Scragg Jadine, Hobson Alice, Willis Lia, Taylor Kathryn S, Dixon Sharon, Jebb Susan A
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom (J.S., S.A.J.).
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (A.H., L.W., K.S.T., S.D.).
Ann Intern Med. 2024 Dec;177(12):1664-1674. doi: 10.7326/M23-3179. Epub 2024 Nov 5.
Polycystic ovary syndrome (PCOS) is common in women of reproductive age and is associated with obesity. Clinical guidelines recommend weight loss, but the impact on the clinical manifestations of PCOS is unclear.
To quantify the effect of weight loss interventions on clinical features of PCOS, compared with usual care.
MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, and trial registries were searched from inception through June 2024.
Randomized controlled trials comparing interventions aiming to reduce weight against usual care, including lower-intensity weight loss interventions in people with PCOS. Conversations with people with PCOS informed the outcomes.
Pairs of independent reviewers screened studies, extracted data, and assessed risk of bias (RoB). Outcomes included glycemic control (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR], fasting insulin and glucose), hormonal markers (free androgen index [FAI] and other sex hormones), menstrual frequency, hirsutism, and PCOS-related quality of life (QoL). Pooled mean differences were obtained from random-effects meta-analysis with Knapp-Hartung adjustment.
Primary analyses included 29 comparisons with 1529 participants: 13, 12, and 4 comparisons were judged as high, some, or low RoB, respectively. Twelve used behavioral interventions, 9 used glucagon-like peptide-1 (GLP1) agonists, and 8 used other weight loss medications. Weight loss interventions were associated with significantly greater improvements in HOMA-IR (mean difference, -0.45 [-0.75 to -0.15]; = 24%), FAI (mean difference, -2.03 [-3.0 to -1.07]; = 48%), and menstrual frequency (mean difference, 2.64 [0.65 to 4.63]; = 43%). There was no evidence that weight loss interventions were associated with clinically or statistically significant improvements in hirsutism, QoL, or other sex hormones, which may be due to the limited power of the available data.
There was high statistical heterogeneity in the interventions, comparators, and outcomes, largely unexplained by sensitivity and subgroup analyses.
Weight loss interventions were associated with improvements in some important features of PCOS and should be considered as a routine treatment option for people with PCOS.
National Institute for Health and Care Research School for Primary Care Research. (PROSPERO: CRD42022367488).
多囊卵巢综合征（PCOS）在育龄女性中很常见，且与肥胖有关。临床指南建议减重，但对PCOS临床表现的影响尚不清楚。
与常规护理相比，量化减重干预对PCOS临床特征的影响。
检索了MEDLINE、Embase、PsycINFO、CINAHL、Cochrane、科学引文索引以及试验注册库，检索时间从建库至2024年6月。
比较旨在减重的干预措施与常规护理的随机对照试验，包括针对PCOS患者的低强度减重干预。与PCOS患者的交流为结局指标提供了参考。
由独立的评审员对研究进行筛选、提取数据并评估偏倚风险（RoB）。结局指标包括血糖控制（胰岛素抵抗稳态模型评估[HOMA-IR]、空腹胰岛素和血糖）；激素指标（游离雄激素指数[FAI]和其他性激素）；月经频率；多毛症；以及PCOS相关生活质量（QoL）。通过采用Knapp-Hartung校正的随机效应荟萃分析获得合并平均差。
主要分析纳入了29项比较研究，共1529名参与者：其中13项、12项和4项比较研究分别被判定为高、中、低RoB。12项研究采用行为干预，9项研究使用胰高血糖素样肽-1（GLP1）激动剂，8项研究使用其他减重药物。减重干预与HOMA-IR（平均差，-0.45[-0.75至-0.15]；P = 24%）、FAI（平均差，-2.03[-3.0至-1.07]；P = 48%）和月经频率（平均差，2.64[0.65至4.63]；P = 43%）的显著更大改善相关。没有证据表明减重干预与多毛症、QoL或其他性激素在临床或统计学上的显著改善相关，这可能是由于现有数据的效力有限。
干预措施、对照和结局存在高度统计学异质性，敏感性分析和亚组分析在很大程度上无法解释这一现象。
减重干预与PCOS的一些重要特征的改善相关，应被视为PCOS患者的常规治疗选择。
国家卫生与保健研究所初级保健研究学院。（国际前瞻性系统评价注册库：CRD42022367488）
