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

Author:

Kazemi Maryam12ORCID,Kim Joy Y1,Wan Cynthia1,Xiong Julia D1,Michalak Julia1,Xavier Isabella B1,Ganga Kiran1,Tay Chau Thien3,Grieger Jessica A45ORCID,Parry Stephen A6,Moran Lisa J34ORCID,Lujan Marla E1ORCID

Affiliation:

1. Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University , Ithaca, NY, USA

2. Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA

3. Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University , Clayton, Australia

4. Robinson Research Institute, University of Adelaide , North Adelaide, SA, Australia

5. Adelaide Medical School, University of Adelaide , Adelaide, SA, Australia

6. Cornell Statistical Consulting Unit, Cornell University , Ithaca, NY, USA

Abstract

Abstract 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.

Funder

Division of Nutritional Sciences at Cornell University

National Institutes of Health

National Heart Foundation Future Leader Fellowship

National Health and Medical Research Council Ideas

Canadian Institutes of Health Research Postdoctoral Fellowship

Publisher

Oxford University Press (OUP)

Subject

Obstetrics and Gynecology,Reproductive Medicine

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