Abstract
Background
There is no randomized study comparing the isocaloric (ICHD) and hypocaloric diet (HCD) in PCOS subjects.
Objective
To compare ICHD and HCD in weight-matched PCOS subjects.
Methods
PCOS subjects were randomized to receive either a HCD or ICHD. Clinical, biochemical, hormonal and dietary assessments were performed at baseline, 3 months and at one year.
Results
There were 168 PCOS subjects randomized to receive either ICHD (n = 84) or HCD (n = 84). We observed that while the hypocaloric diet was more effective in reducing weight, both the diets were effective in improving clinical symptoms. Around 50% patients showed improvement in clinical symptoms at 3 months and 30% were on diet alone therapy at one year in both the groups. The effect on hirsuitism was modest by both the diets at one year. The effectiveness of both the diets was similar with both the per protocol and the Intention to treat analysis; nevertheless, there was a greater loss to follow-up in patients on ICHD with high baseline caloric intakes.
Conclusion
HCD and ICHD are equally effective in as many as 30% patients with mild symptoms over long term. Patients having higher caloric intakes at baseline should not be offered isocaloric diets.
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References
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R. CK Welt Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–92.
Bates GW, Whitworth NS. Effect of body weight reduction on plasma androgens in obese, infertile women. Feril Steril. 1982;38(4):406–9.
Kiddy DS, Sharp PS, White DM, Scanlon MF, Mason HD, Bray CS, Polson DW, Reed MJ, Franks S. Differences in clinical and endocrine features between obese and non- obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol (Oxf). 1990;32(2):213–20.
Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92(1):83–92.
Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R. Role of diet in the treatment of polycystic ovary syndrome. Fertil Steril. 2006;85(3):679–88.
Crosignani PG, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. HumReprod. 2003;18(9):1928–32.
Toscani MK, Mario FM, Radavelli-Bagatini S, Wiltgen D, Matos MC, Spritzer PM. Effect of high protein or normal protein diet on weight loss, body composition, hormone and metabolic profile in Southern Brazilian women with polycystic ovary syndrome: a randomized study. GynecolEndocrinol. 2011;27(11):925–30.
Moran LJ, Noakes M, Clifton PM, Tomlinson L, Galletly C, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(2):812–9.
Kulshreshtha B, Ganie MA, Praveen EP, Gupta N, Lal Khurana M, Seith A, Dwivedi SN, Kumar G, Ammini AC. Insulin response to oral glucose in healthy, lean young women and patients with polycystic ovary syndrome. GynecolEndocrinol. 2008;24(11):637–43.
Kulshreshtha B, Sharma N, Pant S, Sharma L, Pahuja B, Singh P. PCOS patients differ in meal timings rather than total caloric or macronutrient intake in comparison to weight matched controls. Eur J Obstet Gynecol Reprod Biol. 2022;270:11–6.
Tutakne MA, Chari KVR. Acne, rosacea and perioral dermatitis. In: Valia RG, Valia AR, editors. IADVL Textbook and atlas of dermatology. 2nd ed. Mumbai: Bhalani publishing House; 2003. p. 689–710.
Gopalan C, Rama Sastri BV, Balasubramanian SC. Nutritive value of Indian foods. National Institute of Nutrition, Hyderabad, India: Indian Council of Medical Research, 2015.
Longvah T, Anantham R, Bhaskarachary K, Venkaiah K. Indian food composition tables. National Institute of Nutrition, Hyderabad, India: Indian Council of Medical Research, 2017.
Khanna K, Gupta S, Seth R, Mahna R, Rekhi T. The art and science of cooking. Department of Food and Nutrition, Institute of Home Economics, New Delhi, 2013.
Garaulet M, Gómez-Abellán P, Alburquerque-Béjar JJ, Lee YC, Ordovás JM, Scheer FA. Timing of food intake predicts weight loss effectiveness. Int J Obes (Lond). 2013;37(4):604–11.
Vani KR, Veena KS, Subitha L, Kumar VRH, Bupathy A. Menstrual abnormalities in school going girls - are they related to dietary and exercise pattern? J ClinDiagn Res. 2013;7(11):2537–40.
Campmans-Kuijpers MJ, Sluijs I, Nöthlings U, Freisling H, Overvad K, Weiderpass E, Fagherazzi G, Kühn T, Katzke VA, Mattiello A, Sonestedt E, Masala G, Agnoli C, Tumino R, Spijkerman AM, Barricarte A, Ricceri F, Chamosa S, Johansson I, Winkvist A, Tjønneland A, Sluik D, Boeing H, Beulens JW. Isocaloric substitution of carbohydrates with protein: the association with weight change and mortality among patients with type 2 diabetes. Cardiovasc Diabetol. 2015;18:14–39.
Saidi O, Rochette E, Del Sordo G, Peyrel P, Salles J, Doré E, Merlin E, Walrand S, Duché P. Isocaloric diets with different protein-carbohydrate ratios: the effect on sleep, melatonin secretion and subsequent nutritional response in healthy young men. Nutrients. 2022;14(24):5299.
