1. Introduction
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. Globally, it affects around 6% and 20% of women of reproductive age [1,2]. As per Rotterdam criteria, it is characterized by any two symptoms from hyperandrogenism, ovulatory dysfunction (OD, oligo-ovulation/anovulation), and polycystic ovaries (PCO) [3]. Further, PCOS can be categorized into four phenotypes based on the above symptoms. These are phenotype A (OD + hyperandrogenism + PCO), phenotype B (hyperandrogenism + OD), phenotype C (PCO + hyperandrogenism), and phenotype D (OD + PCO) [4]. It is a multifaceted disease with several metabolic disturbances like (insulin resistance), obesity, dyslipidemia, and an increased risk of type 2 diabetes and cardiovascular disease (Figure 1) [5]. One of the main pathophysiological characteristics of PCOS is defined as insulin resistance (IR), which exacerbates the clinical appearance of PCOS and contributes to hyperandrogenism (increase in free androgen levels) [6]. Hyperandrogenism can lead to an increase in PCOS symptoms like acne, hirsutism, and ovulatory dysfunction [7].
Although the exact causes of PCOS are still unknown, it is believed that both endogenous and exogenous factors play a significant role. Various factors like genetics, epigenetics, dietary preference, lifestyle, and environmental factors play an essential role in the etiology of PCOS (Figure 1) [8,9]. Hormonal dysregulation is also one of the hallmark features of PCOS, which manifests in elevated levels of androgens (hyperandrogenism) and the disrupted secretion of gonadotropins like luteinizing hormone (LH) and follicle-stimulating hormone (FSH) [10]. Furthermore, hyperinsulinemia exacerbates hyperandrogenism by stimulating ovarian theca cells to produce excess androgens. This suppresses sex hormone-binding globulin (SHBG), which increases free androgen levels in the [11,12]. Additionally, several immunological factors are recognized as playing roles in the development of PCOS [13]. Immunological factors involved in PCOS pathogenesis include chronic low-grade inflammation, characterized by a rise in IL-6, TNF-α, and CRP levels [14,15]
Oxidative stress and chronic inflammation together play critical roles in the development and progression of PCOS [16]. Oxidative stress exacerbates insulin resistance and hyperandrogenism, while inflammation disrupts ovarian function and increases cardiovascular risk [17]. Because of its multifactorial nature, the management of PCOS is complex, and it requires a comprehensive and individualized approach. According to the most recent international evidence-based guidelines, lifestyle interventions are the primary early strategy for assessing and managing PCOS [18]. Lifestyle changes, dietary patterns, physical activity, and stress management are crucial for controlling the symptoms of PCOS [19].
Diet and exercise are two crucial areas that must be addressed for lifestyle change adjustments to be successful. Dietary habits, including caloric intake, macronutrient composition, and the quality of food choices, play a critical role in weight management, insulin sensitivity, and inflammatory markers in women with PCOS [20]. A diet low in refined carbohydrates and high in fiber can help to regulate blood sugar levels and improve insulin sensitivity. Previous studies have reported the impact of various dietary patterns, including the consumption of low levels of saturated fat, a low glycemic index (GI) score, and the consumption of a high-fiber and ketogenic Mediterranean diet on PCOS management [21,22]. A diet low in refined carbohydrates and high in fiber helps to regulate blood sugar levels and improve insulin sensitivity [23]. Additionally, findings also revealed that dietary supplements such as inositol, vitamin D, and omega-3 fatty acids; mineral supplements (zinc, magnesium selenium, and chromium); and antioxidants like N-acetylcysteine (NAC) help in reducing insulin resistance, improving ovulatory function, and decreasing inflammation in PCOS patients [24,25,26]. Oxidative stress is linked to several clinical conditions, including obesity, type 2 diabetes, and cardiovascular illnesses. An increase in oxidative stress affects the pathophysiology of PCOS patients, which results in insulin resistance, increased androgen, and chronic inflammation [27]. A diet rich in antioxidants or a high-antioxidant-capacity diet (α-tocopherol, vitamin C, vitamin D, polyphenols, and β-carotene) decrease the odds of PCOS [28,29]. Obesity exacerbates PCOS symptoms; therefore, weight loss is also considered one of the strategies of PCOS management. Moreover, dietary modifications can help weight loss in overweight or obese women, lowering IR, testosterone levels, and other risk factors [30].
Physical activity is another cornerstone of PCOS management. Any movement the skeletal muscles produce that requires energy use is considered physical activity [31]. Physical activity and regular exercise (a combination of aerobic and resistance training) help improve insulin sensitivity, reduce body fat, and enhance cardiovascular health in women with PCOS [32]. Exercise also improves psychological wellbeing in women with PCOS. Along with this, various other methods like yoga (breathing, asana, mudras, and meditation), acupuncture, and naturopathy also help in managing regular hormone levels and menstrual cycles and reduce stress and anxiety in women with PCOS [33,34].
Conventional approaches to PCOS treatment have focused on pharmacological interventions like insulin sensitizers, anti-androgens, oral contraceptives, and ovulation induction [35,36]. These methods have not always addressed the underlying lifestyle factors that contribute to the development and persistence of PCOS. Further, this has led to the development of an interest in non-pharmacological approaches, particularly lifestyle modifications, for the management of PCOS. The present review aims to assess the studies in the last ten years and provide a systematic overview of the current evidence regarding the role of lifestyle modifications in managing PCOS.
2. Study Selection and Screening
We performed extensive literature searches in the PubMed, Embase, and Web of Sciences databases. The search strategy included the following keywords along with their medical subject headings (MeSH terms): “PCOS” OR “Polycystic ovarian syndrome” OR “Polycystic ovary syndrome” OR “Polycystic ovary disease” OR “Polycystic ovary disorder” OR “PCOD”; “diet” OR “low glycemic index diet” OR “anti-inflammatory diet” OR “high fiber diet” OR “lean protein”OR”omega-3 fatty acids” OR “antioxidant-rich diet” OR “ketogenic diet” OR “keto diet” OR “calorie restricted diet” OR “high protein diet” OR “time restricted diet” OR “microbiome rich diet”; “physical activity” OR “aerobic exercise” OR “regular exercise” OR “resistance training” OR “yoga” OR “meditation” OR “lifestyle” OR “quality of life”; “behavior modification” OR “mindfulness training program” OR “education module”; “clinical trial” OR “randomized controlled trial”. Only articles written in the English language and published in the last 10 years were included (Figure 2). Studies conducted in animal models and in vitro models were excluded. Only randomized controlled trials were included and all other study designs, such as observational studies, single-arm studies, systematic reviews, narrative reviews, etc., were excluded. Two authors screened titles and abstracts to verify their inclusion using Rayyan software (
We have received a total of 1157 studies, out of which 555 studies were found to be duplicates. After removing duplicates, 821 studies were primarily screened by title and abstract. After primary screening, 209 articles were selected, but only 103 articles in the full text were retrieved. After full-text screening, 80 papers were finally included in the study. Further papers were divided into three categories: ‘diet and supplements’, ‘physical activity’, and ‘behavioral and education model therapy’. This review was further developed by addressing each subcategory separately.
3. Dietary Habits and Supplements in PCOS Management
Several types of diets were assessed for PCOS management (Figure 3). The results of such RCT studies are summarized in Table 1. Each type of diet and its mechanisms are summarized below.
3.1. Low-Glycemic-Index (GI) Diet
A low-GI diet includes foods that cause a slow, gradual rise in blood sugar levels, helping to improve insulin sensitivity [86]. Further, stable insulin levels help to reduce excess androgen (testosterone) production and help to control symptoms like acne, hirsutism, and irregular menstrual cycles [87]. Studies have shown that incorporating a low-GI diet can play a significant role in controlling the metabolic and hormonal imbalances associated with PCOS in women. Additionally, low-GI foods, like whole grains (oats, quinoa, barley), legumes (beans, lentils), fruits (berries, apples, pears), and vegetables (leafy greens, broccoli, cauliflower), are rich in anti-inflammatory compounds. Findings show that dietary intervention (via a low-calorie, low-glycemic diet) increases uric acid and GPx3 (glutathione peroxidase) activity, further reducing inflammation and oxidative stress in women with PCOS [88]. In an RCT study on 37 women with PCOS, low-glycemic-index diets were given to 19 women, and 18 women received diets with normal glycemic index scores. The results showed an increase in ovulatory cycles and improvement in insulin resistance with decreased serum androgen levels [89]. In recent meta-analysis findings, low-GI diets reduce HOMA-IR, fasting insulin, total cholesterol, LDL cholesterol, triglycerides, waist circumference, and total testosterone levels compared to HGI diets in women with PCOS [90].
3.2. Ketogenic Diet
The ketogenic diet (KD) is a high-fat, adequate-protein and low-carbohydrate diet that forces the body into a metabolic state called ketosis [91]. In this condition, the body becomes highly adept at using fat rather than carbohydrates as fuel [92]. A ketogenic diet contains fats (55–60%), proteins (35%), and carbohydrates (5–10%) in total daily calories [93]. The therapeutic role of the KD diet has been observed in diabetes, obesity, epilepsy, depression, renal function, Alzheimer’s cardiovascular disease, etc. [94,95]. In an umbrella review including 17 meta-analyses of 68 RCT results, VLCKD (very-low-calorie ketogenic diet) was significantly associated with improving anthropometric and cardiometabolic outcomes [96]. Women with PCOS are frequently obese or overweight, which exacerbates IR and hormone abnormalities. The ketogenic diet may result in more successful weight loss because the body burns fat instead of glucose when in the metabolic state of ketosis. Studies have reported that a ketogenic diet helps to lower androgen levels and improve reproductive hormone levels, insulin sensitivity, and SHBG levels in PCOS women [21]. Similar results have been observed in a systematic review and analysis performed on 11 RCTs: the findings showed that the ketogenic diet significantly decreases [96] weight loss, BMI, waist circumference, and fat mass in obese or overweight women with PCOS [97]. However, it cannot be recommended in the long term as it has low carbohydrate and high fat content which can negatively affects the body as it has less nutritional value. Most of the studies have also intervened in KD for a shorter period only, with gradually increasing the calories during the intervention.
3.3. Anti-Inflammatory Rich Diet
Systemic inflammation plays a role in the etiology of PCOS [98]. In obese people, adipocytes release many pro-inflammatory cytokines that activate macrophages, leading to chronic low-grade inflammation. Further, increased cytokine levels result in disorder progressions like cardiovascular disease and insulin resistance [99,100]. Anti-inflammatory diets, rich in fruits, vegetables, whole grains, and omega-3 fatty acids, can help to mitigate inflammation. In RCT, the beneficial effects of green cardamom on the inflammatory markers in women with PCOS were observed. Findings from the study showed that inflammatory markers like TNF-α and IL-6 and CRP serum levels significantly declined in the intervention group compared to the placebo group [43]. Moreover, similar results were observed in a pilot study by Mizger et al., which showed that an anti-inflammatory diet improves total antioxidant capacity, IL-1 and IL-6, TNF-α, and androstenedione levels in girls with PCOS [101]. In addition to the above foods, onion (Allium cepa L.) has good anti-inflammatory properties, and results from clinical trials studies revealed that obese/overweight women with PCOS who consume a high dose of raw red onion showed a decrease in serum adiponectin, leptin, and hs-CRP level with non-significant changes in IR and anthropometric parameters [102,103].
3.4. Antioxidant-Rich Diet
Oxidative stress is an imbalance between antioxidants and oxidants in living biological systems [104]. Oxidative stress plays a vital role in the pathogenesis of PCOS, leading to insulin resistance, androgen excesses, and chronic inflammation [105,106]. Women with PCOS have an imbalance in their total serum antioxidant content, which exacerbates cellular damage and alters the defense mechanism [107]. Studies have shown that pregnant women with PCOS have high serum MDA (malondialdehyde) levels (an oxidative stress marker) and low antioxidant vitamin levels compared to healthy pregnant women [108,109]. Vitamin D plays a significant role as an antioxidant, reducing oxidative stress and inflammation in the body, and it helps to mitigate the harmful effects of reactive oxygen species (ROS) [110]. In a double-blind, placebo-controlled trial on 70 vitamin-deficient women with PCOS, when administrated to vitamin D supplementation for 4 weeks, the results showed beneficial effects on glucose homeostasis parameters, hs-CRP, and MDA levels [111]. Further findings from various clinical trials have shown that vitamin D supplementation to women with PCOS help to improve insulin sensitivity, glucose metabolism, lipid profiles, HOMA-B (homeostasis model of assessment-estimated B cell function), adiponectin, and other biochemical parameters [112,113,114]. In another RCT, women with PCOS, co-administered with vitamin D and omega-3 fatty acid for 12 weeks, saw beneficial effects on serum total testosterone, hs-CRP, and plasma TAC and MDA levels [115]. In addition to the above-mentioned antioxidant food, clinical trials have shown that the administration of various antioxidant supplements like selenium, green cardamom, astaxanthin, berberine phytosome, and isoflavones helps to improve anthropometric parameters, biochemical, hormonal and metabolic symptoms in women with PCOS [116,117,118,119,120].
