The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials

doi:10.1155/2019/4386401

Review

. 2019 Nov 26;2019:4386401.

doi: 10.1155/2019/4386401. eCollection 2019.

The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Xiaoshuai Zhang¹, Yang Zheng¹, Yanan Guo¹, Zhiwen Lai²

Affiliations

¹ Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing 400010, China.
² Department of Gynecology, Chengdu Xinan Gynecological Hospital, Chengdu, China.

PMID: 31885557
PMCID: PMC6899277
DOI: 10.1155/2019/4386401

Free PMC article

Review

The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Xiaoshuai Zhang et al. Int J Endocrinol. 2019.

Free PMC article

. 2019 Nov 26;2019:4386401.

doi: 10.1155/2019/4386401. eCollection 2019.

Authors

Xiaoshuai Zhang¹, Yang Zheng¹, Yanan Guo¹, Zhiwen Lai²

Affiliations

¹ Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing 400010, China.
² Department of Gynecology, Chengdu Xinan Gynecological Hospital, Chengdu, China.

PMID: 31885557
PMCID: PMC6899277
DOI: 10.1155/2019/4386401

Favorites

Abstract

Objective: To assess the effect of a low carbohydrate diet (LCD) on women with polycystic ovary syndrome (PCOS).

Methods: Data from randomized controlled trials (RCTs) were obtained to perform a meta-analysis of the effects of LCD in PCOS patients. The primary outcomes included the changes in BMI, homeostatic model assessment for insulin resistance (HOMA-IR), and blood lipids, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), follicle-stimulating hormone (FSH), luteotropic hormone (LH), total testosterone (T), and sex hormone-binding globulin (SHBG).

Results: Eight RCTs involving 327 patients were included. In comparison with the control group, the LCD decreased BMI (SMD = -1.04, 95% CI (-1.38, -0.70), P < 0.00001), HOMA-IR (SMD = -0.66, 95% CI (-1.01, -0.30), P < 0.05), TC (SMD = -0.68, 95% CI (-1.35, -0.02), P < 0.05), and LDL-C (SMD = -0.66, 95% CI (-1.30, -0.02), P < 0.05). Stratified analyses indicated that LCD lasting longer than 4 weeks had a stronger effect on increasing FSH levels (MD = 0.39, 95% CI (0.08, 0.71), P < 0.05), increasing SHBG levels (MD = 5.98, 95% CI (3.51, 8.46), P < 0.05), and decreasing T levels (SMD = -1.79, 95% CI (-3.22, -0.36), P < 0.05), and the low-fat and low-CHO LCD (fat <35% and CHO <45%) had a more significant effect on the levels of FSH (MD = 0.40, 95% CI (0.09, 0.71), P < 0.05) and SHBG (MD = 6.20, 95% CI (3.68, 8.72), P < 0.05) than the high-fat and low-CHO LCD (fat >35% and CHO <45%).

Conclusion: Based on the current evidence, LCD, particularly long-term LCD and low-fat/low-CHO LCD, may be recommended for the reduction of BMI, treatment of PCOS with insulin resistance, prevention of high LDL-C, increasing the levels of FSH and SHBG, and decreasing the level of T level. Together, the analyzed data indicate that proper control of carbohydrate intake provides beneficial effects on some aspects of PCOS and may represent one of the important interventions improving the clinical symptoms of affected patients.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Figures

**Figure 1**
Flowchart of literature search, review process, and selection of studies.

**Figure 2**
Graphical representation of the risk of bias in the selected studies.

**Figure 3**
Meta-analysis of the effect of LCD on BMI in PCOS patients.

**Figure 4**
Meta-analysis of the effect of LCD on HOMA-IR in PCOS patients.

**Figure 5**
Meta-analysis of the effect of (a) LCD duration on FSH levels in PCOS patients and (b) LCD type on FSH levels in PCOS patients.

