Moslehi Nazanin, Zeraattalab-Motlagh Sheida, Rahimi Sakak Fatemeh, Shab-Bidar Sakineh, Tehrani Fahimeh Ramezani, Mirmiran Parvin
Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Nutr Rev. 2023 Apr 11;81(5):555-577. doi: 10.1093/nutrit/nuac075.
Numerous meta-analyses have been conducted on the effects of nutritional interventions on various health outcomes in women with polycystic ovary syndrome (PCOS). However, the strength of the evidence and its clinical significance are unclear.
This umbrella review aimed to summarize the effects of nutritional interventions on women with PCOS and assess the strength of the evidence.
PubMed, Scopus, and Web of Science were searched from inception until March 17, 2021.
Meta-analyses of randomized clinical trials (RCTs) that examined the impact of dietary modifications or supplementations on women with PCOS were selected. Data extraction, quality assessments of the meta-analyses, and evaluation of the strength of the evidence were conducted independently by 2 investigators and confirmed by a third.
Twenty-eight RCT meta-analyses were included, reporting 40 different outcomes. Lower carbohydrate, Dietary Approaches to Stop Hypertension, or lower glycemic index/load diets in women with PCOS significantly improved some anthropometric and metabolic characteristics (with very low to low certainty). Probiotics/synbiotics reduced fasting plasma glucose, fasting insulin (FI), and homeostasis model assessment-estimated insulin resistance (HOMA-IR) (with moderate to high certainty). Curcumin supplementation decreased fasting plasma glucose, FI, and HOMA-IR (with moderate certainty). Fish oil supplementation decreased FI and HOMA-IR, and omega-3 reduced triglycerides (with moderate certainty). There were also improvements in FI after taking vitamin D or inositol supplements (with moderate certainty). Supplementation with fish oil increased adiponectin (with high certainty), and probiotics/synbiotics reduced total testosterone (with moderate certainty). In subfertile women with PCOS, inositol increased the ovulation rates (with moderate certainty).
There was no high-certainty evidence that diets alone in women with PCOS improved health or reproductive outcomes. Supplementation with vitamin D, probiotics/synbiotics, omega-3, inositol, and curcumin showed favorable effects on some metabolic outcomes. Probiotics/synbiotics possibly reduces total testosterone, and inositol stimulates ovulation in women with PCOS.
PROSPERO registration no. CRD42021251496.
关于营养干预对多囊卵巢综合征（PCOS）女性各种健康结局的影响，已经进行了大量的荟萃分析。然而，证据的强度及其临床意义尚不清楚。
本综述旨在总结营养干预对PCOS女性的影响，并评估证据的强度。
检索了PubMed、Scopus和Web of Science数据库，检索时间从建库至2021年3月17日。
选择了对饮食调整或补充剂对PCOS女性影响进行研究的随机临床试验（RCT）的荟萃分析。由2名研究人员独立进行数据提取、荟萃分析的质量评估以及证据强度评估，并由第三名研究人员进行确认。
纳入了28项RCT荟萃分析，报告了40种不同的结局。PCOS女性采用低碳水化合物饮食、终止高血压饮食方法（DASH饮食）或低血糖指数/负荷饮食可显著改善一些人体测量和代谢特征（证据确定性极低至低）。益生菌/合生元可降低空腹血糖、空腹胰岛素（FI）和稳态模型评估法估计的胰岛素抵抗（HOMA-IR）（证据确定性为中至高）。补充姜黄素可降低空腹血糖、FI和HOMA-IR（证据确定性为中）。补充鱼油可降低FI和HOMA-IR，ω-3可降低甘油三酯（证据确定性为中）。服用维生素D或肌醇补充剂后，FI也有改善（证据确定性为中）。补充鱼油可增加脂联素（证据确定性高），益生菌/合生元可降低总睾酮水平（证据确定性为中）。在PCOS不孕女性中，肌醇可提高排卵率（证据确定性为中）。
没有高确定性证据表明PCOS女性单纯饮食可改善健康或生殖结局。补充维生素D、益生菌/合生元、ω-3、肌醇和姜黄素对某些代谢结局有有益影响。益生菌/合生元可能降低总睾酮水平，肌醇可刺激PCOS女性排卵。
PROSPERO注册号CRD42021251496。