Prins PJ, Noakes TD, Buga A, D’Agostino DP, Volek JS, Buxton JD, Heckman K, Jones DW, Tobias NE, Grose HM, Jenkins AK, Jancay KT, Koutnik AP. Low and high carbohydrate isocaloric diets on performance, fat oxidation, glucose and cardiometabolic health in middle age males. Front Nutr. 2023;10:1–21.
Noakes M, Foster PR, Keogh JB, James AP, Mamo JC, Clifton PM. Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk. Nutr Metab (Lond). 2006;11:3–7.
Gower BA, Chandler-Laney PC, Ovalle F, Goree LL, Azziz R, Desmond RA, Granger WM, Goss AM, Bates GW. Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS. Clin Endocrinol (Oxf). 2013;79(4):550–7.
Koliaki C, Spinos T, Spinou Μ, Brinia ΜE, Mitsopoulou D, Katsilambros N. Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults. Healthcare (Basel). 2018;6(3):73.
Heymsfield SB, Harp JB, Reitman ML, Beetsch JW, Schoeller DA, Erondu N, Pietrobelli A. Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective. Am J Clin Nutr. 2007;85(2):346–54.
Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, Frearson M, Thondan M, Stepto N, Teede HJ. Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. J Acad Nutr Diet. 2013;113(4):520–45.
Barr S, Reeves S, Sharp K, Jeanes YM. An isocaloric low glycemic index diet improves insulin sensitivity in women with polycystic ovary syndrome. J Acad Nutr Diet. 2013;113(11):1523–31.
Goss AM, Chandler-Laney PC, Ovalle F, Goree LL, Azziz R, Desmond RA, Wright Bates G, Gower BA. Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism. 2014;63(10):1257–64.
Panico A, Lupoli GA, Cioffi I, Zacchia G, Caldara A, Lupoli G, Contaldo F, Pasanisi F, et al. Effects of an isocaloric low glycemic load diet in polycystic ovary syndrome. Nutr Ther Metab. 2014;32(2):85–92.
Shang Y, Zhou H, Hu M, Feng H. Effect of diet on insulin resistance in polycystic ovary syndrome. J Clin Endocrinol Metab. 2020;105(10):3346–60.
Lopez-Minguez J, Gómez-Abellán P, Garaulet M. Timing of breakfast, lunch, and dinner effects on obesity and metabolic risk. Nutrients. 2019;11(11):2624.
Bandín C, Scheer FA, Luque AJ, Ávila-Gandía V, Zamora S, Madrid JA, Gómez-Abellán P, Garaulet M. Meal timing affects glucose tolerance, substrate oxidation and circadian-related variables: a randomized, crossover trial. Int J Obes (Lond). 2015;39(5):828–33.
Jakubowicz D, Barnea M, Wainstein J, Froy O. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Clin Sci (Lond). 2013;125(9):423–32.
Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S-225S.
Wardzinski EK, Hyzy C, Duysen KU, Melchert UH, Jauch-Chara K, Oltmanns KM. Hypocaloric dieting unsettles the neuroenergetic homeostasis in humans. Nutrients. 2021;13(10):3433.
Lin AW, Lujan ME. Comparison of dietary intake and physical activity between women with and without polycystic ovary syndrome: a review. Adv Nutr. 2014;5(5):486–96.
Waruni S, Rupasinghe WA, HarshaniPerera TS, Nirmali W. A comprehensive review on dietary assessment methods in epidemiological research. J Pub Health Nutri. 2020;3(1):204–11.
Walker JL, Ardouin S, Burrows T. The validity of dietary assessment methods to accurately measure energy intake in children and adolescents who are overweight or obese: a systematic review. Eur J Clin Nutr. 2018;72(2):185–97.
Frank GC, Berenson GS, Schilling PE, Moore MC. Adapting the 24-hr recall for epidemiologic studies of school children. J Am Dietet Assoc. 1977;71(1):26–31.
Acknowledgment
We acknowledge the help of Deepti Kaur for data entry and analysis. We acknowledge the help of Dr Shekhar and Dr YP Gupta for statistical analysis. We acknowledge the contribution of ICMR (IRIS ID no. 2013-0976) for sponsoring this project.
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BK conceptualized the study, was involved in all stages, and wrote the manuscript. SP, BP, and PS were involved in data collection, statistical analysis, and literature review including manuscript preparation. NS and LS were involved in data collection, laboratory data, and manuscript preparation. All the authors approved the final version of the manuscript.
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This study was approved by the Insti-tutional Ethics Committee (IRIS ID no. 2013-0976). Consenting subjects and controls underwent a detailed history and physical examination including anthropometry.
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Kulshreshtha, B., Sharma, N., Pant, S. et al. Isocaloric diet is as effective as the hypocaloric diet in ameliorating symptoms in PCOS patients. Int J Diabetes Dev Ctries 44, 356–365 (2024). https://doi.org/10.1007/s13410-023-01256-7
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DOI: https://doi.org/10.1007/s13410-023-01256-7