A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome

Stamets, Kelly; Taylor, Denise S; Kunselman, Allen; Demers, Laurence M; Pelkman, Christine L; Legro, Richard S

doi:10.1016/j.fertnstert.2003.08.023

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Volume 81, Issue 3 , Pages 630-637, March 2004

A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome☆

Presented in part at the 83rd Annual Meeting of the Endocrine Society, Denver, Colorado, June 20–23, 2001.

Kelly Stamets, M.D.
- Department of Obstetrics and Gynecology, Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
- Current address: Department of Family Practice, Fairview Hospital, Cleveland, Ohio, USA
Denise S Taylor, M.S., FR.D.
- General Clinical Research Center, Pennsylvania State University, State College, Pennsylvania, USA
Allen Kunselman, M.A.
- Department of Health Evaluation Sciences, Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
Laurence M Demers, Ph.D.
- Department of Pathology, Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
Christine L Pelkman, Ph.D.
- Department of Nutrition, Pennsylvania State University, State College, Pennsylvania, USA. (Current address: Nutrition Program, State University of New York at Buffalo, Buffalo, New York.)
Richard S Legro, M.D.
- Department of Obstetrics and Gynecology, Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
- Reprint requests: Richard S. Legro, M.D., Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, 500 University Drive, M.S. Hershey Medical Center, Hershey, Pennsylvania 17033 (FAX: 717-531-8478, USA

Received 25 March 2003; received in revised form 4 August 2003; accepted 4 August 2003.

Abstract

Objective

We performed this study as a pilot experiment to investigate the short term effects of two diets of varying composition on weight loss as the primary outcome in obese women with polycystic ovary syndrome (PCOS) seeking fertility.

Design

Randomized clinical trial.

Setting

Academic medical center.

Patient(s)

Thirty-five obese women with PCOS.

Intervention(s)

We examined the effects of a 1-month dietary intervention on the PCOS phenotype. Participants were randomized to one of two energy-restricted diets; high protein (HP: 30% protein, 40% carbohydrate, and 30% fat) or high carbohydrate (HC: 15% protein, 55% carbohydrate, and 30% fat). The fat content was held constant in both diets.

Main outcome measure(s)

Primary — change in body weight; Secondary — biometric, hormonal, lipid and lipoprotein, and markers of glucose homeostasis and energy metabolism.

Result(s)

Twenty-six women completed the study. Both the HP (−3.7 ± 1.9 kg) and HC (−4.4 ± 1.5 kg) diets resulted in significant weight loss, but there was no significant difference in mean weight loss between the two groups. There were also no differences between diets on a variety of measures including circulating androgens, measures of glucose metabolism, and leptin. However, the effects of a hypocaloric diet per se on improving metabolic and reproductive abnormalities in a group of PCOS women were marked by a decline in circulating androgens (P=.03), fasting and area under the curve (AUC) insulins (P<.05) on a 3-hour oral glucose tolerance test (OGTT), and fasting and AUC leptin levels (P<.0001). There was a high prevalence of menstrual bleeding during the trial (14 out of 26 patients).

Conclusion(s)

Those who completed the short-term hypocaloric diet had a significant weight loss and a significant improvement in their reproductive and metabolic abnormalities. There was no increased benefit to a high-protein diet. Future diet studies evaluating the ideal composition of a hypocaloric diet in women with PCOS will require a large study population, and will most likely require a multicenter trial.

Keywords: Polycystic ovary syndrome, hyperandrogenism, anovulation, insulin resistance, weight loss