3.5. Omega-3 Fatty Acids Rich Diet
Omega-3 fatty acids have powerful anti-inflammatory properties that can improve insulin sensitivity and decrease androgen levels in metabolic syndromes like PCOS [121]. An increasing intake of omega-3 and other PUFAs can help to reduce and alleviate low-grade chronic inflammation and other symptoms in women with PCOS via TGF-β signaling [122]. The sources of omega-3 fatty acids are fish, like salmon, mackerel, sardines, trout, and nuts, and seed oils, like flaxseed oil, chia seed oil, and walnut oil. The results from a double-blind RCT conducted on 64 overweight or obese women with PCOS showed improvement in serum adiponectin levels, IR, and the lipid profile in the intervention group as compared to the control group [123]. Studies also showed that omega-3 and vitamin E intake effectively improved the mental health parameters and gene expression of PPAR-γ, IL-8 and TNF-α in women with PCOS [124]. Further, omega-3 fatty acid supplements in women with PCOS helped to improve biochemical parameters LH, LH/FSH, lipid profiles, WC, adiponectin levels, and regularized the menstrual cycle [125,126].
3.6. High-Fiber, High-Protein Diet and Other Dietary Supplements
Foods rich in fiber content and a high-protein diet, preferably from lean protein sources, helped to slow the absorption of sugar into the bloodstream, preventing spikes in blood glucose and insulin levels [127]. Improved insulin sensitivity can help to reduce androgen levels and improve androgen levels, hormones, and menstrual irregularities. High-fiber foods include vegetables (broccoli, spinach, carrots, and kale), fruits (apples, berries, pears, and oranges), whole grains (brown rice, quinoa, whole oats, and barley), legumes (lentils, chickpeas, and black beans), and nuts and seeds (almonds, flaxseeds, and chia seeds). Studies have shown that fiber intake in women with PCOS was negatively correlated with IR, fasting insulin, glucose tolerance, and androgen levels [128]. Additional findings from an RCT study on 48 women with PCOS showed a reduction in serum insulin, TAG and LDL, and cholesterol and a significant increase in TAC and GSH levels in those groups in which women consumed a diet rich in fruits, vegetables, whole grains, and low-fat dairy products. Many dietary supplements like carnitine reduce carotid intima-media thickness and inflammatory factors in women with PCOS [129]. The administration of melatonin in women with PCOS also showed a reduction in hirsutism, testosterone, hs-CRP, and MDA levels with an elevation in TAC and GSH levels [130].
In addition to the above-mentioned dietary supplements DASH (The Dietary Approaches to Stop Hypertension) diet is also found be effective for women with PCOS, improving reproductive health [131]. A DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets; in addition to this, the intake of sodium should be less than 2400 mg/day [132]. The DASH eating plan is a low-glycemic-index low-energy-dense diet that was first suggested to lower blood pressure [133]; however, the beneficial effects of DAH diet alone and with whole-food, plant-based diets have also been reported regarding insulin resistance, inflammation diabetes, and metabolic syndrome [134,135,136].
3.7. Microbiome Rich Diet
Research has shown the existence of a close association between the gut microbiota of PCOS patients and the development of insulin resistance, which is a corresponding factor for PCOS, manifesting through short-chain fatty acids, lipopolysaccharides, sex hormones, and the brain–gut axis [78]. Compared with healthy people, the diversity in the gut microbiota of PCOS patients shows a reduction with changes in composition, damaging the intestinal mucosal barrier [137]. Healthy gut microbiota can be restored by switching to a healthy diet. A microbiome-rich diet is rich in fermented foods, whole grains, fruits/seeds, and fiber. It can also be supplied via probiotic or symbiotic supplements. In an RCT where women with PCOS were treated with multispecies probiotic supplementation for 8 weeks, the results showed non-significant improvement in pancreatic β-cell function and the CRP level in women with PCOS [138]. In another double-blind RCT on sixty women with PCOS, the administration of synbiotic supplementation (Lactobacillus and Bifidobacterium strains) for 12 weeks resulted in beneficial effects on IR, triglycerides, and VLDL cholesterol levels [116]. A meta-analysis of 7 RCTs revealed that probiotic/symbiotic supplementation decreased insulin and triglyceride levels and increased HDL levels compared to the control in women with PCOS. Although insignificant, they also improved other biochemical and anthropometric parameters [139]. Another meta-analysis of 8 RCTs showed that probiotic/symbiotic treatment can effectively improve hormonal, glucose homeostasis, and inflammatory outcomes of PCOS [140]. Therefore, they can also serve as a good option for PCOS management.
4. Physical Activity (Aerobic Exercise and Resistance Training) and PCOS
Aerobic exercise is any activity that uses large muscle groups, is maintained continuously, and is rhythmic in nature [141]. Studies have proven that exercise, particularly aerobic workouts, offers multiple benefits for managing PCOS symptoms, such as improving insulin sensitivity, cardiovascular health, and hormonal balance (Figure 4) [142,143]. Aerobic exercise, such as brisk walking, running, cycling, or swimming, helps to enhance insulin sensitivity by improving how muscles absorb glucose from the blood. It may regulate menstrual periods by lowering insulin levels and enhancing ovarian function [144,145]. In a study on women with PCOS, a significant decrease in BMI and fat mass was observed, along with an increase in FSH, free testosterone, and sex-hormone-binding globulin (SHBG) levels, in the experimental group (exercised for 12 weeks, 3 sessions of 20 min) as compared to the control [146]. International guidelines for the management of PCOS also recommended that adults (18–64 years) should aim for a minimum of 250 min/per week of moderate-intensity activities or 150 min/per week of vigorous-intensity activities or an equivalent combination of both, plus muscle-strengthening activities (e.g., resistance/flexibility), ideally on two non-consecutive days per week [18]. Various types of aerobic exercises which can be used to improve PCOS symptoms are listed below:
(i) HIIT (high-intensity interval training) includes short bursts of intense activity followed by rest or low-intensity periods. (ii) MICT (moderate-intensity interval) training includes moderate-intensity exercise, such as jogging, swimming, or cycling. (iii) IAT (intermittent aerobic training) is similar to HIIT but has lower intensity and longer active intervals. (iv) CAT (continuous aerobic training) includes steady-state aerobic exercise with consistent pace and intensity and long-distance running or cycling. The results of clinical trials that assess the impact of physical activity in managing PCOS are summarized in Table 2.
Resistance training is a kind of strength or weight training encompassing workouts that enhance muscle strength and endurance by working against some form of resistance. Findings from various studies have shown that resistance training alone and along with aerobic exercise helped in reducing the symptoms of PCOS. Combined (RT resistance training + MICT) is a type of physical exercise that incorporates both aerobic (moderate-intensity) and resistance (strength) training and also helps to improve metabolic function, overall fitness, and weight management in women with PCOS. A systematic review including 7 RCTs showed that physical exercise helped to improve reproductive functions, hormonal balance, and menstrual cycle regularity [160]. Likewise, meta-analysis related to physical exercise interventions on women with PCOS (data from 19 studies) has shown that physical exercise helps to reduce BMI and waist circumference. Results also suggested that a minimum of 120 min per week of vigorous-intensity exercise is required to produce beneficial health effects for women with PCOS [161].
5. Behavioral and Education Module
A lot of mental issues, like depression, anxiety, body image concerns, low self-esteem, eating disorders, stress, emotional strain, mood swings, sleep disorders, etc., are also associated with PCOS [162]. These issues often degrade patients’ quality of life and must be addressed via conventional treatment [163,164]. Developing a behavioral or education model can be an effective way to help women with PCOS to improve the effectiveness of conventional treatment and provide a holistic approach to PCOS management [165,166]. These modules may include education about understanding PCOS and treatment options available, behavioral interventions (diet, exercise, sleep), stress management (relaxation techniques, cognitive therapy), dealing with body changes, goal setting, tracking progress, positive reinforcement, etc. [167,168]. They can be designed as counselling/therapy sessions, group discussions, workshops, education materials, or mobile apps [169,170]. Table 3 summarizes the results of RCTs that have studied the effectiveness of these modules in PCOS patients.
In an RCT involving 161 patients, a one-time structured education module significantly (p < 0.05) improved the understanding of PCOS and quality of life (emotions, fertility, weight and mental wellbeing), but could not improve anthropometric and biochemical parameters [182]. Another study focused on 181 women with PCOS who wanted to conceive and received 20 group sessions of cognitive behavioral therapy (CBT) with or without a short message service (SMS) as compared to standard care. Groups receiving CBT showed better weight loss results than those receiving standard care, and the inclusion of SMS further enhanced the benefits [183]. Additionally, an RCT study with 28 women with PCOS was administered with 2 months of mindfulness stress management training, which resulted in a significant decrease in anxiety, depression, and stress and an increase in quality of life as compared to the control [184]. In a recent meta-analysis (8 RCTs), it was shown that supplementing behavioral interventions to routine treatment of PCOS plan enhances the reduction in weight, BMI, and waist circumference and improvement in depression conditions [185]. In a meta-analysis of 8 studies, it was observed that cognitive behavioral therapy helps to reducing anxiety and improve the quality of life, compliance, and pregnancy rate in PCOS patients [186].
Further, several clinical trials have been conducted using multiple lifestyle interventions like dietary measures, behavioral measures, and physical exercise for the treatment of PCOS. In a randomized three-arm parallel study, women with PCOS received structured support, including dietary counseling, a tailored exercise regimen, and behavior change strategies to improve physical activity levels. Results showed that BMI, waist circumference, and total cholesterol levels were significantly decreased in the intervention group. Findings from the study showed that dietary changes were associated with better metabolic outcomes, suggesting that targeted nutritional adjustments are essential for effective PCOS management, particularly for weight control and reducing metabolic risks [187]. In an RCT, women with PCOS received a structured lifestyle program focused on diet and exercise. This was tailored to improving physical activity levels and addressing common exercise barriers. The intervention significantly reduced perceived barriers to exercise. It enhanced perceived benefits, suggesting that lifestyle modification can make exercise more accessible and appealing for women with PCOS, potentially supporting better long-term health outcomes [151].
6. Future Perspective
As research on PCOS treatment goes on, lifestyle modifications like dietary changes, physical activity, and behavioral changes are recognized as essential components of its management or treatment. Integrating multiple lifestyle modifications provides the most comprehensive benefits in managing PCOS. Evidence shows that these changes help to improve PCOS symptoms like insulin sensitivity, weight management, menstrual cycle regularity, and metabolic parameters. Further, due to heterogeneity in PCOS in terms of phenotypes, clinical presentations, underlined pathophysiology, and response to treatment, personalized interventions are needed. This can be achieved using artificial intelligence to plan individualized dietary/exercise interventions [188]. Further, women with PCOS often experience depression, anxiety, and a diminished quality of life, which can undermine adherence to lifestyle changes. Future research should explore integrative approaches that combine lifestyle interventions with mental health support, such as cognitive-behavioral therapy or mindfulness/meditation practices, which can reduce depression and improve quality of life.
7. Conclusions
In conclusion, lifestyle modifications, encompassing dietary changes, physical activity, and behavioral interventions, are pivotal in managing PCOS by addressing both metabolic and reproductive complications. Evidence from various RCTs suggests that dietary, interventions such as low-glycemic-index foods; caloric restrictions; high-fiber, ketogenic, and Mediterranean diets; omega three- and antioxidant-rich food; and anti-inflammatory diets help to improve insulin sensitivity and hormonal balance and reduce PCOS symptoms. Out of these, the DASH diet and low-glycemic-index (GI) diet are highly effective for PCOS management as they improve insulin sensitivity, reduce androgen levels, and regulate menstrual cycles. Likewise, regular physical activities (aerobic and resistance exercises) also enhance metabolic function and help to reduce weight, achieve glucose homeostasis, balance hormone levels, and improve overall quality of life. Among all the forms of exercise, the aerobic exercise (AE) was found to be more effective in PCOS. Furthermore, continuous aerobic training (CAT) and intermittent aerobic training (IAT) were found to be equally effective in reducing anthropometric indices and hyperandrogenism and in the improvement of quality of life (QOL) in women with PCOS. Further, the future of PCOS management lies in integrating personalized dietary and physical exercise interventions using technology-driven approaches.
R.G.: writing original draft, conceptualization, methodology; P.M.: writing original draft and editing, drawing figure; A.J.: editing, data curation; A.K.: editing, data curation; N.M.: conceptualization, editing, supervision, T.A.: editing, supervision, conceptualization. All authors have read and agreed to the published version of the manuscript.
