Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA.
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.
Hum Reprod Update. 2022 Nov 2;28(6):910-955. doi: 10.1093/humupd/dmac023.
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.
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.
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).
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.
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.
生活方式（饮食和/或体力活动[PA]）的改变被推荐为多囊卵巢综合征（PCOS）管理的一线治疗方法。目前的建议是基于健康的生活方式实践，因为 PCOS 独特的生活方式方法的证据有限且质量较低。
我们旨在综合患有 PCOS 和不患有 PCOS 的女性之间的饮食和 PA 行为的证据。主要结局是总体饮食质量、总能量摄入和总 PA，次要结局包括宏量营养素、微量营养素、食物组、食物、血糖指数、久坐时间和坐姿水平。我们进行这项工作是为了确定患有 PCOS 的女性中存在的任何独特的生活方式行为，这些行为可能是 PCOS 中体重增加和肥胖的倾向的基础，并成为精准营养和 PA 干预的目标。这些发现可用于为未来的实践建议和研究提供信息，以更有效地解决这一高危人群的并发症（体重增加、肥胖、糖尿病、不孕、心血管疾病和心理健康）。
直到 2022 年 2 月 15 日，我们在 MEDLINE、Web of Science、Scopus 和 CINAHL 数据库中搜索了观察性研究，以确定记录患有 PCOS 和不患有 PCOS（对照组）的女性之间饮食和 PA 行为的研究。排除了针对儿童、青少年（<18 岁）、孕妇或绝经后年龄（>50 岁）的研究。通过随机效应模型汇总数据，并以（标准化）均数差（MD）和 95%置信区间（CI）表示。通过纽卡斯尔-渥太华量表（NOS）评估偏倚风险。
有 54 项研究（N=39471 名参与者；[n=8736 名 PCOS；30735 名对照组）符合条件（96%[52/54]NOS 评分≥7）。与对照组相比，患有 PCOS 的女性胆固醇水平较高（MD：12.78，95%CI：1.48 至 24.08mg/天；P=0.03；I2=19%），镁水平较低（MD：-21.46，95%CI：-41.03 至-1.91mg/天；P=0.03；I2=76%），锌水平有降低的趋势（MD：-1.08，95%CI：-2.19 至-0.03mg/天；P=0.05；I2=96%），尽管她们的酒精摄入量较低（MD：-0.95，95%CI：-1.67 至 0.22g/天；P=0.02；I2=0%）。此外，患有 PCOS 的女性总 PA 水平较低（标准化均数差：-0.38，95%CI：-0.72 至 0.03；P=0.03；I2=98%）。相反，能量、宏量营养素（碳水化合物、脂肪、蛋白质、纤维）、微量营养素（叶酸、铁、钙、钠）、血糖指数和血糖负荷相似（均：P≥0.06）。大多数合格研究报告称，患有 PCOS 的女性整体饮食质量较差，饮食摄入较差（较高的胆固醇、较低的镁和锌），总 PA 水平较低，尽管她们的酒精摄入量较低，这些情况是通过叙述性描述的，因为可变的研究方法不允许进行荟萃分析。
大量证据表明，与不患有 PCOS 的女性相比，患有 PCOS 的女性总体饮食质量较差，饮食摄入较差（胆固醇较高，镁和锌较低），总 PA 水平较低，尽管她们的酒精摄入量较低。研究之间存在相当大的异质性，这强调了需要进行研究，以确定其他因素（例如遗传、代谢或社会人口统计学）对观察到的差异的相对贡献。这些澄清可能有助于为精准生活方式医学时代监测和管理 PCOS 的未来循证指南建议提供信息。
