standard, balanced hypocaloric diet such as Mediterranean diet (MD).

METHODS

Participants were assigned to receive, in a 1:1 ratio, one of the two following dietary sequences: KD or MD. In all subjects anthropometric parameters, body composition and metabolic and endocrine parameters were obtained at baseline and after dietetic treatment.

RESULTS

Our results showed a significant change in the anthropometric and biochemical parameters in both groups after both diet therapies, with statistically significant differences (p < 0.001). Though, the reductions of all parameters were significantly greater in KD group than in MD group.

CONCLUSION

Our results suggest that a reduction of dietary intake of carbohydrates by KD may be considered as a valuable non-pharmacological treatment for PCOS.

A PCOS Paradox: Does Inositol Therapy Find a Rationale in All the Different Phenotypes?

A recent evaluation of the published data regarding the PCOS topic has highlighted a paradox in the definition of this condition. Even though the name of the syndrome refers to ovarian dysfunction, it seems that patients diagnosed with PCOS are more likely affected by an endocrine and metabolic issue. The term PCOS might not be appropriate to indicate the phenotypes described by the Rotterdam criteria, since the only phenotype with a gynecological issue alone is PCOS phenotype D. This novel perspective regarding how PCOS is currently defined leads the way to a reinterpretation of the entire pathological context and the treatment prescribed, such as inositols. A new point of view on the etiopathogenesis of the disease completely changes the current meaning of PCOS and consequently the therapeutic rationale evaluated to date.

Diet and Exercise in the Management of Polycystic Ovary Syndrome: Practical Considerations for Person-Centered Care

Polycystic ovary syndrome (PCOS) is a complex multisystem condition associated with life-long reproductive, metabolic, and psychological symptoms. Individuals with PCOS are at an increased risk of cardiovascular disease and type 2 diabetes, with approximately 70% of all PCOS cases presenting with insulin resistance. Lifestyle interventions have historically been recommended as first-line therapies for the management of PCOS-related cardiometabolic disorders. The term "lifestyle management" incorporates a multifaceted approach to dietary, exercise, and behavioral strategies, aiming to promote a healthy lifestyle. This approach has been commonly employed in practice, in particular through exercise and dietary modulation, due to its effect on cardiometabolic outcomes as well as its tolerability. Furthermore, there is evidence to suggest that combining dietary change with exercise may yield the greatest improvements in clinical outcomes. However, such practices require careful consideration and coordination, as there are instances where certain exercise and/or dietary prescriptions may compromise the effectiveness of the respective interventions. Thus, this review aims to provide practical guidance on diet and exercise planning in the routine care of PCOS. Such recommendations include emphasizing realistic and achievable goals, as well as minimizing barriers to lifestyle changes in order to increase the long-term sustainability of this treatment strategy.

Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS)

PURPOSE OF REVIEW

The polycystic ovary syndrome (PCOS) is an endocrine dysfunction associated with a myriad of metabolic disorders and high rate of infertility. In order to aid its management, several lifestyle/dietary interventions have been evaluated. Very low-calorie ketogenic diet (VLCKD) is rapidly showing promising benefits not only in obesity but also in the treatment of other metabolic diseases. The main objective of this review is to assess the scientific evidence in support of this dietary pattern as an effective measure for treating PCOS and the metabolic disorders associated with it.

RECENT FINDINGS

Preliminary data suggested significant improvements in body weight and composition, metabolic profile (glucose, serum insulin, triglycerides, total and low-density lipoprotein cholesterol), and insulin resistance following VLCKD. However, the evidence is still scarce and needs to be more substantiated. Weight reduction in women with PCOS has been shown to improve metabolic derangements and body composition, but there is no consensus on the ideal dietary pattern or macronutrient composition. There is some evidence supporting the possible role of the Mediterranean diet in improving infertility (along with other well-known metabolic benefits) in women with PCOS. Of note, VLCKD might be considered a potential intervention for the short-term treatment of PCOS, but it must be prescribed and carefully guided by professionals.