The authors declare no conflict of interest.
Footnotes
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
List of studies (RCTs) showing the effects of different dietary and supplement interventions on women with PCOS.
| S. No. | Participant Details (n = Sample Size) | Location | Study Design | Intervention and Duration | Outcomes Studied | Major Findings * | Reference |
|---|---|---|---|---|---|---|---|
| Low-Glycemic-Index (GI) Diet | |||||||
| 1. | Women with PCOS, BMI < 45 kg/m2, aged 21–50 years (n = 30) | Birmingham, UK | Crossover RCT | 1 = LGL diet (41/19/40%, cho/protein/fat) | Self-reported appetite, ghrelin, glucagon | ↑ 4 h glucagon (1) | [ |
| 2. | Women with PCOS, (13–21 years), BMI > 85th percentile (n = 19) | Boston, US | RCT | 1 = LGL (45/20/35%, cho/protein/fat) | HT, WT, BMI, FT, TT, SHBG, DHEAS, TC, LDL, HDL, TG, hs-CRP, progesterone, OGTT, INS, HRQoL | ↓ BMI (2) > (1) | [ |
| Ketogenic Diet | |||||||
| 3. | Women with PCOS, aged (18–45 years), BMI 28–40 kg/m2 (n = 22) | Bologna, Italy | RCT open label | 1 = VLCKD | LH, FSH, E2, SHBG, HT, WT, BMI, WC, HC, FM, FFM, FG score, INSF, HDL, IR, TC, DBP, SBP, HOMA IR | ↓ BMI, WC, FM, FFM, DBP, SBP, INSF, HOMA IR, TC, HDL (1) | [ |
| 4. | Women with PCOS, aged (18–45 years), BMI > 25 kg/m2 (n = 14) | Padova, Vicenza territory | RCT (single-arm study) | 1 = KEMEPHY, (1600/1700 kcal with phytoextracts) | WT, BMI, FBM, LBM, VAT, FBM%, HDL, LDH, TG, TC, FT, TT, HOMA IR, INS, BG, E2, LH, FSH, DHEAS, LH/FSH, SHBG, FG score | ↓, WT, BMI, FBM, VAT, TG, TC, LDL, FBG, INS, LH, FSH, LH/FSH, FT | [ |
| Antioxidant-rich diet and omega-3 supplement | |||||||
| 5. | Women with PCOS, aged 18–45 years, (n = 41) | Iran | RCT open label | 1 = lifestyle modification + flax seeds (30 G) | HT, WT, BMI, WC, INS, HOMA IR, QUICKI, TT, SHBG, FAI, FG score, hs-CRP, IL-6, adiponectin, leptin, TG, BG, HDL, LDL, TC | ↓ WT, BMI, (1 = 2) | [ |
| 6. | Women with PCOS, aged (18–40 years), BMI > 25 kg/m2 (n = 62) | Iran | Double-blinded RCT | 1 = 2 omega-3 pills/day (180 mg EPA + 120 mg DHA) + 400 IU vitamin E | TAC, GSH, CAT, MDA, DIET, PAL | ↑ TAC, CAT (1) | [ |
| 7. | Women with PCOS, aged (18–45 years), BMI > 30 kg/m2 (n = 199) | Iran | RCT (double-blinded) | 1 = 3 g cardamom/meal +LCD | WT, BMI, WC, FM, LH, FSH, TSH, PRL, TT, AD, DHEAS, TNF-α, IL-6r, hs-CRP | ↓ WT, BMI, WC, FM (1 = 2) | [ |
| 8. | Non-diabetic PCOS women, aged > 18 years, (n = 96) | Spain | Partial RCT | 1 = MN group (ALA, 75 mg + NAC,100 mg + B6, 0.65 mg + SAMe, 200 mg) | BMI, WT, INS, BG, TG, TC, HDL, LDL, ALT, AST, GGT, BP, BIL, HOMA IR,17βEstradiol, 17 OHP, LH, FSH, FT, SHBG, DHEAS, AD, acne, hirsutism, alopecia, infertility, and QoL | ↓ HOMA-IR (1) | [ |
| 9. | PCOS women, aged (18–45 years), BMI < 30 kg/m2 (n = 60) | Iran | RCT (double blind) | 1 = 1 cap (200 mg EA) | WT, BMI, FBG, INS, IR, TC, TG, LDL, HDL, TAC, CRP, MDA, TNF-α, AMH, LH, FSH | ↓ FBG, INS, IR, TC, TG, LDL, MDA, CRP, TNF-α, TT, PRL, AMH (1) | [ |
| 10. | PCOS infertile women, aged (25–38 years) (n = 34) | Jerusalem | RCT (double blind) | 1 = omega-3 supplementation (3 × 600 mg) (360 mg EPA and 240 DHA) | HT, WT, BMI, LH, FSH, TT, ET, follicle number, E2 | 26.7% clinical pregnancy with ↓ BMI (1) | [ |
| 11. | PCOS women, aged (20–45 years) BMI 30–40 kg/m2 (taking OCPs) | Iran | RCT (double blind) | 1 = Thylakoid-rich (5 g spinach extract) + hypocaloric diet | HT, WT, BMI, HC, WC, LPF, BNDF, OS (MDA, TAC and CAT), S 100B, LH/FSH, FBG, HOMA IR, FTI, INS, PAL | ↓ LPF (1) | [ |
| 12. | PCOS women, aged 18–45 years, (n = 80) | India | RCT | 1 = intervention (n = 40), NAC—1200 mg/day, twice/day | HOMA IR, WT, QoL, BMI, AD, TT, SHBG, menstrual regularity | ↓ HOMA IR, TT, (1 = 2) | [ |
| 13. | PCOS women, aged 20–50, BMI 30–30 kg/m2 (n = 80) | Iran | RCT | 1 = INTERVENTION (n = 40), 800 mg/day garlic pill | WT, BMI, WC, HC, WHR, TAC, CAT, GSH, MDA | ↓ WT, BMI, WC, CAT, GSH | [ |
| 14. | PCOS women, aged 20–40 years, BMI 25–35 kg/m2 (n = 86) | Iran | RCT | 1 = 200 mg CoQ10 daily + vitamin E placebo (n = 22) | WT, BMI, LH, FSH, TT, SHBG, P, E2, FAI, HOMA IR | ↓ TT, FBG (1 = 2 = 3) | [ |
| 15. | PCOS women, aged 18–40 years, (n = 80) | Iran | RCT | 1 = intervention (n = 40) oligopin 50 mg | WT, BMI, WC, TT, FAI, SHBG, DHEAS, LH, FSH, HbA1C, HOMA IR, FG score, PRL, C-Peptide, INS, TSH, FBG, ALT, AST, ALP, TG, TC, HDL, LDL, BUN, hs-CRP | ↑ FSH (1) | [ |
| 16. | PCOS women, aged 18–45 years, (n = 72) | Iran (Fatty Acid) | RCT (double blind) | 1 = intervention canola (25 mg) (n = 24) | WT, BMI, TG, HDL, LDL, TC, SHBG, FBG, INSF, FATTY LIVER GRADE, MUFA | ↑ MUFA (1 = 2) | [ |
| 17. | PCOS women, aged 19–35 years, (n = 60) | Viena, Austria | RCT (double blind) | 1 = MSG (1 Cap omega 3 fatty acid + 1 Cap FA, Vit E, Se, catechin, glycyrrhizin, co-enzyme Q10 | AMH, TT, AD, LH, FSH, LH/FSH, SHBG, E2, TSH, PRL, | ↓ LH/FSH, AMH, TT (1) | [ |
| Vitamin D Supplement | |||||||
| 18. | Vitamin D-deficient PCOS women, aged 21–34 years (n = 60) | China | RCT | 1 = Intervention (n = 30), vitamin D 2000 IU/day + Healthy diet + physical activity | WT, BMI, WC, HC, WHR, AMH, LH, FSH, PRL, E2, P, TT, OGTT, HOMA IR, TC, TG, LDL, HDL, INS | ↓ BMI, WHR, INS, HOMA IR, TG, TC, LDL (1) | [ |
| 19. | PCOS women, aged 18–45 years, BMI 18.5–40 kg/m2 (n = 80) | Iran | RCT | 1 = Vit D (n = 20), vitamin D 50,000 IU/weekly + placebo (paraffin oil daily) | WT, BMI, WC, TG, TC, LDL, HDL, FBG, HOMA IR, SHBG, PAL, INS | ↓ WC (1) = (2) = (3) | [ |
| High-Protein and High-Fiber Diet | |||||||
| 20. | PCOS women (n = 64) | Iran | RCT (double blind) | 1 = HSDF (hypocaloric) std diet, 55/15/30% carb/protein/fat + fennel, 2 cap/day) | HT, WT, BMI, WC, HC, WHR, TT, SHBG, FAI | ↑ Protein intake (2) | [ |
| 21. | PCOS women, aged 18–40 years, (n = 60), | Iran (protein) | RCT | 1 = test diet, (n = 30)–0.8 g protein/kg/body weight (35% animal proteins, 35% textured soy protein and 30% vegetable proteins) | WT, BMI, WC, HC, INSF, HOMA IR, QUICKI, FG score, menstrual irregularities, FBG, TG, HDL, LDL, VLDL, SFA, hs-CRP, NO, TAC, GSH, MDA, LH, FSH, TT, | ↓ WT, BMI, WC, HC, SFA (INTAKE), INSF, HOMA IR, FBG, TT, TG, VLDL, MDA (1) | [ |
| 22. | PCOS women, aged 15–41 years, (n = 25) | China (high-protein) | RCT | 1 = WTP (n = 14), high-fiber diet + prebiotic whole grains | WT, BMI, OGTT, HbA1C, TT, FG score, LH/FSH, LH, FSH, LIPIDS, OREXIN, SPEXIN, IR, LEPTIN | ↑ TT (1) | [ |
| 23. | PCOS women (18–35 y) | Canada | Parallel-group-stratified RCT | 1 = pulse-based diet (2 pulse meals) | WT, HT, BMI, WC, TG, TC, LDL, HDL, hs-CRP, LH, FSH, HbA1C, SHBG, DHEAS, 17-OHP, TSH, OGTT, Diet, PAL | ↓ INS, DBP, TG, TC/HDL,(1) | [ |
| Calorie-Restricted Diet | |||||||
| 24. | PCOS women, 18–45 years, BMI 25–35 kg/m2 (n = 72) | Iran | Double-blinded RCT | 1 = LCD + 3 capsule of licorice extract (500 mg licorice+ 36.5 mg glycyrrhizic acid | WT, FM, BMI, FBG, INS, LDL, HDL, TC, TG, HOMA IR, HOMA B | BMI, FM, HOMA IR, TC, TG, LDL, HDL (1) | [ |
| 25. | PCOS pregnant women, 18–45 years, BMI > 25 kg/m2 (n = 296) | China | RCT | 1 = individualized diet and exercise (1500/1600 kcal, 55/20/25% carbs/protein/fat) | GWG, GDM, PIH, TC, LDL, TG, HDL, FBG, FINS, HOMA IR | ↓ GWG (1) | [ |
| 26. | PCOS overweight/obese women, aged (18–45 years), >24 kg/m2 | Shenghai, China | RCT (open label) | 1 = Dulaglutide + CRD | WT, WC, BMI, FBG, FINS, HbA1C, ALT, AST, TC, TG, HDL, LDL, SUA, SHBG, INSPP, PPG, OGTT, LH, FSH, TT, PRL, FT, AD, DHEAS, FAI, HOMA IR | Shorter time to loss 7% wt loss (1) | [ |
| 27. | Overweight PCOS women, aged 16–45 years, BMI > 24 kg/m2 (n = 72) | China (med) | RCT | 1 = MD/LC, n = 36, (<20% CHO,100 g/day, ↑ proteins, fats, whole grains, good fats) | WT, BMI, WC, WHR, INSF, FBG, HOMA IR, menstrual irregularity, QUICKI, TC, TG, LDL, HDL, TT, LH, FSH, PRL, BF%, E2, | ↓ WT, BMI, WC, WHR, BF%, INSF, HOMA IR, TG, QUICKI, LDL, (1 > 2) | [ |
| 28. | PCOS women aged 13–18 years, BMI ≥ 95 percentile (n = 40) | Turkey | RCT (single-blinded) | 1 = RESMENA, n = 20 (7 meals/d, 40% CHO, 30% protein, 30% Fat) | Diet Quality, TEI, WT, PAL, FM, BF%, FFM, HC, WC, WHR, NC, BMI, FBG, INSF, TC, LDL, HDL, TG, ALT, HbA1C, TT, FT, DHEAS, AD, PRL, 17-OHP, SHBG, IL-6, TNF-α, hs-CRP, FG score, LH/FSH, HOMA IR, QUICKI, FAI, CHO, fiber, omega-3, | ↓ TEI, BMI, FM, BF, WT, WC, HC, FFM, (1 > 2) | [ |
| 29. | Adolescent PCOS, aged 15–17 years (n = 40) | Greece (med) | RCT | 1 = MD (n = 20), individualized dietary intervention | WT, BMI, diet quality, anxiety, depression, vitamin D, TG, FM, fiber, Ca | ↓ WT (1) > (2) | [ |
| 30. | Obese PCOS women, aged 20–45 years, BMI 30–40 kg/m2 (n = 48) | Iran | RCT | 1 = intervention (n = 21), 5 g thylakoid + CRD | WT, BMI, HC, WC, FM, FFM, WHR, FBG, INS, NEFA, HOMA IR, HOMA B, QUICKI, LH, FSH, DHEAS, TT, SHBG | ↓ WT, WC, FM, HOMA-IR, HOMA-B, QUICKI, INS, TT, (1 > 2) | [ |
| 31. | PCOS women, aged (18–45 years), BMI 30–45 kg/m2 (n = 40) | UK | RCT (open label) | 1 = VLCD (800 increased to 1600 kcal) | WT, BMI, WC, HC, FBG, FINS, TC, TG, HDL, LDL, HOMA IR, hs-CRP, BP, FAI | ↓ FAI, BW, WC, TC, FBG (1) | [ |
| Time-Restricted Diet | |||||||
| 32. | PCOS women aged (18–40 years), BMI > 24 kg/m2, (n = 18) | China | RCT | 6 weeks (1 week stabilizing + 5 week TRF (time-restricted feed) | BW, BMI, WHR, SMM, BFM, BF%, VFA, LH, FSH, LH/FSH, TT, SHBG, FAI, FG, FINS, HOMA IR, TG, TC, LDL, HDL, hs-CRP, ALT, AST, IGF 1, emotional eating, cognitive restraint scale | ↓ BMI, BFM, BF%, VFA, TT, FAI, FINS, HOMA IR, hs-CRP | [ |
| Microbiome-Rich Diet | |||||||