**Figure 6**
Meta-analysis of the effect of (a) LCD duration on LH levels in PCOS patients and (b) LCD type on LH levels in PCOS patients.

**Figure 7**
Meta-analysis of the effect of (a) LCD duration on SHBG levels in PCOS patients and (b) LCD type on SHBG in PCOS patients.

**Figure 8**
Meta-analysis of the effect of (a) LCD duration on T levels in PCOS patients and (b) LCD type on T levels in PCOS patients.

**Figure 9**
Meta-analysis of the effect of LCD on blood lipids in PCOS patients. (a), TC; (b), LDL-C; (c), HDL-C.

See this image and copyright information in PMC

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References

1. Walters K. A., Bertoldo M. J., Handelsman D. J. Evidence from animal models on the pathogenesis of PCOS. Best Practice & Research Clinical Endocrinology & Metabolism. 2018;32(3):271–281. doi: 10.1016/j.beem.2018.03.008. - DOI - PubMed
1. Patel S. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology. 2018;182:27–36. doi: 10.1016/j.jsbmb.2018.04.008. - DOI - PubMed
1. Teede H. J., Misso M. L., Costello M. F., et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility. 2018;110:364–379. doi: 10.1016/j.fertnstert.2018.05.004. - DOI - PMC - PubMed
1. Faghfoori Z., Fazelian S., Shadnoush M., Goodarzi R. Nutritional management in women with polycystic ovary syndrome: a review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S429–S432. doi: 10.1016/j.dsx.2017.03.030. - DOI - PubMed
1. Chavarro J. E., Rich-Edwards J. W., Rosner B. A., Willett W. C. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology. 2007;110(5):1050–1058. doi: 10.1097/01.aog.0000287293.25465.e1. - DOI - PubMed

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[1] Walters K. A., Bertoldo M. J., Handelsman D. J. Evidence from animal models on the pathogenesis of PCOS. Best Practice & Research Clinical Endocrinology & Metabolism. 2018;32(3):271–281. doi: 10.1016/j.beem.2018.03.008. - DOI - PubMed

[2] Walters K. A., Bertoldo M. J., Handelsman D. J. Evidence from animal models on the pathogenesis of PCOS. Best Practice & Research Clinical Endocrinology & Metabolism. 2018;32(3):271–281. doi: 10.1016/j.beem.2018.03.008. - DOI - PubMed

[3] Patel S. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology. 2018;182:27–36. doi: 10.1016/j.jsbmb.2018.04.008. - DOI - PubMed

[4] Patel S. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology. 2018;182:27–36. doi: 10.1016/j.jsbmb.2018.04.008. - DOI - PubMed

[5] Teede H. J., Misso M. L., Costello M. F., et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility. 2018;110:364–379. doi: 10.1016/j.fertnstert.2018.05.004. - DOI - PMC - PubMed

[6] Teede H. J., Misso M. L., Costello M. F., et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility. 2018;110:364–379. doi: 10.1016/j.fertnstert.2018.05.004. - DOI - PMC - PubMed

[7] Faghfoori Z., Fazelian S., Shadnoush M., Goodarzi R. Nutritional management in women with polycystic ovary syndrome: a review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S429–S432. doi: 10.1016/j.dsx.2017.03.030. - DOI - PubMed

[8] Faghfoori Z., Fazelian S., Shadnoush M., Goodarzi R. Nutritional management in women with polycystic ovary syndrome: a review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S429–S432. doi: 10.1016/j.dsx.2017.03.030. - DOI - PubMed

[9] Chavarro J. E., Rich-Edwards J. W., Rosner B. A., Willett W. C. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology. 2007;110(5):1050–1058. doi: 10.1097/01.aog.0000287293.25465.e1. - DOI - PubMed

[10] Chavarro J. E., Rich-Edwards J. W., Rosner B. A., Willett W. C. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology. 2007;110(5):1050–1058. doi: 10.1097/01.aog.0000287293.25465.e1. - DOI - PubMed

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