The role of diet therapy in insulin resistance in women with polycystic ovary syndrome

H.B. Semenyna; T.V. Fartushok; N.V. Fartushok; N.Ya. Dumanchuk; O.M. Yurchyshyn

doi:10.26641/2307-0404.2024.4.319179

Authors

H.B. Semenyna Danylo Halytsky Lviv Medical University, Pekarska str., 69, Lviv, 79010, Ukraine https://orcid.org/0000-0003-2247-6731
T.V. Fartushok Danylo Halytsky Lviv Medical University, Pekarska str., 69, Lviv, 79010, Ukraine https://orcid.org/0000-0001-6571-0108
N.V. Fartushok HPEI “Lviv Medical University”, V. Polishchuk str., 76, Lviv, 79018, Ukraine https://orcid.org/0000-0003-2824-8473
N.Ya. Dumanchuk HPEI “Lviv Medical University”, V. Polishchuk str., 76, Lviv, 79018, Ukraine https://orcid.org/0009-0008-5006-8982
O.M. Yurchyshyn Ivan Horbachevsky Ternopil National Medical University, Maidan Voli, 1, Ternopil, 46001, Ukraine https://orcid.org/0000-0002-0754-2983

DOI:

https://doi.org/10.26641/2307-0404.2024.4.319179

Keywords:

polycystic ovary syndrome, insulin resistance, diet therapy, mediterranean diet, ketogenic diet, low-carbohydrate diet, low-fat diet, HOMA

Abstract

The purpose of the study is to substantiate, based on a review of literary sources, the effectiveness of various types of diet therapy as an initial method of treatment in women with polycystic ovary syndrome and insulin resistance, their effect on the normalization of the menstrual cycle, correction of metabolic disorders and reduction of the level of insulin resistance. From 2018 to 2024 40 articles were analyzed with key words: polycystic ovary syndrome (PCOS), insulin resistance, diet therapy, Mediterranean diet, ketogenic diet, low-carbohydrate diet, low-fat diet, Homeostasis model assessment (HOMA) according to which a review of the available literature was conducted in PubMed, National Library of Medicine, Medscape. The study did not include pregnant, lactating women who took hormonal therapy and/or insulin sensitizers during the last 2 months, had liver, kidney, and heart diseases that failed local treatment of hirsutism, with congenital hyperplasia of the adrenal glands, androgen-secreting tumors, Cushing's syndrome. A review and analysis of studies on the effects of a ketogenic diet for 12 weeks, in which 14 overweight women with a diagnosis of polycystic ovary syndrome, participated. 40 articles were studied using bibliographic and analytical methods. At the beginning of the study patients had HOMA-IR above 2.5, which confirms insulin resistance. After using ketogenic diet, a significant decrease in the level of glucose, insulin, and, therefore, the HOMA index was observed. There were significant changes in lipid profiles with a decrease in triglycerides, total cholesterol, and low-density lipoproteins along with increases in high-density lipoprotein. Anthropometric measurements revealed a weight loss of 8.78 kg and a significant decrease in the body mass index of 3.18. A study of 72 women with PCOS showed a superior efficacy of a Mediterranean diet (MED) combined with a low-carbohydrate (LC) diet versus a low-fat diet alone. In patients who used the combination of MED/LC diet, in 86.7% of cases, the regular menstrual cycle was restored, and pregnancy occurred.

References

Paoli A, Mancin L, Giacona MC, et al. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med. 2020;18:104. doi: https://doi.org/10.1186/s12967-020-02277-0

Mirabelli M, Chiefari E, Arcidiacono B, Corigliano DM, Brunetti FS, Maggisano V, et al. Miterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients. 2020;12(4):1066. doi: https://doi.org/10.3390/nu12041066

Mei S, Jie D, Wang K, Zhexin N, Jin Yu. Mediterranean Diet Combined With a Low-Carbohydrate Dietary Pattern in the Treatment of Overweight Polycystic Ovary Syndrome Patients. Front Nutr. 2022;9:876620. doi: https://doi.org/10.3389/fnut.2022.876620

Cincione RI, Losavio F, Ciolli F, Valenzano А, Cibelli G, Messina G, et al. Effects of Mixed of a Ketogenic Diet in Overweight and Obese Women with Polycystic Ovary Syn¬drome. Int J Environ Res Public Health. 2021;18(23):12490. doi: https://doi.org/10.3390/ijerph182312490

Che X, Chen Z, Liu M, Mo Z. Dietary Inter-ventions: A Promising Treatment for Polycystic Ovary Syndrome. Ann Nutr Metab. 2021;77:313-23. doi: https://doi.org/10.1159/000519302