| 33. | PCOS women, aged 18–45 years (n = 40) | Poland | RCT | 1 = energy-restricted group | WT, WC, FM, BMI, TC, HDL, LDL, TG, Fecal SCFA (acetic, propionic, butyric acid) | ↓ WT, BMI, FM, acetic acid, (1 = 2) | [ |
| 34. | PCOS women, BMI > 25 kg/m2 (n = 65) | Poland | RCT (double-blinded, placebo) | 1 = LM + placebo | WT, BMI, FG score, OGTT (30, 60, 90, 120), INS, TT, LH, FSH, SHBG, 17-OHP, DHEAS, BF%, TC, TG, HDL, LDL, WC, WHR, HC | ↓ 95% BW, 5% BMI, HC, BF%, (1) | [ |
| 35. | PCOS women, aged (18.5–45 years), BMI 18–35 kg/m2 | Iran | RCT (triple-blinded) | 1 = intervention (2-g of 1011 Bacillus coagulans, 1010 Lactobacillus rhamnosus, 1010 Lactobacillus helveticus, 500 mg fructooligosaccharides, 0.7% natural orange flavoring) | WT, HT, BMI, WC, HC, PCOSQ (emotional, menstrual problem, infertility, body hair, weight, PSS, SF-12 (physical, mental) | ↑ PCOSQ (emotional, infertility) (1) | [ |
| 36. | PCOS women, aged (18–40 years) BMI 17–34 kg/m2, IR −1.4–4 (n = 60) | Iran | RCT (double-blinded) | 1 = intervention (vitamin D, 50,000 IU + 4 freeze-dried strains: Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus reuteri, Lactobacillus fermentum (2 × 109 CFU/g each) | WT, BMI, FG score, TT, SHBG, sleep quality, depression, anxiety, 25-OH vitamin D, hs-CRP, TAC, GSH, MDA, mental health | ↓ TT, FG score, MDA, hs-CRP, depression, stress, anxiety (1) | [ |
| 37. | PCOS women, aged (18–40), (n = 60) | Iran | RCT (double-blinded, placebo control) | 1 = 8 × 109 CFU/day probiotic (Lactobacillus acidophilus, Lactobacillus reuteri, Lactobacillus fermentum and Bifidobacterium bifidum (2 × 109 CFU/g each) + 200 μg/day selenium | WT, BMI, FG score, mental health, stress, anxiety, TT, SHBG, FAI, hs-CRP, TAC, GSH, MDA | ↑ Mental health, TAC, GSH | [ |
| 38. | PCOS women, aged (18–40 years) (n = 60) | Iran | RCT (double-blinded, placebo control) | 1 = intervention (Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2 × 109 CFU/g each) + 0.8 g inulin) | WT, BMI, FG score, FAI, hs-CRP, INS, NO, TAC, GLT, MDA, HOMA IR, FBG, SHBG, METs | ↑ SHBG, NO (1) | [ |
| 39. | Obese or overweight PCOS women, aged 20–44 years, BMI 25–44 kg/m2 | Iran | RCT | 1 = synbiotic (n = 34), Lactobacillus casei 3 × 109 CFU/g, Lactobacillus rhamnosus 7 × 109 CFU/g, Lactobacillus bulgaricus 5 × 108 CFU/g, genus Lactobacillus acidophilus 3 × 1010 CFU/g, Bifidobacterium longum 1 × 109 CFU/g, Streptococcus thermophilus 3 × 108 CFU/g, inulin-type prebiotics, FOS | WT, BMI, WC, HC, WHR, WHtR, PAL, INS, HOMA IR, TG, TC, HDL, LDL, FBG | ↓ HOMA IR, INS, WC, WHR, HC, WT, FBG, (1) | [ |
| 40. | Married PCOS women, aged 18–38 years, (n = 40) | Iran | RCT | 1 = Lactofem plus letrozole (n = 20), Lactobacillus acidophilus 2 × 109, Bifidobacterium bifidus 2 × 109, Lactobacillus rutri 2 × 109, Lactobacillus fermentum 2 × 109; capsule weight of 500 mg bio-capsule | BMI, WT, ACNE, FG score, clinical and chemical pregnancy, sexual function, body image, INS, FBG, TT, LH/FSH | ↑ Chemical and clinical pregnancy, sexual function, body image (1) | [ |
| 41. | PCOS women aged (19–37 years) | Iran | RCT (double-blinded) | 1 = synbiotic supplement (500 mg of seven strains beneficial bacteria) | WT, BMI, TG, TC, HDL, LDL, FSH, LH, E2, Progesterone, TT | ↑ HDL (1) | [ |
| 42. | PCOS women, aged (19–37 years), BMI > 25 kg/m2 (n = 88) | Iran | RCT (double-blinded, placebo) | 1 = intervention (Lactobacillus acidophilus 3 × 1010(CFU)/g, Lactobacillus casei 3 × 109 CFU/g, Lactobacillus bulgaricus 5 × 108 CFU/g, Lactobacillus rhamnosus 7 × 109 CFU/g, Bifidobacterium longum 1 × 109 CFU/g, Bifidobacterium breve 2 × 1010 CFU/g, Streptococcus thermophilus 3 × 108 CFU/g), prebiotic inulin | WT, BMI, FBG (0, 2 h), HbA1C, hs-CRP, apelin 36, HOMA IR, QUICKI, | ↓ apelin 36 (1) | [ |
| Micronutrient supplement | |||||||
| 43. | PCOS women, aged 18–45 years (n = 64) | Iran | RCT | 1 = intervention (n = 32), magnesium 250 mg/day | DHEAS, TT, sleep quality, FG score, | ↑ DHEAS (1) | [ |
| 44. | Infertile PCOS women, >18 years, (n = 48) | Turkey | RCT | 1 = micronutrient (n = 24) betaine 200 mg, l-cystine 200 mg, chelated zinc 10 mg, niacin (vit. B3) 16 mg, pyridoxine (vit. B6) 1.4 mg, riboflavin (vit. B2) 1.4 mg, 5-methyl-tetrahydrofolate, 400 μg, methylcobalamin 2.5 μg | Clinical pregnancy, blastocyst rate | Clinical pregnancy 58% (1) | [ |
| 45. | PCOS women, aged 18–45 years, (n = 64) | Iran | RCT | 1 = intervention (n = 32), 250 mg magnesium | Physical functioning, physical health, emotional problem, emotional wellbeing, energy fatigue, QoL, general health, social functioning, acne, alopecia, AUB | ↑ Physical functioning, physical health, emotional problem, emotional wellbeing, energy fatigue, QoL, general health, social functioning | [ |
| Essential Amino Acid Supplement | |||||||
| 46. | Adolescent PCOS women, aged 12–21, BMI > 90 percentile kg/m2 (n = 21) | Colorado, USA | RCT | 1 = intervention, 15 g EAA, 10% histidine, 11% isoleucine, 32% leucine, 16% lysine, 10% phenylalanine, 10% threonine, and 11% valine | WT, BMI, TG, AST, TT, HOMA IR, VLDL, PAL, TDE, WC, ALT, SHBG, FFA, HS, SUGAR, Visceral fat, subQ fat, BF%, PCOS-HS index | ↓ AST, HS, VLDL, TG, SUGAR (1) | [ |
| DASH Diet | |||||||
| 47. | Overweight/obese PCOS women, aged 18–40 y, BMI > 25 kg/m2 (n = 48) | Iran | RCT | 1 = DASH diet (52% CHO, 18% proteins, and 30% fats, Na < 2400 mg/day) (n = 24) | WT, BMI, WC, HC, FBG, INS, HOMA IR, HOMA B, QUICKI, hs-CRP | ↑ QUICKI (1) | [ |
| 48. | Overweight or obese PCOS women, aged 20–40 years, BMI 25–40 kg/m2 (n = 60) | Iran | RCT | 1 = DASH Diet (50–55% CHO, 15–20% Proteins, and 25–30% Fats, Na < 2400 mg/day) (n = 30) | HT, WT, BMI, WHR, WC, HC, SHBG, FAI, androstenedione, TT, TAC, FM | ↓WT, BMI, FM, androstenedione, TT, FAI, (1) | [ |
| 49. | Overweight/obese PCOS women, Aged 18–40 years, BMI > 25 kg/m2 (n = 48) | Iran | RCT | 1 = DASH diet (52% CHO, 18% proteins, and 30% fats, Na < 2400 mg/day) (n = 24) | WT, BMI, TG, TC, HDL, LDL, GSH, TAC, VLDL | ↑ TAC, GSH (1) | [ |
* Note: ↑ sign indicate increase and ↓ sign indicate decrease in the outcome mentioned adjacent to it. Parenthesis represents the groups in which significant difference was observed as compared to baseline. (<, =, >) signs indicates the intergroup relationship for the mentioned outcome. Abbreviations: VLCKD (very-low-calorie keto diet), LCD (low-calorie diet), E2 (estradiol), SHBG (sex-hormone-binding globulin), HT (height), FM (fat mass), FFM (fat-free mass), IR (insulin-resistant), DBP (diastolic blood pressure), SBP (systolic blood pressure), GWG (gestational weight gain), GDM (gestational diabetes), PIH (pregnancy-induced hypertension), FBG (fasting blood glucose), ALT (alanine aminotransferase), AST (aspartate aminotransferase), TC (total cholesterol), TG (triglyceride), SUA (serum uric acid), INSPP (insulin postprandial), PPG (postprandial glucose), OGTT (oral glucose tolerance test), PRL (prolactin), FT (free testosterone), AD (androstenedione), DHEAS (dehydroepiandrosterone sulfate), BF% (body fat percentage), TEI (total energy intake), PAL (physical activity level), NC (neck circumference), LDL (low-density lipoprotein), HDL (high-density lipoprotein), 17-OHP (17-hydroxy progesterone), IL-6 (interleukin factor 6), TNF-α (tumor necrotizing factor alpha), FAI (free androgen index), CHO (carbohydrate), Ca (calcium), INS (insulin), NEFA (non-esterified fatty acid), WT (weight), BMI (body mass index), WC (waist circumference), HC (hip circumference), WHR (waist hip ratio), MD (Mediterranean diet), RESMENA (metabolic syndrome reduction in Navarra), LC (low-carbohydrate), CRD (calorie-restricted diet), HSDF (hypocaloric standard diet with fennel), HHPF (hypocaloric high-protein diet with fennel), HSDP (hypocaloric standard diet with placebo), HHPP (hypocaloric high-protein diet with placebo), INSF (insulin fasting), HOMA B (homeostasis model assessment of β-cell), QUICKI (quantitative insulin sensitivity check index), VLDL (very-low-density lipoprotein), SFA (saturated fatty acids), hs-CRP (high-sensitivity C-reactive protein), NO (nitric oxide), TAC (total antioxidant capacity), GSH (glutathione), MDA (malondialdehyde), TT (total testosterone), LGL (low glycemic load), HGL (high glycemic load), UK (United Kingdom), USA (United States of America), HbA1C (haemoglobinA1c), FG score (Ferryman–Gallwey score), HOMA IR (homeostasis model assessment of index), LH (luteinizing hormone), FSH (follicle-stimulating hormone), LF (low-fat) WTP (whole grain, traditional Chinese, prebiotics), CAT (catalase activity), EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid), TSH (thyroid-stimulating hormone), GGT (gamma-glutamyl transferase), BP (blood pressure), BIL (billubirin), MN (micronutrient), NAC (N-acetyl cysteine), SAMe (S-Adenosylmethionine), B6 (vitamin b6), ALA (Alpha-lipoic acid), OC (oral contraceptive), ET (endometrium thickness), LPF (lipopolysaccharide), BNDF (brain-derived neurotrophic factor), OS (oxidant stress), S 100B (S100 calcium-binding protein B), FTI (free testosterone index), QoL (quality of life), CoQ10 (co-enzyme Q10), IU (international unit), ALP (alkaline phosphatase), BUN (blood urea nitrogen), MUFA (monounsaturated fatty acid), fecal SCFA (short-chain fatty acid), LM (lifestyle modification), PCOSQ (PCOS quality of life), PSS (perceived stress score), SF-12 (short form), CFU (colony forming units), MET (metabolic equivalent), WHR (waist–height ratio), AMH (anti-mullerian hormone), P (progesterone), O3 (omega-3), TDE (total dietary intake), HS (hepatic stenosis), subQ fat (subcutaneous fat), PCOS-HS (health survey) index, AUB (abnormal uterine bleeding).
