Lifestyle interventions in women with PCOS: the role of a pulse-based diet
Context: Polycystic ovary syndrome (PCOS) is complex disorder associated with many metabolic abnormalities. PCOS is one of the most common endocrine disorders occurring in women of reproductive age and affects about 6-7% of the population. Women with PCOS have insulin resistance and hyperinsulinemia, thus increasing their risk of developing Type 2 diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease, and endometrial cancer Overall Objective: To compare anthropometric features (weight, BMI, WC, body fat percent), antral follicle count (AFC), fasting glucose and insulin levels, HOMA score, menstrual bleeding patterns, and abdominal adiposity before and after a dietary intervention. Materials and Methods: The work presented herein represents a subset of the data being analyzed in an ongoing study titled "Lifestyle Intervention for Women with Polycystic Ovary Syndrome: The Role of a Pulse-Based Diet and Aerobic Exercise on Infertility Measures and Metabolic Syndrome Risk". PCOS was diagnosed by two of the three diagnostic criteria as defined by the Rotterdam consensus: a history of cycles >35 days in length, hyperandrogenism as defined by a Ferriman and Gallwey score of >6 or hyperandrogenemia, as well as polycystic ovaries (PCO), defined by >25 follicles visualized upon transvaginal ultrasonography (TVU). Participants were randomized to either a 16 week pulse-based diet or to a TLC diet for 16 weeks. All participants were asked to follow an exercise program for the 16 week duration of the intervention. Changes in demographic, anthropometric features AFC, fasting insulin levels, and intervals between menstrual cycles were assessed. Results: Twenty four women completed the 16 week dietary intervention to date (pulse n=13, TLC n=11). Participants were found to be similarly matched for age, weight, BMI, WC, and FAI. Weight (p=0.002) and body fat (p=0.0004) decreased significantly. No significant differences were detected in BMI and waist circumference. Antral follicle counts were decreased in the right ovary (p=0.04) but not the left ovary (p=0.11). There was no change in fasting glucose levels detected. There was a decrease in fasting insulin levels (p=0.02) and in HOMA score (p=0.02). No change in abdominal adiposity was detected (p=0.88). There was a tendency toward a change of fasting insulin levels and HOMA score due to the pulse-based diet. The average interval between menses decreased after the intervention (p=0.04). The longest length of time between menses also decreased after the intervention (p=0.01). Conclusions: Our hypothesis was partially supported. We observed significant decreases in weight, body fat percent, AFC in the right ovary, fasting insulin levels and intermenstrual intervals. In most women, the decreased intermenstrual interval translated into the resumption of menstrual cyclicity. However, the participants' BMI, WC, AFC in the left ovary, and abdominal adiposity were not affected. Consuming food of a lower glycemic index without a calorie restriction may help women with PCOS gain healthier anthropometric profiles, decrease serum insulin levels and insulin resistance, and increase the regularity of menstrual cycles. Further study involving weight reduction and dietary intervention with pulses may prove to be more successful than calorie reduction alone.
PCOS, insulin, follicle count, menstrual cyclicity, pulse
Master of Science (M.Sc.)