Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México City, Mexico.
Departamento de Genética, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2901 Col. Volcanes, C.P. 72000, Puebla, Pue, Mexico.
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:110-117. doi: 10.1016/j.ejogrb.2020.03.010. Epub 2020 Mar 6.
Women with polycystic ovary syndrome (PCOS) are associated with increased levels of insulin resistance (IR). Other than treatment with insulin-sensitizing drugs, specialized diets have also been implemented to reduce the patient's IR. However, the capacity of certain diets, concerning with the severity of the patient's IR, to improve insulin sensitivity has not fully been explored. Therefore, we conducted a meta-analysis to determine in PCOS subjects from low to severe IR, if hypocaloric diets improve insulin sensitivity.
PubMed, SCOPUS, EBSCO, and LILACS databases and retrieved studies' bibliographies were searched for prospective studies that investigated the association between diets and IR in PCOS women until October 2018. Diet was defined as a modification of the patients' nutrition intake according to caloric restriction, change in protein intake, or by using a specialized diet. IR measures (HOMA1-IR), pre- and post-intervention were extracted. Using Comprehensive Meta-Analysis software, depending on the level heterogeneity, determined by the ψ-based Q-test and the I-test, fixed-effects or random-effects models were used to calculate the pooled standard paired differences (SPD) and 95 %CI.
20 publications (25 studies) fulfilled the inclusion criteria. Due to the heterogeneity of the diets, the random-effects model was used. In 48 % of the studies, the diets led to a decrease of IR, where 44 % had no effect. In 2 studies, the diets increased IR. Overall, the diets decreased IR (SPD=-0.58; 95 %CI: -0.81 to -0.36). Subjects with severe IR (HOMA1-IR>4.2) had a marked improvement (SPD=-1.22; 95 %CI: -1.61 to -0.84). Moreover, diets low in carbohydrate (<50 %) was also determined to improve IR (SPD=-0.86; 95 %CI: -1.23 to -0.50).
Here, we demonstrate that diets are more likely to improve IR in PCOS women with severe IR. Therefore, it is crucial to determine a subject's IR status before considering any intervention containing a diet.
多囊卵巢综合征（PCOS）患者存在胰岛素抵抗（IR）水平升高。除了使用胰岛素增敏药物治疗外，还实施了专门的饮食来降低患者的 IR。然而，某些饮食针对患者 IR 的严重程度改善胰岛素敏感性的能力尚未得到充分探索。因此，我们进行了一项荟萃分析，以确定在从低到严重 IR 的 PCOS 患者中，低热量饮食是否可以改善胰岛素敏感性。
检索了 PubMed、SCOPUS、EBSCO 和 LILACS 数据库以及检索到的研究参考文献，以查找直至 2018 年 10 月调查 PCOS 女性饮食与 IR 之间关联的前瞻性研究。饮食定义为根据热量限制、蛋白质摄入的改变或使用特殊饮食来改变患者的营养摄入。提取干预前后的 IR 测量值（HOMA1-IR）。使用 Comprehensive Meta-Analysis 软件，根据 ψ 基于 Q 检验和 I 检验确定的水平异质性，使用固定效应或随机效应模型计算汇总标准配对差异（SPD）和 95%置信区间。
20 篇出版物（25 项研究）符合纳入标准。由于饮食的异质性，使用了随机效应模型。在 48%的研究中，饮食导致 IR 下降，其中 44%没有效果。在 2 项研究中，饮食增加了 IR。总体而言，饮食降低了 IR（SPD=-0.58；95%CI：-0.81 至-0.36）。IR 严重（HOMA1-IR>4.2）的受试者有明显改善（SPD=-1.22；95%CI：-1.61 至-0.84）。此外，低碳水化合物饮食（<50%）也被确定可以改善 IR（SPD=-0.86；95%CI：-1.23 至-0.50）。
在这里，我们证明饮食更有可能改善严重 IR 的 PCOS 女性的 IR。因此，在考虑任何包含饮食的干预措施之前，确定患者的 IR 状态至关重要。