List of studies investigating the effects of physical activity (exercise) PCOS outcomes.
| S. No | Participant Details (n = Sample Size) | Location | Study Design | Intervention and Duration | Control | Outcomes Studied | Major Findings * | References |
|---|---|---|---|---|---|---|---|---|
| 1. | Women with PCOS, age = 18 to 39 years, | Brazil | RCT | 1 = CAT | 3 = no intervention (n = 30) | FSH, LH, TSH, SHBG, | ↓ HC, HR, T, C, LDL, BF (1 > 2) | [ |
| 2. | Women with PCOS, | Brazil | RCT | 1 = MICT = 50 min, 3 times/week (n = 25) | 3 = no intervention | I, C, BMI, VO2 peak, VO2, VCO2, HR, SBP, DBP, MBP, ECG, HRV, BPV, BRS | ↓ HR, T (1 = 2) | [ |
| 3. | Women with PCOS, | Egypt | RCT | 1 = AEM = treadmill walking, 3 sessions/weeks + 1500 mg Metformin for 12 weeks, (n = 20) | -- | IL-6, CRP, TNF-α, TVS, BMI, MFG score | ↓ IL-6, CRP, TNF-α (1 > 2) | [ |
| 4. | Women with PCOS, age = 18–40 years, (n = 47) | Canada | Pilot RCT | 1 = HIIT = BMI < 28 kg/m2 = 10 cycles of 30 s at high intensity (90% of HRR), (n = 16) | 3 = no intervention, (n = 17) | BMI, Glu, C, HDL, TG, ALT, GGT, LDL, VO2 max | ↓ BMI (2 > 3), | [ |
| 5. | Women with PCOS, | Australia | RCT | 1 = DO, 6000 KJ/day energy-restricted high-protein meal plan (n = 13) | -- | EBBSscore, BMI, VO2 peak, PCOSQ, CES-D | ↑ VO2max (2 > 3) | [ |
| 6. | Women with PCOS, (n = 31) | Norway | Pilot RCT | 1 = HIIT = BMI > 27 kg/m2, HIT 2 sessions 4 times 4 min at 90–95% of HRmax) (n = 10) | 3 = 150 min of MIE (n = 10) | HOMA-IR, G, C, HDL, LDL, TG, CRP, I, adiponectin, TG, L, T, H, AMH, SHBG, DHEAS, FMD, W, BC, VF, VO2max, FMD, FAI, MFG score | ↑ HOMA-IR, HDL, FMD (1 > 2) | [ |
| 7. | Women with PCOS, age = 18 to 40 years, (n = 45) | Iran | RCT | 1= HIIT | 3 = no intervention (n = 15) | W, BMI, WHR, FP, VAT, VO2max, MSFT | ↓ W, BMI, WHR, FP, VAT (1 = 2) | [ |
| 8. | PCOS overweight/obese women, | Brazil | RCT | 1 = 14 = AE | 2 = no intervention (n = 13) | HRQL, VO2max, W, H, BP, WC, OGTT, HDL, LDL, TNF-α, IL-6, CRP, HOMA-IR, MFG, DHES, LH, FSH, HRmax, CRF, C, SBP, DBP | ↑ CRF and HRQL (1) | [ |
| 9. | Women with PCOS | Iran | RCT | 1 = 14 = HIIT | 2 = no intervention (n = 14) | VAI, Glu, HDL, AIP, H, CRP, W, BMI, FP, WHR, VAT, VO2max, I, HOMA-IR, LDL, C, HDL, TG. | ↓ BMI, WHR, VF, I, IR, LDL, AIP, C, CO (1) | [ |
| 10. | Women with PCOS | Iran | RCT | 1 = 20 = AE | 2 = no intervention | W, BMI, T, Pr, E, BM, BMI, C, TG, LDL, HDL | ↓ T, Pr, E, BM, BMI, C, TG, LDL (1) | [ |
| 11. | Women with PCOS, | Australia | Two centre RCT | 1 = HV-HIIT | 3 = no intervention | PCOSQ, FG score, HRmax, VO2max, OGTT, HOMA-IR, C, LDL, HDL, TG, Pr, T, AMH, SHBG, I, WC, HC, FP, BP, pregnancy rate | ↑ Pregnancy rate (2 > 3) | [ |
| 12. | Women with PCOS, | Brazil | RCT | 1 = CAT | 3 = no intervention | FSH, LH, TSH, SHBG, | ↓ WC, HP, C, LDL, T (1) | [ |
| 13. | Women with PCOS, aged 18–40 years, 18.5–40 kg/m2 (n = 23) | Brazil | RCT | 1 = Intervention (n = 12), HIIT 40–60 min, 3 days/week followed by detraining 30 days | 2 = Control (n = 11) | W, BMI, WC, HC, WHR, QOL, anxiety, depression, FG score, FBG, OGTT, TC, HDL, LDL, TG, total fat, trunk fat, gynoid, android | ↑ QOL (1) | [ |
* Note: ↑ sign indicate increase and ↓ sign indicate decrease in the outcome mentioned adjacent to it. Parenthesis represents the groups in which significant difference was observed as compared to baseline. (<, =, >) signs indicates the intergroup relationship for the mentioned outcome. Abbreviations: group (G), control group (CG), minutes (mins), weight (W), height (H), aerobic exercise (AE), continuous aerobic training (CAT), intermittent aerobic training (IAT), aerobic exercise group (AEM), metformin group (M), continuous aerobic exercise training (CAET), heart rate reserve (HRR), diet only (DO), diet and aerobic exercise (DA), diet and combined aerobic resistance exercise (DC), high-intensity training (HIT) high-intensity interval training (HIIT),physical exercise (PE), moderate intensity (MI), insulin resistance (HOMA-IR), strength training (ST), between (b/w), heart rate maximum (HRmax), anti-Müllarian hormone (AMH), insulin resistance (IR), inulin fasting (I-F), insulin postprandial (I-PP) flow-mediated vasodilation (FMD), free androgen index (FAI), clomiphene citrate (CC), moderate-intensity continuous training (MICT), depression anxiety stress scales (DASS-21), 36–item short-form health survey (SF-36), polycystic ovary syndrome questionnaire (PCOSQ), body composition (BC), body fat (BF), maximal oxygen consumption (VO2 max), peak heart rate (HRpeak), insulin sensitivity index (ISI), metabolic equivalent (MET), depression (D), anxiety (A), stress score (SS), physical functioning (PF), general health (GH), combined resistance training (CRT), moderate-intensity interval continuous training (MICT), multi stage fitness test (MSFT), fat percentage (FP), visceral adipose tissue (VAT), waist to hip ratio (WHR), hip circumference (HC), homocysteine (H), leptin (L), visceral fat (VF), modified Ferriman–Gallwey score (MFG score), waist (W), waist circumference (WC), luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), prolactin (Pr), testosterone (T), dehydroepiandrosterone sulfate (DHEAS), sex-hormone-binding globulin (SHBG), insulin (I), glucose (Glu), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (C), triglycerides (TG), serum glutamic oxloacetic transaminase (SGOT), C-reactive protein (CRP), telomere length (TL), transvaginal scan (TVS), hyperandrogenism (HA), 75-g oral glucose tolerance test (OGTT), cortisol (CO), androstenedione (A), muscle biopsy (MB), body fat mass (BFM), body mass (BM), estradiol (ES), fat-free mass (FFM), repetition maximum (RM), moderate-intensity exercise (MIE), oral contraceptive pill (OCP), lifestyle modification (LM), calorie restriction (CR), meal replacement (MR), antiobesity medication (AOM), behavioral modification (BM), physical activity (PA), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), electrocardiographic (ECG), heart rate (HR), blood pressure variability (BPV), baroreflex sensitivity (BRS), ventilation of carbon dioxide production (VCO2), volume of oxygen (VO2), moderate-intensity exercise (MIE), quality of life (QOL), ovarian volume (OV), antral follicle count (AFC), cardio respiratory fitness (CRF), atherogenic index of plasma (AIP), maximum aerobic velocity (MAV), estrogen (E), 17-hydroxyprogesterone (OHP), low-volume–high-intensity interval training (LV–HIIT), high-volume–high-intensity interval training (HV-HIIT), trunk fat percentage (TFP), leg fat percentage (LFP), total gynoid mass (TGP),free androgen index (FAI), quality of life SF–36 (QOL SF-36), health-related quality of life (HRQL), resistance training(RT), baroreflex sensitivity (BRS), and mean blood pressure (MBP), peak oxygen uptake (VO2 peak), body mass index (BMI), blood pressure (BP), Ferriman–Gallwey score (FG score), glucose tolerance test (GTT), Exercise Benefits/Barriers Scale (EBBS), Centre for Epidemiologic Studies Depression Scale (CES-D), visceral adiposity index (VAI), interleukin-6 (IL6), tumor necrosis factor (TNF-α), alanine transminase (ALT), heart rate variability (HRV), combined (COM), fasting blood glucose (FBG).
List of studies investigating the effects of behavioral and education modules on PCOS management.