The Effect on Inflammation of Adherence to the Mediterranean Diet in Polycystic Ovary Syndrome

PURPOSE OF REVIEW

Polycystic ovary syndrome (PCOS), which is common in women of reproductive age worldwide, is a syndrome that reduces the lifelong quality of life and poses a significant risk for various diseases. PCOS is a combination of symptoms of hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology (PCOM). In PCOS, which is characterized by chronic low-grade inflammation, some inflammatory cytokines are increased. This review aimed to explain possible mechanisms of inflammation in PCOS and the effects of Mediterranean diet components on reducing this inflammation.

RECENT FINDINGS

Although the exact mechanisms of inflammation in PCOS are not yet fully known, it is stated that it is mediated by obesity, insulin resistance, and high androgen concentration. This inflammatory state negatively impacts the risk of future health problems and the quality of life of PCOS. Therefore, strategies to reduce inflammation are thought to be important. Dietary adjustments have important effects in reducing this inflammation and preventing disease. At this point, the Mediterranean diet, which has been proven to have a protective effect against many diseases, draws attention. Among the components of the Mediterranean diet, especially omega-3, antioxidants and dietary fiber may contribute to the reduction of inflammation through different mechanisms. PCOS is characterized by chronic low-grade inflammation, which increases women's risk of health problems, both now and in the future. Reducing inflammation is therefore extremely important, and it can be achieved with adherence to the Mediterranean diet. Inflammation pathways and the effect of the components of the Mediterranean diet in PCOS. AGE, advanced glycation end products; NF-κB, nuclear factor kappa-B. Obesity, insulin resistance, and hyperandrogenism may cause inflammation in PCOS through different mechanisms. Antioxidants, omega-3, and dietary fiber, which are the main components of the Mediterranean diet, may be effective in reducing this inflammation in PCOS. (Created with BioRender.com).

The Influence of Metabolic Factors and Diet on Fertility

Infertility is a disease globally affecting 20-30% of the reproductive age female population. However, in up to 50% on recorded cases, problems with infertility are ascribed to men; therefore, it is important to popularize healthy eating also in this group. During the last decade, it has been observed that society's lifestyle changed drastically: reduced energy expenditure in physical activity per day, increased consumption of hypercaloric and high-glycemic-index foods with high content of trans fats, and reduced consumption of dietary fiber, which negatively affects fertility. Increasing evidence points to a link between diet and fertility. It is becoming clear that well-planned nutrition can also contribute to the effectiveness of ART. The low-GI plant-based diet appears to have a positive effect, especially when it is based on Mediterranean dietary patterns: rich in antioxidants, vegetable protein, fiber, MUFA fatty acids, omega-3, vitamins, and minerals. Importantly, this diet has been shown to protect against chronic diseases associated with oxidative stress, which also translates into pregnancy success. As lifestyle and nutrition seem to be important factors affecting fertility, it is worth expanding knowledge in this regard among couples trying to conceive a child.

Exposure to bisphenol A and its analogs and polycystic ovarian syndrome in women of childbearing age: A multicenter case-control study

BACKGROUND/OBJECTIVES

In recent years, the reproductive toxicity of new bisphenol analogs has garnered much interest, but it remains to be determined whether bisphenol analogs affect polycystic ovarian syndrome (PCOS).

METHODS

This study utilized data from a multicenter hospital-based case-control study conducted in 2014-2016 to examine the association between endocrine-disrupting chemicals and infertility in China. 321 PCOS cases and 412 controls were included in the current analysis. We quantified seven bisphenol analogs in urine samples, including bisphenol A (BPA), bisphenol AP (BPAP), bisphenol AF (BPAF), bisphenol B (BPB), bisphenol S (BPS), bisphenol P (BPP), and bisphenol Z (BPZ). Spearman correlation and generalized linear regression were used in assessing the relationship between bisphenol analogs and hormonal parameters. To examine the association of bisphenol analogs with odds of PCOS, multiple logistic regression, and two multi-pollutant models [quantile-based g-computation (QGC) and extreme gradient boosting (XGBoost) methods] were used.