Feng X, Wang D, Hu L, Lu H, Ling B, Huang Y, et al. Dendrobium officinale polysaccharide ameliorates polycystic ovary syndrome via regulating butyrate dependent gut–brain–ovary axis mechanism. Front Endocrinol. 2022;13:962775. doi: https://doi.org/10.3389/fendo.2022.962775

Zhang J, Xing С, Xiangyi Cheng X, He B. Canagliflozin combined with metformin versus metformin monotherapy for endocrine and metabolic profiles in overweight and obese women with polycystic ovary synd-rome: A single-center, open-labeled prospective rando-mized controlled trial. Front Endocrinol. 2022;13:1-11. doi: https://doi.org/10.3389/fendo.2022.1003238

Rodriguez Paris V, Solon-Biet SM, Senior AM, et al. Defining the impact of dietary macronutrient balance on PCOS traits. Nat Commun. 2020;11:5262. doi: https://doi.org/10.1038/s41467-020-19003-5

Gambineri А, Pelusi С, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. International Journal of Obesity. 2020;26:883-96. doi: https://doi.org/10.1038/sj.ijo.0801994

Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc. 2019;3(8):1545-73. doi: https://doi.org/10.1210/js.2019-00078

Fartushok TV, Semenyna HB, Yurchyshyn OM, Komissarova OS. Ways to improve natural fertility. Wiadomosci Lekarskie. 2021;74(1):144-9. doi: https://doi.org/10.36740/WLek202101128

Markin LB, Korutko OO, Fartushok TV, Fartushok NV, Fedevych YuM, Dzhalilova EA, et al. Association of polycystic ovary syndrome with multiple health factors and adverse pregnancy outcomes. International Journal of Endocrinology. 2023;19(2):137-42. doi: https://doi.org/10.22141/2224-0721.19.2.2023.1259

Semenyna HB, Korytko OO. Effectiveness of vitex agnus castus extract in the primary dysmenorrhea. International Journal of Endocrinology. 2022;18(1);17-21. doi: https://doi.org/10.22141/2224-0721.18.1.2022.1141

Mirabelli M, Chiefari E, Arcidiacono B, Corigliano DM, Brunetti FS, Maggisano V, et al. Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients. 2020;12(4):1066. doi: https://doi.org/10.3390/nu12041066

Muscogiuri G, Barrea L, Laudisio D, Pugliese G, Salzano C, Savastano S, et al. The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide. J Transl Med. 2019;17(1):356. doi: https://doi.org/10.1186/s12967-019-2104-z

Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G, et al. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of endocrinology (SIE). J Endocrinol Invest. 2019;42(11):1365-86. doi: https://doi.org/10.1007/s40618-019-01061-2

Paoli A, Cancellara P, Pompei P, Moro T. Keto-genic diet and skeletal muscle hypertrophy: a frenemy relationship? J Hum kinet. 2019;68:233-47. doi: https://doi.org/10.2478/hukin-2019-0071

De Amicis R, Leone A, Lessa C, Foppiani A, Ravella S, Ravasenghi S, et al. Long-term effects of a classic ketogenic diet on ghrelin and leptin concentration: a 12-month prospective study in a cohort of Italian children and adults with GLUT1-deficiency syndrome and drug resistant epilepsy. Nutrients. 2019;11(8):1716. doi: https://doi.org/10.3390/nu11081716

Hong SH, Choi KM. Sarcopenic Obesity, Insulin Resistance, and Their Implications in Cardiovascular and Metabolic Consequences. Int J Mol Sci. 2020 Jan 13;21(2):494. doi: https://doi.org/10.3390/ijms21020494

Soliman AR, Hegazy M, Ahmed RM, Abdelghaffar S, Gomaa M, Alwakil S, et al. Dietary recommendations for people with diabetes in special situations: a position statement report by Arabic Association for the Study of Diabetes and metabolism (AASD). J Health Popul Nutr. 2024 Sep 3;43(1):139. doi: https://doi.org/10.1186/s41043-024-00619-y

Chen JH, Chen JY, Chen YC, Li WC. Sex difference in the association between creatinine-to-cystatin C ratio and metabolic syndrome among Chinese adults. Front Endocrinol (Lausanne). 2024;15:1389295. doi: https://doi.org/10.3389/fendo.2024.1389295

Christensen S, Robinson K, Thomas S, Williams DR. Dietary intake by patients taking GLP-1 and dual GIP/GLP-1 receptor agonists: A narrative review and discus¬sion of research needs. Obes Pillars. 2024 Jul 25;11:100121. doi: https://doi.org/10.1016/j.obpill.2024.100121

Chen J, Jia S, Guo C, Fan Z, Yan W, Dong K. Research Progress on the Effect and Mechanism of Exercise Intervention on Sarcopenia Obesity. Clin Interv Aging. 2024 Aug 8;19:1407-22. doi: https://doi.org/10.2147/CIA.S473083