| S. No. | Participant Details (n = Sample Size) | Location | Study Design | Intervention and Duration | Control | Outcomes Studied | Major Findings * | Reference |
|---|---|---|---|---|---|---|---|---|
| 1. | Women with PCOS, age => 18 years | China | RCT | 1 = TTM (n = 61) expert consultation provided—online chat assessment and recording of diet and exercise (consisting of PAG, AG, MG) | 2 = routine care, general advice on diet and exercise (n = 61) | SDS, SAS, WC, BMI, SDC | ↓ BMI, WC, SAS, SDS, anxiety, depression (1) | [ |
| 2. | Women with PCOS, | Iran | RCT | 1 = Counselling + CBT (n = 42) | 2 = routine care (n = 42) | SDOBQ, STAI, BDI, PCOSQ, | ↓ anxiety, depression (1) | [ |
| 3. | Women with PCOS | Netherlands | RCT | 1 = LI with SMS, maintaining active lifestyle by exercising and developing healthy dietary habits (n = 60) 20 CBT sessions with SMS | 3 = CAU = unstructured consultation by physician (n = 60) | DEBQ, EDEQ | Improved EDEQ scores (1 = 2) | [ |
| 4. | Women with PCOS | Australia | RCT | 1 = SIT = 3.5 h (n = 7) | -- | FMD, resting BP, resting FSR | ↑ mean FSR, BP (2 > 1) | [ |
| 5. | Women with PCOS, aged (18–42 years), (n = 52) | Iran | RCT (parallel, 3 stage design) | 1 = Intervention | 2 = control | Body image concerns, self-esteem | ↓ body image concern (at all 3 stages (1) | [ |
| 6. | PCOS women, aged (18–49 years) (n = 85) | Malaysia | RCT (single-blinded) | 1 = Intervention (info regarding PCOS, MS, Healthy lifestyle, nutrition, physical activity) | 2 = control (usual lifestyle modification) | KAP of diet, | ↑ knowledge of nutrition, IPAQ | [ |
| 7. | PCOS women, aged (n = 70) | Iran | RCT (double-blinded) | 1 = 5As | 2 = without 5As model | psychological symptoms, somatization, interpersonal sensitivity, anxiety, depression, hostility, obsessive–compulsive disorders | ↑ psychological symptoms, somatization, interpersonal sensitivity, anxiety, and hostility decreased (1) | [ |
| 8. | Infertile women with PCOS, aged 15–40 years (n = 60) | Iran | RCT | 1 = intervention, n = 30 (motivational interview 1/week, five sessions) | 2 = control, n = 30 (routine care) | health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, QOL | ↑ health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations (1) | [ |
| 9. | Women with PCOS, aged (18–40 years), BMI > 27 kg/m2 | Sweden | RCT | 1 = intervention (behavior modification, formal course, group meetings 3 times/month, with individualized coaching) | 2 = control (minimal intervention, healthy lifestyle recommendation) | HT, BW, WT, WHR, menstrual function, BF%, LBM, trunk fat, SHBG, HOMA IR, ET, TT, FAI | ↑ Menstrual function (59%), ET (1) | [ |
| 10. | Women with PCOS, aged (14–23 years) (n = 37) | Central Texas | RCT (pre–post) | 1 = mindfulness training program (medication adherence, nutrition, physical activity, sleep) | - | psychological distress, mindfulness, physical activity strategies, nutrition, exercise self-efficacy | ↑ nutrition self-efficacy, physical activity strategies, physical activity self-efficacy (1) | [ |
| 11. | Women with PCOS, | Netherlands | RCT | 1 = LI with SMS, maintaining active lifestyle by exercising and developing healthy dietary habits(n = 60) 20 CBT sessions with SMS | 3 = CAU = unstructured consultation by physician (n = 60) | IPAQ, PAR-Q | ↑ IPAQ (1 > 3) | [ |
| 12. | Women with PCOS | Netherlands | RCT | 1 = LI with SMS, maintaining active lifestyle by exercising and developing healthy dietary habits (n = 60) 20 CBT sessions with SMS | 3 = CAU = unstructured consultation by physician (n = 60) | HOMA-IR, BP, WC, Glu, I, cMetS z-score | ↓cMetS z-score (1 > 3) | [ |
| 13. | Women with PCOS | Iran | RCT | 1 = TTM–we conducted chat-based motivational interviews, diet and exercise diary (n = 35) | 2 = unstructured advised about healthy behavior | WC, BMI, SDC, HPLP-II | ↑HPLP-II (1) | [ |
| 14. | Women with PCOS, | Korea | RCT | 1 = LM-mobile application–calculation of calories, exercise time, hirsutism and acne scale | 2 = maintain usual lifestyle (n = 14) | FSH, LH, SHBG, DHEAS, ES, T, FG score, GAGS, K-CESD, I F and PP | ↓ weight, depressive symptoms, I PP, hirsutism (1 > 2) | [ |
* Note: ↑ sign indicate increase and ↓ sign indicate decrease in the outcome mentioned adjacent to it. Parenthesis represents the groups in which significant difference was observed as compared to baseline. (<, =, >) signs indicates the intergroup relationship for the mentioned outcome. Abbreviations: cognitive behavioral therapy (CBT), self-rating depression scale (SDS), self-rating anxiety scale (SAS), waist circumference (WC), body mass index (BMI), sociodemographic characteristics (SDC), sociodemographics and obstetric characteristics questionnaire (SDOBQ), Spielberger state-trait anxiety inventory (STAI), beck depression inventory (BDI), quality of life questionnaire for women with polycystic ovary syndrome (PCOSQ), quality of life (QOL), lifestyle intervention with additional short message service (LI with SMS), care as usual (CAU), Dutch eating behavior questionnaire (DEBQ), eating disorder examination questionnaire (EDEQ), pre-action group (PAG), action group (AG), maintenance group (MG), uninterrupted sitting (SIT), simple resistance activities (SRA), flow-mediated vasodilation (FMD), resting femoral shear rate (FSR), resting blood pressure (resting BP), lifestyle intervention with additional short message service (LSI with SMS), international physical activity questionnaire (IPAQ), physical activity readiness questionnaire (PAR-Q), metabolic syndrome (MetS), MetS severity z-score (cMetS z-score), sociodemographic characteristics (SDC), intervention group (IG), health-promoting lifestyle profile (HPLP)-II, self-efficacy scale for chronic disease (SECD6), transtheoretical model (TTM), aerobic exercise (AE), intertrochanteric section modulus (ISC), estradiol (ES), bone mineral density (BMD), bone mineral content (BMC), fat percentage (FP), testosterone (T), global acne grading system (GAGS), Korean version of the epidemiological studies depression scale (K-CESD), lifestyle modification (LM), resting femoral shear rate (resting FSR), resting blood pressure (resting BP), glucose (Glu), insulin (I), Ferriman–Gallwey score (MFG score), dehydroepiandrosterone sulfate (DHEAS), inulin fasting (I-F), insulin postprandial (I-PP), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex-hormone-binding globulin (SHBG), therapeutic lifestyle changes (TLC), knowledge attitude practice (KAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), eating attitude test (EAT-26), three factor eating questionnaire (TFEQ – R18), height (HT), weight (WT), waist hip ratio (WHR), body fat % (BF%), lean body mass (LBM), insulin resistance (HOMA-IR), endometrial thickness (ET), total testosterone (TT), free androgen index (FAI), ACT (Acceptance and commitment therapy, PCOS (Polycystic Ovarian Syndrome), MS (Metabolic Syndrome).
References
1. Singh, S.; Pal, N.; Shubham, S.; Sarma, D.K.; Verma, V.; Marotta, F.; Kumar, M. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. J. Clin. Med.; 2023; 12, 1454. [DOI: https://dx.doi.org/10.3390/jcm12041454] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36835989]
2. Deswal, R.; Narwal, V.; Dang, A.; Pundir, C.S. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J. Hum. Reprod. Sci.; 2020; 13, pp. 261-271. [DOI: https://dx.doi.org/10.4103/jhrs.JHRS_95_18]
3. Fauser, B.C.J.M. Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome. Fertil. Steril.; 2004; 81, pp. 19-25. [DOI: https://dx.doi.org/10.1016/j.fertnstert.2003.10.004]
4. Lizneva, D.; Suturina, L.; Walker, W.; Brakta, S.; Gavrilova-Jordan, L.; Azziz, R. Criteria, Prevalence, and Phenotypes of Polycystic Ovary Syndrome. Fertil. Steril.; 2016; 106, pp. 6-15. [DOI: https://dx.doi.org/10.1016/j.fertnstert.2016.05.003] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27233760]
5. Livadas, S.; Anagnostis, P.; Bosdou, J.K.; Bantouna, D.; Paparodis, R. Polycystic Ovary Syndrome and Type 2 Diabetes Mellitus: A State-of-the-Art Review. World J. Diabetes; 2022; 13, pp. 5-26. [DOI: https://dx.doi.org/10.4239/wjd.v13.i1.5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35070056]
6. Rojas, J.; Chávez, M.; Olivar, L.; Rojas, M.; Morillo, J.; Mejías, J.; Calvo, M.; Bermúdez, V. Polycystic Ovary Syndrome, Insulin Resistance, and Obesity: Navigating the Pathophysiologic Labyrinth. Int. J. Reprod. Med.; 2014; 2014, 719050. [DOI: https://dx.doi.org/10.1155/2014/719050]
7. Wang, J.; Wu, D.; Guo, H.; Li, M. Hyperandrogenemia and Insulin Resistance: The Chief Culprit of Polycystic Ovary Syndrome. Life Sci.; 2019; 236, 116940. [DOI: https://dx.doi.org/10.1016/j.lfs.2019.116940]
8. Gautam, R.; Prambil, A.M.; Patel, A.K.; Arora, T. Emerging Pollutants in Etiology and Pathophysiology of Polycystic Ovary Syndrome. Reprod. Toxicol.; 2024; 123, 108515. [DOI: https://dx.doi.org/10.1016/j.reprotox.2023.108515]
9. Sharma, I.; Dhawan, C.; Arora, P.; Chandel, P.; Bhattacharjee, S. Role of Environmental Factors in PCOS Development and Progression. Herbal Medicine Applications for Polycystic Ovarian Syndrome; CRC Press: Boca Raton, FL, USA, 2023; pp. 281-300. [DOI: https://dx.doi.org/10.1201/9781003344728-12]
10. Kicińska, A.M.; Maksym, R.B.; Zabielska-Kaczorowska, M.A.; Stachowska, A.; Babińska, A. Immunological and Metabolic Causes of Infertility in Polycystic Ovary Syndrome. Biomedicines; 2023; 11, 1567. [DOI: https://dx.doi.org/10.3390/biomedicines11061567] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37371662]
11. Turki, T.G.; Ammar, J.W. Role of Gonadotropin-Releasing Hormone, Leptin Hormone, Luteinizing Hormone, Follicle-Stimulating Hormone, and Obesity in Polycystic Ovarian Syndrome. Int. J. Sci. Res. Biol. Sci.; 2024; 11, pp. 1-6.