RESULTS

After covariates adjustment, BPA, BPS, and BPAF were positively correlated with testosterone (T) in the control group (P < 0.05). Dose-response relationships were discovered between BPA, BPS, BPZ, and BPAF quartiles and PCOS. Mixed exposure to seven bisphenol analogs was found to be positively associated with the odds of PCOS (adjusted odds ratio = 1.26; 1.12-1.45), which was primarily driven by BPS (weight = 0.51), BPZ (weight = 0.26), and BPAF (weight = 0.23). Women who were overweight or obese tended to have a stronger association between bisphenol analogs and PCOS than normal-weight women.

CONCLUSIONS

Environmental exposure to bisphenol analogs was associated with increased odds of PCOS in this case-control study. This association was stronger among obese and overweight women.

Lower Fiber Consumption in Women with Polycystic Ovary Syndrome: A Meta-Analysis of Observational Studies

Polycystic ovary syndrome is a common endocrine disorder associated with metabolic abnormalities and gut microbiota dysbiosis. The deficiency of dietary fiber, a crucial nutrient in the daily diet, is also associated with a wide range of metabolic and reproductive abnormalities, as well as an altered gut microbial ecosystem. This study is a meta-analysis to summarize the available evidence on the dietary fiber intake level in PCOS patients. Databases of PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched for observational studies, and 13 studies were finally included. The pooled standardized mean difference (SMD) with the 95% confidence interval (CI) of daily dietary fiber intake and total energy intake were calculated using the random-effects model. The pooled result (12 studies) on absolute dietary fiber intake showed that while there was no significant difference in the total energy intake [−0.17 (−0.44, 0.09), p = 0.208], the dietary fiber intake was significantly lower in PCOS women than those of controls [−0.32 (−0.50, −0.14), p < 0.001]. However, significant heterogeneity was detected across the studies (I2 = 65.6%, p = 0.001). Meta-regression suggested that geographic region and dietary assessment method may confer borderline significance of influence on the heterogeneity. The pooled result (two studies) on dietary fiber intake which adjusted for total energy intake, however, showed no significant difference [−2.11 (−4.77, 0.56), p = 0.122]. In subgroup analyses based on absolute dietary fiber intake, a lower dietary fiber intake in PCOS was observed in studies conducted in Asia, adopted food diary or records or food recall as the dietary assessment method, had a case−control study design, or used Rotterdam criteria for PCOS diagnosis. The difference in SMD was still significant in the adult subgroup or in studies matched or unmatched for age.

Phase angle (PhA) in overweight and obesity: evidence of applicability from diagnosis to weight changes in obesity treatment

Phase angle (PhA) is a recently proposed marker of nutritional status in many clinical conditions. Its use in patients with obesity presents different critical concerns due to the higher variability of the two measured parameters (resistance, R, and reactance, Xc) that contribute to the determination of PhA. Controversial is the relation between PhA and BMI that might vary with graded levels of obesity due to the variation in fat and free fat mass. Obesity is frequently associated with metabolic, hepatic, cardiovascular and kidney diseases that introduce variations in PhA values, in relation to multimorbidity and severity degree of these diseases. It is reported that the improvement of clinical condition is associated with a positive change in PhA. Also, the treatment of obesity with weight loss might confirm this effect, but with different responses in relation to the type and duration of the intervention applied. In fact, the effect appears not only related to the percentage of weight loss but also the possible loss of free fat mass and the nutritional, metabolic and structural modifications that might follow each therapeutic approach to decrease body weight. We can conclude that the PhA could be used as marker of health status in patients with obesity supporting an appropriate weight loss intervention to monitor efficacy and fat free mass preservation.

Mediterranean Diet and Obesity-related Disorders: What is the Evidence?

PURPOSE OF REVIEW

Obesity is a chronic disease, a major public health problem due to its association with non-communicable diseases and all-cause mortality. Indeed, people with obesity are at increased risk for a variety of obesity-related disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease, and several cancers. Many popular diets with very different macronutrient composition, including the Mediterranean diet (MD), have been used, proposed, and studied for prevention and management of obesity. In particular, MD has been the subject of countless studies over the years and now boasts a large body of scientific literature. In this review, we aimed to update current knowledge by summarizing the most recent evidence on the effect of MD on obesity and obesity-related disorders.