Damanti S, Citterio L, Zagato L, Brioni E, Magnaghi C, Simonini M, et al. Sarcopenic obesity and pre-sarcopenia contribute to frailty in community-dwelling Italian older people: data from the FRASNET study. BMC Geriatr. 2024 Jul 31;24(1):638. doi: https://doi.org/10.1186/s12877-024-05216-6

Wang M, Tan Y, Shi Y, Wang X, Liao Z, Wei P. Diabetes and Sarcopenic Obesity: Pathogenesis, Diag-nosis, and Treatments. Front Endocrinol (Lausanne). 2020 Aug 25;11:568. doi: https://doi.org/10.3389/fendo.2020.00568

Diolintzi A, Panagiotakos DB, Sidossis LS. From Mediterranean diet to Mediterranean lifestyle: a narrative review. Public Health Nutr. 2019 Oct;22(14):2703-13. doi: https://doi.org/10.1017/S1368980019000612

Galan-Lopez P, Sanchez-Oliver AJ, Pihu M, Gís-ladóttír T, Domínguez R, Ries F. Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The Adoles Health Study. Nutrients. 2019 Dec 27;12(1):77. doi: https://doi.org/10.3390/nu12010077

American Diabetes Association. Lifestyle Mana-gement: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019 Jan;42(Suppl 1):S46-S60. doi: https://doi.org/10.2337/dc19-S005

Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, et al. Mediterranean-Style Diet Improves Systolic Blood Pressure and Arterial Sti¬ffness in Older Adults. Hypertension. 2019;73(3):578-86. doi:https://doi.org/10.1161/HYPERTENSIONAHA.118.12259

Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc. 2019 Aug 20;8(16):e012865. doi: https://doi.org/10.1161/JAHA.119.012865

Mirabelli M, Chiefari E, Caroleo P, Arcidiacono B, Corigliano DM, Giuliano S, et al. Long-Term Effec-tiveness of Liraglutide for Weight Management and Glycemic Control in Type 2 Diabetes. Int J Environ Res Public Health. 2019;17(1):207. doi: https://doi.org/10.3390/ijerph17010207

Brown TJ, Brainard J, Song F, Wang X, Abdelha-mid A, Hooper L, et al. Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;366:l4697. doi: https://doi.org/10.1136/bmj.l4697

Al-Ishaq RK, Abotaleb M, Kubatka P, Kajo K, Büsselberg D. Flavonoids and Their Anti-Diabetic Effects: Cellular Mechanisms and Effects to Improve Blood Sugar Levels. Biomolecules. 2019;9(9):430. doi: https://doi.org/10.3390/biom9090430

Xu H, Luo J, Huang J, Wen Q. Flavonoids intake and risk of type 2 diabetes mellitus: A meta-analysis of prospective cohort studies. Medicine (Baltimore). 2018;97(19):e0686. doi: https://doi.org/10.1097/MD.0000000000010686

Vilar-Gomez E, Calzadilla-Bertot L, WaiSun Wong V, Castellanos M, Aller-de la Fuente R, Metwal-ly M, et al. Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Stu¬dy. Gastroenterology. 2018;155(2):443-57.e17. doi: https://doi.org/10.1053/j.gastro.2018.04.034

Ganguli S, DeLeeuw P, Satapathy SK. A Review Of Current And Upcoming Treatment Modalities In Non-Alcoholic Fatty Liver Disease And Non-Alcoholic Steatohepatitis. Hepat Med. 2019;11:159-78. doi: https://doi.org/10.2147/HMER.S188991

Kaliora AC, Gioxari A, Kalafati IP, Diolintzi A, Kokkinos A, Dedoussis GV. The Effectiveness of Medi-terranean Diet in Nonalcoholic Fatty Liver Disease Clinical Course: An Intervention Study. J Med Food. 2019 ul;22(7):729-40. doi: https://doi.org/10.1089/jmf.2018.0020

Folch J, Olloquequi J, Ettcheto M, Busquets O, Sánchez-López E, Cano A, et al. The Involvement of Peripheral and Brain Insulin Resistance in Late Onset Alzheimer's Dementia. Front Aging Neurosci. 2019;11:236. doi: https://doi.org/10.3389/fnagi.2019.00236

Afzal M, Redha A, AlHasan R. Anthocyanins Potentially Contribute to Defense against Alzheimer's Disease. Molecules. 2019;24(23):4255. doi: https://doi.org/10.3390/molecules24234255

Rhea EM, Banks WA. Role of the Blood-Brain Barrier in Central Nervous System Insulin Resistance. Front Neurosci. 2019;13:521. doi: https://doi.org/10.3389/fnins.2019.00521