12. Wang, K.; Li, Y.; Chen, Y. Androgen Excess: A Hallmark of Polycystic Ovary Syndrome. Front. Endocrinol.; 2023; 14, 1273542. [DOI: https://dx.doi.org/10.3389/fendo.2023.1273542] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38152131]
13. Rudnicka, E.; Suchta, K.; Grymowicz, M.; Calik-ksepka, A.; Smolarczyk, K.; Duszewska, A.M.; Smolarczyk, R.; Meczekalski, B. Chronic Low Grade Inflammation in Pathogenesis of PCOS. Int. J. Mol. Sci.; 2021; 22, 3789. [DOI: https://dx.doi.org/10.3390/ijms22073789] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33917519]
14. Deng, H.; Chen, Y.; Xing, J.; Zhang, N.; Xu, L. Systematic Low-Grade Chronic Inflammation and Intrinsic Mechanisms in Polycystic Ovary Syndrome. Front. Immunol.; 2024; 15, 1470283. [DOI: https://dx.doi.org/10.3389/fimmu.2024.1470283]
15. Baptiste, C.G.; Battista, M.C.; Trottier, A.; Baillargeon, J.P. Insulin and Hyperandrogenism in Women with Polycystic Ovary Syndrome. J. Steroid Biochem. Mol. Biol.; 2009; 122, 42. [DOI: https://dx.doi.org/10.1016/j.jsbmb.2009.12.010] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20036327]
16. Zuo, T.; Zhu, M.; Xu, W. Roles of Oxidative Stress in Polycystic Ovary Syndrome and Cancers. Oxid. Med. Cell. Longev.; 2015; 2016, 8589318. [DOI: https://dx.doi.org/10.1155/2016/8589318]
17. Zeber-Lubecka, N.; Ciebiera, M.; Hennig, E.E. Polycystic Ovary Syndrome and Oxidative Stress—From Bench to Bedside. Int. J. Mol. Sci.; 2023; 24, 14126. [DOI: https://dx.doi.org/10.3390/ijms241814126] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37762427]
18. Teede, H.J.; Tay, C.T.; Laven, J.J.E.; Dokras, A.; Moran, L.J.; Piltonen, T.T.; Costello, M.F.; Boivin, J.; Redman, L.M.; Boyle, J.A. et al. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome* on Behalf of the International PCOS Network. J. Clin. Endocrinol. Metab.; 2023; 108, pp. 2447-2469. [DOI: https://dx.doi.org/10.1210/clinem/dgad463] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37580314]
19. Lim, S.S.; Hutchison, S.K.; Van Ryswyk, E.; Norman, R.J.; Teede, H.J.; Moran, L.J. Lifestyle Changes in Women with Polycystic Ovary Syndrome. Cochrane Database Syst. Rev.; 2019; 2019, CD007506. [DOI: https://dx.doi.org/10.1002/14651858.CD007506.pub4]
20. Xenou, M.; Gourounti, K. Dietary Patterns and Polycystic Ovary Syndrome: A Systematic Review. Maedica; 2021; 16, 516. [DOI: https://dx.doi.org/10.26574/maedica.2021.16.3.516] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34925611]
21. Barrea, L.; Verde, L.; Camajani, E.; Cernea, S.; Frias-Toral, E.; Lamabadusuriya, D.; Ceriani, F.; Savastano, S.; Colao, A.; Muscogiuri, G. Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS). Curr. Nutr. Rep.; 2023; 12, pp. 56-64. [DOI: https://dx.doi.org/10.1007/s13668-023-00456-1]
22. Barrea, L.; Arnone, A.; Annunziata, G.; Muscogiuri, G.; Laudisio, D.; Salzano, C.; Pugliese, G.; Colao, A.; Savastano, S. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients; 2019; 11, 2278. [DOI: https://dx.doi.org/10.3390/nu11102278] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31547562]
23. Porchia, L.M.; Hernandez-Garcia, S.C.; Gonzalez-Mejia, M.E.; López-Bayghen, E. Diets with Lower Carbohydrate Concentrations Improve Insulin Sensitivity in Women with Polycystic Ovary Syndrome: A Meta-Analysis. Eur. J. Obstet. Gynecol. Reprod. Biol.; 2020; 248, pp. 110-117. [DOI: https://dx.doi.org/10.1016/j.ejogrb.2020.03.010] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32200247]
24. Greff, D.; Juhász, A.E.; Váncsa, S.; Váradi, A.; Sipos, Z.; Szinte, J.; Park, S.; Hegyi, P.; Nyirády, P.; Ács, N. et al. Inositol Is an Effective and Safe Treatment in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Reprod. Biol. Endocrinol.; 2023; 21, 10. [DOI: https://dx.doi.org/10.1186/s12958-023-01055-z]
25. Devi, N.; Boya, C.; Chhabra, M.; Bansal, D. N-Acetyl-Cysteine as Adjuvant Therapy in Female Infertility: A Systematic Review and Meta-Analysis. J. Basic Clin. Physiol. Pharmacol.; 2020; 32, pp. 899-910. [DOI: https://dx.doi.org/10.1515/jbcpp-2020-0107]
26. Elobeid, T.; Awad, M.O.; Ganji, V.; Moawad, J. The Impact of Mineral Supplementation on Polycystic Ovarian Syndrome. Metabolites; 2022; 12, 338. [DOI: https://dx.doi.org/10.3390/metabo12040338] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35448525]
27. González, F. Inflammation in Polycystic Ovary Syndrome: Underpinning of Insulin Resistance and Ovarian Dysfunction. Steroids; 2012; 77, 300. [DOI: https://dx.doi.org/10.1016/j.steroids.2011.12.003] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22178787]
28. Shoaibinobarian, N.; Eslamian, G.; Noormohammadi, M.; Malek, S.; Rouhani, S.; Mirmohammadali, S.N. Dietary Total Antioxidant Capacity and Risk of Polycystic Ovary Syndrome: A Case-Control Study. Int. J. Fertil. Steril.; 2022; 16, pp. 200-205. [DOI: https://dx.doi.org/10.22074/IJFS.2021.526579.1107] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36029057]
29. Zhao, J.F.; Li, B.X.; Zhang, Q. Vitamin D Improves Levels of Hormonal, Oxidative Stress and Inflammatory Parameters in Polycystic Ovary Syndrome: A Meta-Analysis Study. Ann. Palliat. Med.; 2021; 10, pp. 169-183. [DOI: https://dx.doi.org/10.21037/apm-20-2201] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33545754]
30. Rocha, A.L.; Oliveira, F.R.; Azevedo, R.C.; Silva, V.A.; Peres, T.M.; Candido, A.L.; Gomes, K.B.; Reis, F.M. Recent Advances in the Understanding and Management of Polycystic Ovary Syndrome. F1000Research; 2019; 8, 565. [DOI: https://dx.doi.org/10.12688/f1000research.15318.1]
31. Sabag, A.; Patten, R.K.; Moreno-Asso, A.; Colombo, G.E.; Dafauce Bouzo, X.; Moran, L.J.; Harrison, C.; Kazemi, M.; Mousa, A.; Tay, C.T. et al. Exercise in the Management of Polycystic Ovary Syndrome: A Position Statement from Exercise and Sports Science Australia. J. Sci. Med. Sport; 2024; 27, pp. 668-677. [DOI: https://dx.doi.org/10.1016/j.jsams.2024.05.015] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38960811]
32. Miranda-Furtado, C.L.; Ramos, F.K.P.; Kogure, G.S.; Santana-Lemos, B.A.; Ferriani, R.A.; Calado, R.T.; Dos Reis, R.M. A Nonrandomized Trial of Progressive Resistance Training Intervention in Women With Polycystic Ovary Syndrome and Its Implications in Telomere Content. Reprod. Sci.; 2016; 23, pp. 644-654. [DOI: https://dx.doi.org/10.1177/1933719115611753] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26586671]
33. Patil, A.D.; Pathak, S.D.; Kokate, P.; Bhogal, R.S.; Badave, A.S.; Varadha, M.; Joshi, B.N.; Tandon, D.; Begum, S.; Surve, S.V. et al. Yoga Intervention Improves the Metabolic Parameters and Quality of Life among Infertile Women with Polycystic Ovary Syndrome in Indian Population. Int. J. Yoga; 2023; 16, pp. 98-105. [DOI: https://dx.doi.org/10.4103/ijoy.ijoy_88_23]
34. Shrivastava, R.; Mishra, S.; Singh, R.; Shrivastava, P. Effect of Integrated Approach of Yoga and Naturopathy on Polycystic Ovarian Syndrome: A Case Study. J. Fam. Med. Prim. Care; 2022; 11, 1525. [DOI: https://dx.doi.org/10.4103/jfmpc.jfmpc_651_21] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35516692]
35. Rashid, R.; Mir, S.A.; Kareem, O.; Ali, T.; Ara, R.; Malik, A.; Amin, F.; Bader, G.N. Polycystic Ovarian Syndrome-Current Pharmacotherapy and Clinical Implications. Taiwan J. Obstet. Gynecol.; 2022; 61, pp. 40-50. [DOI: https://dx.doi.org/10.1016/j.tjog.2021.11.009]
36. Forslund, M.; Melin, J.; Alesi, S.; Piltonen, T.; Romualdi, D.; Tay, C.T.; Witchel, S.; Pena, A.; Mousa, A.; Teede, H. Different Kinds of Oral Contraceptive Pills in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Eur. J. Endocrinol.; 2023; 189, pp. S1-S16. [DOI: https://dx.doi.org/10.1093/ejendo/lvad082] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37440702]
37. Hoover, S.E.; Gower, B.A.; Cedillo, Y.E.; Chandler-Laney, P.C.; Deemer, S.E.; Goss, A.M. Changes in Ghrelin and Glucagon Following a Low Glycemic Load Diet in Women with PCOS. J. Clin. Endocrinol. Metab.; 2021; 106, pp. E2151-E2161. [DOI: https://dx.doi.org/10.1210/clinem/dgab028]
38. Wong, J.M.W.; Gallagher, M.; Gooding, H.; Feldman, H.A.; Gordon, C.M.; Ludwig, D.S.; Ebbeling, C.B. A Randomized Pilot Study of Dietary Treatments for Polycystic Ovary Syndrome in Adolescents. Pediatr. Obes.; 2016; 11, pp. 210-220. [DOI: https://dx.doi.org/10.1111/ijpo.12047] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26132306]
39. Pandurevic, S.; Mancini, I.; Mitselman, D.; Magagnoli, M.; Teglia, R.; Fazzeri, R.; Dionese, P.; Cecchetti, C.; Caprio, M.; Moretti, C. et al. Efficacy of Very Low-Calorie Ketogenic Diet with the Pronokal® Method in Obese Women with Polycystic Ovary Syndrome: A 16-Week Randomized Controlled Trial. Endocr. Connect.; 2023; 12, e220536. [DOI: https://dx.doi.org/10.1530/EC-22-0536] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37018117]
40. Paoli, A.; Mancin, L.; Giacona, M.C.; Bianco, A.; Caprio, M. Effects of a Ketogenic Diet in Overweight Women with Polycystic Ovary Syndrome. J. Transl. Med.; 2020; 18, 104. [DOI: https://dx.doi.org/10.1186/s12967-020-02277-0] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32103756]
41. Haidari, F.; Banaei-Jahromi, N.; Zakerkish, M.; Ahmadi, K. The Effects of Flaxseed Supplementation on Metabolic Status in Women with Polycystic Ovary Syndrome: A Randomized Open-Labeled Controlled Clinical Trial. Nutr. J.; 2020; 19, 8. [DOI: https://dx.doi.org/10.1186/s12937-020-0524-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31980022]
42. Sadeghi, F.; Alavi-Naeini, A.; Mardanian, F.; Ghazvini, M.R.; Mahaki, B. Omega-3 and Vitamin E Co-Supplementation Can Improve Antioxidant Markers in Obese/Overweight Women with Polycystic Ovary Syndrome. Int. J. Vitam. Nutr. Res.; 2020; 90, pp. 477-483. [DOI: https://dx.doi.org/10.1024/0300-9831/a000588] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30961460]
43. Cheshmeh, S.; Ghayyem, M.; Khamooshi, F.; Heidarzadeh-Esfahani, N.; Rahmani, N.; Hojati, N.; Mosaieby, E.; Moradi, S.; Pasdar, Y. Green Cardamom plus Low-Calorie Diet Can Decrease the Expression of Inflammatory Genes among Obese Women with Polycystic Ovary Syndrome: A Double-Blind Randomized Clinical Trial. Eat. Weight Disord.; 2022; 27, pp. 821-830. [DOI: https://dx.doi.org/10.1007/s40519-021-01223-3]
44. Pingarrón Santofímia, C.; Poyo Torcal, S.; López Verdú, H.; Henríquez Linares, A.; Calvente Aguilar, V.; Terol Sánchez, P.; Martínez García, M.S.; Lafuente González, P. Evaluation of the Efficacy of an Antioxidant Combination for the Modulation of Metabolic, Endocrine, and Clinical Parameters in Patients with Polycystic Ovary Syndrome. Gynecol. Endocrinol.; 2023; 39, 2227277. [DOI: https://dx.doi.org/10.1080/09513590.2023.2227277]
45. Kazemi, M.; Lalooha, F.; Nooshabadi, M.R.; Dashti, F.; Kavianpour, M.; Haghighian, H.K. Randomized Double Blind Clinical Trial Evaluating the Ellagic Acid Effects on Insulin Resistance, Oxidative Stress and Sex Hormones Levels in Women with Polycystic Ovarian Syndrome. J. Ovarian Res.; 2021; 14, 100. [DOI: https://dx.doi.org/10.1186/s13048-021-00849-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34330312]
46. Trop-Steinberg, S.; Heifetz, E.M.; Azar, Y.; Kafka, I.; Weintraub, A.; Gal, M. Omega-3 Intake Improves Clinical Pregnancy Rate in Polycystic Ovary Syndrome Patients: A Double-Blind, Randomized Study. Isr. Med. Assoc. J.; 2023; 25, pp. 131-136. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36841983]
47. Nikrad, N.; Farhangi, M.A.; Fard Tabrizi, F.P.; Vaezi, M.; Mahmoudpour, A.; Mesgari-Abbasi, M. The Effect of Calorie-Restriction along with Thylakoid Membranes of Spinach on the Gut-Brain Axis Pathway and Oxidative Stress Biomarkers in Obese Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J. Ovarian Res.; 2023; 16, 216. [DOI: https://dx.doi.org/10.1186/s13048-023-01288-x] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37968684]
48. Gupta, S.; Kumari, R.; Vijaya,. Comparing the Effects of N-Acetylcysteine and Metformin on Biochemical and Clinical Parameters in Women with Polycystic Ovarian Syndrome at a Tertiary Care Hospital. Int. J. Pharm. Clin. Res.; 2024; 16, pp. 318-321. [DOI: https://dx.doi.org/10.18231/j.ijogr.2023.032]