RECENT FINDINGS

The negative effects of obesity are partly reversed by substantial weight loss that can be achieved with MD, especially when low-calorie and in combination with adequate physical activity. In addition, the composition of MD has been correlated with an excellent effect on reducing dyslipidemia. It also positively modulates the gut microbiota and immune system, significantly decreasing inflammatory mediators, a common ground for many obesity-related disorders. People with obesity are at increased risk for a variety of medical disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. Therefore, there is an inevitable need for measures to manage obesity and its related disorders. At this point, MD has been proposed as a valuable nutritional intervention. It is characterized by a high consumption of vegetables, fruit, nuts, cereals, whole grains, and extra virgin olive oil, as well as a moderate consumption of fish and poultry, and a limited intake of sweets, red meat, and dairy products. MD proves to be the healthiest dietary pattern available to tackle obesity and prevent several non-communicable diseases, including cardiovascular disease and type 2 diabetes.

Chronotype and Sleep Quality in Obesity: How Do They Change After Menopause?

PURPOSE OF REVIEW

This review primarily provides an overview of the current evidence on chronotype (which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-h period) and sleep quality changes in obesity in postmenopausal women. It also explores possible nutritional strategies to manage these changes in this phase of a woman's life.

RECENT FINDINGS

Menopause is a life stage frequently associated with sleep disturbances and changes in circadian rhythms. Sleep disturbances are one of the main symptoms of menopause and are caused by several factors such as hormonal changes, obesity, and melatonin reduction. In addition, the chronotype also changes following menopause. Nutritional strategies are essential because they could help manage menopausal sleep disturbances and circadian misalignment, particularly by tackling obesity and overweight. In the management of postmenopausal women, especially those experiencing obesity, careful assessment of sleep disturbances and chronotype and subsequent development of the most appropriate treatment, including nutritional management, should be part of the treatment routine.

The association between serum fatty acids and pregnancy in PCOS women undergoing ovulation induction

BACKGROUND

Long-term dietary fat intake is thought to affect metabolism and pregnancy of polycystic ovary syndrome (PCOS) patients, and the type of fatty acids one consumes plays an important role. Previous studies mostly used questionnaires to analyze the type and proportion of fatty acids.

METHODS

This prospective study included 91 PCOS patients. Serum fatty acids were measured by the gas chromatograph-mass spectrometry method before ovulation induction. We compared the fatty acids between the pregnancy group and the nonpregnancy group and explored the influence of the fatty acids on live births and pregnancy loss.

RESULTS

Nervonic acid was lower in the pregnancy group than in the nonpregnancy group (0.25% vs. 0.30%, p = .017). The following trans-fatty acids were significantly lower in the pregnancy group than in the nonpregnancy group: trans-10-heptadecenoic acid, trans-vaccenic acid, trans-11-eicosenoic acid, and brassidic acid. The level of polyunsaturated fatty acids in the live birth group was significantly higher than the pregnancy loss group (16.95% vs. 15.10%, p = .039). Among individual PUFAs, the levels of linoleic acid (p = .043), docosapentaenoic acid (p = .024), alpha-linolenic acid (p = .042), and eicosapentaenoic acid (p = .035) were higher in the live birth group than in the pregnancy loss group. After adjusting for infertility duration, age, and body mass index, our findings suggested an inverse association between pregnancy and nervonic acid, trans-10-heptadecenoic acid, trans-vaccenic acid, trans-11-eicosenoic acid, and brassidic acid and pregnancy.

CONCLUSIONS

Our findings indicate that polyunsaturated fatty acids are associated with live birth in PCOS patients. Serum trans-fatty acids and nervonic acid might be risk factors for nonpregnancy. The mechanism of the influence of different fatty acids on pregnancy and live birth merits further exploration.

An overview on effects of micronutrients and macronutrients interventions in management of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the common endocrinopathies among women. Changing dietary behaviors for PCOS management has been an important research focus during the last decades. This review has discussed current evidence and clinical trial studies relating to the impact of macronutrients and micronutrients in the management of different clinical feature of PCOS. The possible relationship between the quality and quantity of micronutrients and macronutrients and PCOS as well as the necessity to manage PCOS as a complex condition highlights the importance of diet-related interventions. The growing number of clinical trials related to the effect of micronutrients (zinc, chromium, selenium, vitamin D, inositol, and vitamin E) and macronutrients interventions (manipulation of fat, carbohydrate, protein, and MedDiet, Calorie restriction, Low Glycemic Diet) have been demonstrated to be practical approaches for managing clinical and biochemical features of PCOS, however the potential benefit of micronutrient and macronutrient approaches could be different from one by one, particularly in different phenotypes of PCOS. To achieve optimum outcomes, providing information regarding safety and the best dose selection of micronutrients and macronutrients is necessary. Hence, to better understand the approaches' risk/benefit in women with PCOS, future trials with a large sample size are recommended.

Assessment of Eating Disorders and Eating Behavior to Improve Treatment Outcomes in Women with Polycystic Ovary Syndrome

The essential role of the frequent coexistence of mental disorders and polycystic ovary syndrome (PCOS) is being increasingly recognized in the management of PCOS patients since it influences the success of weight loss interventions. Patients frequently experience disrupted eating behaviors, evidenced by the high prevalence of eating disorders in this population. Therefore, assessment and potential modification of eating disorders and eating-related behavior might be especially relevant to improve obesity treatment outcomes in this population, which remains the most efficient causal treatment in PCOS patients with high metabolic risk. Following a literature overview on common eating disorders and eating behaviors in PCOS, the aim of this review was to explore the prevalence and underlying mechanisms behind those occurrences. Understanding the clinical relevance of those associations and the addition of the assessments of eating disorders as well as eating phenotypes, eating chronotypes, and eating content as essential determinants of eating behavior could aid in the successful management of women with PCOS. In addition, the review also covers the potential of using eating disorders and eating behavior as a tool for the personalization of obesity treatment in PCOS.

Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women

BACKGROUND

Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality.

OBJECTIVE AND RATIONALE

We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population.

SEARCH METHODS

Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS).

OUTCOMES

Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: -21.46, 95% CI: -41.03 to -1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: -1.08, 95% CI: -2.19 to -0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: -0.95, 95% CI: -1.67 to 0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: -0.38, 95% CI: -0.72 to 0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses.

WIDER IMPLICATIONS

Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.

Sodium-glucose cotransporter 2 inhibitor ameliorates high fat diet-induced hypothalamic-pituitary-ovarian axis disorders

High-fat diet (HFD) consumption is known to be associated with ovulatory disorders among women of reproductive age. Previous studies in animal models suggest that HFD-induced microglia activation contributes to hypothalamic inflammation. This causes the dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis, leading to subfertility. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of lipid-soluble antidiabetic drugs that target primarily the early proximal tubules in kidney. Recent evidence revealed an additional expression site of SGLT2 in the central nervous system (CNS), indicating a promising role of SGLT2 inhibitors in the CNS. In type 2 diabetes patients and rodent models, SGLT2 inhibitors exhibit neuroprotective properties through reduction of oxidative stress, alleviation of cerebral atherosclerosis and suppression of microglia-induced neuroinflammation. Furthermore, clinical observations in patients with polycystic ovary syndrome (PCOS) demonstrated that SGLT2 inhibitors ameliorated patient anthropometric parameters, body composition and insulin resistance. Therefore, it is of importance to explore the central mechanism of SGLT2 inhibitors in the recovery of reproductive function in patients with PCOS and obesity. Here, we review the hypothalamic inflammatory mechanisms of HFD-induced microglial activation, with a focus on the clinical utility and possible mechanism of SGLT2 inhibitors in promoting reproductive fitness.

Selenium supplementation for polycystic ovary syndrome: a meta-analysis of randomized controlled trials

Introduction: The efficacy of selenium supplementation was elusive for polycystic ovary syndrome. This meta-analysis aimed to explore the efficacy of selenium supplementation for polycystic ovary syndrome. Methods: PubMed, EMbase, Web of science, EBSCO, Cochrane library database, CNKI, Chongqing VIP database and Wanfang databases have been searched through July 2022 and we included randomized controlled trials (RCTs) reporting the effect of selenium supplementation versus placebo in patients with polycystic ovary syndrome. Results: Five RCTs were included in the meta-analysis. Compared with placebo group for polycystic ovary syndrome, selenium supplementation was associated with significantly reduced total testosterone (SMD=-0.42; 95% CI=-0.78 to -0.06; p = 0.02) and cholesterol (SMD=-0.71; 95% CI=-1.41 to -0.02; p = 0.04), but revealed no remarkable influence on SHBG (SMD=-0.52; 95% CI=-1.29 to 0.25; p = 0.19), triglyceride (SMD=-1.45; 95% CI=-3.62 to 0.73; p = 0.19), LDL (SMD=-0.17; 95% CI=-0.72 to 0.37; p = 0.53), FPG (SMD=-0.95; 95% CI=-3.72 to 1.82; p = 0.50) or HOMA-IR (SMD=-0.51; 95% CI=-3.79 to 2.77; p = 0.76). Conclusions: Selenium supplementation may be able to improve the metabolic response for polycystic ovary syndrome, and this finding should be interpreted with caution.

The Role of Individually Selected Diets in Obese Women with PCOS-A Review

Polycystic ovarian syndrome (PCOS) is one of the most common heterogeneous endocrine and metabolic disorders in premenopausal women. It is a complex multifactorial disorder with strong epigenetic and environmental influences, including factors related to eating habits and lifestyle. There is a close relationship between obesity and PCOS. Weight gain and obesity are often clinical symptoms manifested by biochemical markers. Moreover, abdominal obesity in women with PCOS is involved in the development of inflammatory changes. A significant share of balanced therapies correcting the lifestyle of patients is suggested, e.g., with the implementation of appropriate diets to minimize exposure to inflammatory factors and prevent abnormal immune system stimulation. In the case of obese patients with PCOS, planning a diet program and supporting the motivation to change eating habits play an important role to lose weight and lower BMI. Probiotics/synbiotic supplementation may enhance weight loss during the diet program and additionally positively affect metabolic and inflammatory factors by improving the intestinal microbiome.

Italian Ketogenic Mediterranean Diet in Overweight and Obese Patients with Prediabetes or Type 2 Diabetes

Obesity is a multifactorial disease strongly associated with insulin resistance and/or type 2 diabetes mellitus. Correct nutrition represents a valid strategy to fight these dysmetabolic pathologies responsible for numerous diseases, including inflammatory and cardiovascular ones. Medical nutrition therapy, including a Mediterranean diet (MD) and a very low-calorie ketogenic diet (VLKCD), is the first-line treatment for prediabetes/diabetes and overweight/obesity. Eighty patients (forty women and forty men) affected by overweight/obesity and type 2 diabetes mellitus or impaired glucose tolerance or impaired fasting glucose (51 (ys) ± 1.75; BMI (kg/m2) 33.08 ± 1.93; HA1c (%): 6.8% ± 0.25) were enrolled at the University Service of Diet Therapy, Diabetology and Metabolic Diseases, Policlinico Riuniti Hospital of Foggia, and subjected to a very-low-calorie Mediterranean diet and a very-low-calorie ketogenic Mediterranean diet for thirty days. Both diets result in a marked decrease in body weight (kg) and BMI (kg/m2). At the same time, only the very-low-calories ketogenic Mediterranean diet reduced waist and hip circumferences. Both diets helped reduce fat mass, but a major loss was achieved in a very low-calorie ketogenic Mediterranean diet. Among gluco-metabolic parameters, only the very-low-calorie ketogenic Mediterranean diet group showed a significant decrease in fasting blood glucose and HbA1c, insulin, C-peptide total cholesterol, LDL, and triglycerides. The results of our study seem to show that the very-low-calorie ketogenic Mediterranean diet is a good strategy to improve rapidly metabolic, anthropometric, and body composition parameters in patients with prediabetes or diabetes and overweight/obesity.