49. Zadhoush, R.; Alavi-Naeini, A.; Feizi, A.; Naghshineh, E.; Ghazvini, M.R. The Effect of Garlic (Allium sativum) Supplementation on the Lipid Parameters and Blood Pressure Levels in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Phytother. Res.; 2021; 35, pp. 6335-6342. [DOI: https://dx.doi.org/10.1002/ptr.7282]
50. Izadi, A.; Ebrahimi, S.; Shirazi, S.; Taghizadeh, S.; Parizad, M.; Farzadi, L.; Gargari, B.P. Hormonal and Metabolic Effects of Coenzyme Q10 and/or Vitamin E in Patients With Polycystic Ovary Syndrome. J. Clin. Endocrinol. Metab.; 2019; 104, pp. 319-327. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30202998][DOI: https://dx.doi.org/10.1210/jc.2018-01221]
51. Qorbani, M.; Sanginabadi, M.; Mohajeri-Tehrani, M.R.; Karimi, S.; Gerami, H.; Mahdavi-Gorabi, A.; Shirzad, N.; Samadi, M.; Baygi, F.; Hosseini, S. et al. The Effect of Oligopin Supplementation on Hormonal and Metabolic Profiles in the Polycystic Ovary Syndrome: A Randomized Controlled Trial. Front. Endocrinol.; 2020; 11, pp. 1-8. [DOI: https://dx.doi.org/10.3389/fendo.2020.590392]
52. Yahay, M.; Heidari, Z.; Allameh, Z.; Amani, R. The Effects of Canola and Olive Oils Consumption Compared to Sunflower Oil, on Lipid Profile and Hepatic Steatosis in Women with Polycystic Ovarian Syndrome: A Randomized Controlled Trial. Lipids Health Dis.; 2021; 20, 7. [DOI: https://dx.doi.org/10.1186/s12944-021-01433-9]
53. Hager, M.; Nouri, K.; Imhof, M.; Egarter, C.; Ott, J. The Impact of a Standardized Micronutrient Supplementation on PCOS-Typical Parameters: A Randomized Controlled Trial. Arch. Gynecol. Obstet.; 2019; 300, pp. 455-460. [DOI: https://dx.doi.org/10.1007/s00404-019-05194-w]
54. Wen, X.; Wang, L.; Li, F.; Yu, X. Effects of vitamin D supplementation on metabolic parameters in women with polycystic ovary syndrome: A randomized controlled trial. J. Ovarian Res.; 2024; 17, 147. [DOI: https://dx.doi.org/10.1186/s13048-024-01473-6]
55. Bahramian, H.; Sherafatmanesh, S.; Asadi, N.; Bakhshi, A.; Eftekhari, M.H.; Ekramzadeh, M. Effects of Single-Dose and Co-Supplementation of Vitamin D and Omega-3 on Metabolic Profile in Women with Polycystic Ovary Syndrome: An RCT. Int. J. Reprod. Biomed.; 2023; 21, pp. 541-550. [DOI: https://dx.doi.org/10.18502/ijrm.v21i7.13889] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37727395]
56. Nadjarzadeh, A.; Ghadiri-Anari, A.; Ramezani-Jolfaie, N.; Mohammadi, M.; Salehi-Abargouei, A.; Namayande, S.M.; Mozaffari-Khosravi, H.; Hosseini-Marnani, E. Effect of Hypocaloric High-Protein, Low-Carbohydrate Diet Supplemented with Fennel on Androgenic and Anthropometric Indices in Overweight and Obese Women with Polycystic Ovary Syndrome: A Randomized Placebo-Controlled Trial. Complement. Ther. Med.; 2021; 56, 102633. [DOI: https://dx.doi.org/10.1016/j.ctim.2020.102633] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33271298]
57. Karamali, M.; Kashanian, M.; Alaeinasab, S.; Asemi, Z. The Effect of Dietary Soy Intake on Weight Loss, Glycaemic Control, Lipid Profiles and Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: A Randomised Clinical Trial. J. Hum. Nutr. Diet.; 2018; 31, pp. 533-543. [DOI: https://dx.doi.org/10.1111/jhn.12545] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29468748]
58. Wang, X.; Xu, T.; Liu, R.; Wu, G.; Gu, L.; Zhang, Y.; Zhang, F.; Fu, H.; Ling, Y.; Wei, X. et al. High-Fiber Diet or Combined With Acarbose Alleviates Heterogeneous Phenotypes of Polycystic Ovary Syndrome by Regulating Gut Microbiota. Front. Endocrinol.; 2022; 12, 806331. [DOI: https://dx.doi.org/10.3389/fendo.2021.806331] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35185786]
59. Kazemi, M.; McBreairty, L.E.; Chizen, D.R.; Pierson, R.A.; Chilibeck, P.D.; Zello, G.A. A Comparison of a Pulse-Based Diet and the Therapeutic Lifestyle Changes Diet in Combination with Exercise and Health Counselling on the Cardio-Metabolic Risk Profile in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Nutrients; 2018; 10, 1387. [DOI: https://dx.doi.org/10.3390/nu10101387]
60. Hooshmandi, H.; Ghadiri-Anari, A.; Ranjbar, A.M.; Fallahzadeh, H.; Hosseinzadeh, M.; Nadjarzadeh, A. Effects of Licorice Extract in Combination with a Low-Calorie Diet on Obesity Indices, Glycemic Indices, and Lipid Profiles in Overweight/Obese Women with Polycystic Ovary Syndrome (PCOS): A Randomized, Double-Blind, Placebo-Controlled Trial. J. Ovarian Res.; 2024; 17, 157. [DOI: https://dx.doi.org/10.1186/s13048-024-01446-9]
61. Liu, C.; Zhang, L.; Zheng, W.; Liang, X.; Zhang, L.; Tian, Z.; Li, G. Lifestyle Intervention for Overweight/Obese Pregnant Women with Polycystic Ovarian Syndrome: Lessons and Challenges. Obes. Facts; 2021; 14, pp. 405-414. [DOI: https://dx.doi.org/10.1159/000514931] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34311460]
62. Zhang, Y.; Qu, Z.; Lu, T.; Shao, X.; Cai, M.; Dilimulati, D.; Gao, X.; Mao, W.; Hu, F.; Su, L. et al. Effects of a Dulaglutide plus Calorie-Restricted Diet versus a Calorie-Restricted Diet on Visceral Fat and Metabolic Profiles in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Nutrients; 2023; 15, 556. [DOI: https://dx.doi.org/10.3390/nu15030556] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36771262]
63. Mei, S.; Ding, J.; Wang, K.; Ni, Z.; Yu, J. 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://dx.doi.org/10.3389/fnut.2022.876620] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35445067]
64. Bozbulut, R.; Döger, E.; Çamurdan, M.O.; Bideci, A. Beneficial Effects of RESMENA Diet on Anthropometric, Metabolic and Reproductive Profile in Adolescents with Obesity and Polycystic Ovary Syndrome: A Randomized Controlled Intervention Study. Horm. Res. Paediatr.; 2023; 97, pp. 483-495. [DOI: https://dx.doi.org/10.1159/000535053]
65. Foscolou, A.; Papandreou, P.; Gioxari, A.; Skouroliakou, M. Optimizing Dietary Habits in Adolescents with Polycystic Ovary Syndrome: Personalized Mediterranean Diet Intervention via Clinical Decision Support System-A Randomized Controlled Trial. Children; 2024; 11, 635. [DOI: https://dx.doi.org/10.3390/children11060635] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38929215]
66. Tabrizi, F.P.F.; Farhangi, M.A.; Vaezi, M.; Hemmati, S. The Effects of Spinach-Derived Thylakoid Supplementation in Combination with Calorie Restriction on Anthropometric Parameters and Metabolic Profiles in Obese Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Nutr. J.; 2020; 19, 82. [DOI: https://dx.doi.org/10.1186/s12937-020-00601-4] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32782010]
67. Deshmukh, H.; Papageorgiou, M.; Wells, L.; Akbar, S.; Strudwick, T.; Deshmukh, K.; Vitale, S.G.; Rigby, A.; Vince, R.V.; Reid, M. et al. The Effect of a Very-Low-Calorie Diet (VLCD) vs. a Moderate Energy Deficit Diet in Obese Women with Polycystic Ovary Syndrome (PCOS)—A Randomised Controlled Trial. Nutrients; 2023; 15, 3872. [DOI: https://dx.doi.org/10.3390/nu15183872] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37764656]
68. Li, C.; Xing, C.; Zhang, J.; Zhao, H.; Shi, W.; He, B. Eight-Hour Time-Restricted Feeding Improves Endocrine and Metabolic Profiles in Women with Anovulatory Polycystic Ovary Syndrome. J. Transl. Med.; 2021; 19, 148. [DOI: https://dx.doi.org/10.1186/s12967-021-02817-2]
69. Łagowska, K.; Drzymała-Czyz, S. A Low Glycemic Index, Energy-Restricted Diet but Not Lactobacillus Rhamnosus Supplementation Changes Fecal Short-Chain Fatty Acid and Serum Lipid Concentrations in Women with Overweight or Obesity and Polycystic Ovary Syndrome. Eur. Rev. Med. Pharmacol. Sci.; 2022; 26, pp. 917-926. [DOI: https://dx.doi.org/10.26355/EURREV_202202_28001] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35179758]
70. Chudzicka-Strugała, I.; Kubiak, A.; Banaszewska, B.; Zwozdziak, B.; Siakowska, M.; Pawelczyk, L.; Duleba, A.J. Effects of Synbiotic Supplementation and Lifestyle Modifications on Women With Polycystic Ovary Syndrome. J. Clin. Endocrinol. Metab.; 2021; 106, pp. 2566-2573. [DOI: https://dx.doi.org/10.1210/clinem/dgab369]
71. Hariri, Z.; Yari, Z.; Hoseini, S.; Abhari, K.; Sohrab, G. Synbiotic as an Ameliorating Factor in the Health-Related Quality of Life in Women with Polycystic Ovary Syndrome. A Randomized, Triple-Blind, Placebo-Controlled Trial. BMC Women’s Health; 2024; 24, 19. [DOI: https://dx.doi.org/10.1186/s12905-023-02868-1] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38172876]
72. Ostadmohammadi, V.; Jamilian, M.; Bahmani, F.; Asemi, Z. Vitamin D and Probiotic Co-Supplementation Affects Mental Health, Hormonal, Inflammatory and Oxidative Stress Parameters in Women with Polycystic Ovary Syndrome. J. Ovarian Res.; 2019; 12, 5. [DOI: https://dx.doi.org/10.1186/s13048-019-0480-x]
73. Jamilian, M.; Mansury, S.; Bahmani, F.; Heidar, Z.; Amirani, E.; Asemi, Z. The Effects of Probiotic and Selenium Co-Supplementation on Parameters of Mental Health, Hormonal Profiles, and Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome. J. Ovarian Res.; 2018; 11, 80. [DOI: https://dx.doi.org/10.1186/s13048-018-0457-1]
74. Nasri, K.; Jamilian, M.; Rahmani, E.; Bahmani, F.; Tajabadi-Ebrahimi, M.; Asemi, Z. The Effects of Synbiotic Supplementation on Hormonal Status, Biomarkers of Inflammation and Oxidative Stress in Subjects with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. BMC Endocr. Disord.; 2018; 18, 21. [DOI: https://dx.doi.org/10.1186/s12902-018-0248-0]
75. Darvishi, S.; Rafraf, M.; Asghari-Jafarabadi, M.; Farzadi, L. Synbiotic Supplementation Improves Metabolic Factors and Obesity Values in Women with Polycystic Ovary Syndrome Independent of Affecting Apelin Levels: A Randomized Double-Blind Placebo—Controlled Clinical Trial. Int. J. Fertil. Steril.; 2021; 15, pp. 51-59. [DOI: https://dx.doi.org/10.22074/IJFS.2021.6186] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33497048]
76. Azizi-Kutenaee, M.; Heidari, S.; Taghavi, S.A.; Bazarganipour, F. Probiotic Effects on Sexual Function in Women with Polycystic Ovary Syndrome: A Double Blinded Randomized Controlled Trial. BMC Women’s Health; 2022; 22, 373. [DOI: https://dx.doi.org/10.1186/s12905-022-01955-z] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36096842]
77. Karimi, E.; Heshmati, J.; Shirzad, N.; Vesali, S.; Hosseinzadeh-Attar, M.J.; Moini, A.; Sepidarkish, M. The Effect of Synbiotics Supplementation on Anthropometric Indicators and Lipid Profiles in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Lipids Health Dis.; 2020; 19, 60. [DOI: https://dx.doi.org/10.1186/s12944-020-01244-4] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32248805]
78. Sun, Y.; Gao, S.; Ye, C.; Zhao, W. Gut Microbiota Dysbiosis in Polycystic Ovary Syndrome: Mechanisms of Progression and Clinical Applications. Front. Cell. Infect. Microbiol.; 2023; 13, 1142041. [DOI: https://dx.doi.org/10.3389/fcimb.2023.1142041] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36909735]
79. Gholizadeh-Moghaddam, M.; Ghasemi-Tehrani, H.; Askari, G.; Jaripur, M.; Clark, C.C.T.; Rouhani, M.H. Effect of Magnesium Supplementation in Improving Hyperandrogenism, Hirsutism, and Sleep Quality in Women with Polycystic Ovary Syndrome: A Randomized, Placebo-Controlled Clinical Trial. Health Sci. Rep.; 2023; 6, e1013. [DOI: https://dx.doi.org/10.1002/hsr2.1013] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36620514]
80. Kucuk, T.; Horozal, P.E.; Karakulak, A.; Timucin, E.; Dattilo, M. Follicular Homocysteine as a Marker of Oocyte Quality in PCOS and the Role of Micronutrients. J. Assist. Reprod. Genet.; 2023; 40, pp. 1933-1941. [DOI: https://dx.doi.org/10.1007/s10815-023-02847-3] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37300649]
81. Jaripur, M.; Ghasemi-Tehrani, H.; Askari, G.; Gholizadeh-Moghaddam, M.; Clark, C.C.T.; Rouhani, M.H. The Effects of Magnesium Supplementation on Abnormal Uterine Bleeding, Alopecia, Quality of Life, and Acne in Women with Polycystic Ovary Syndrome: A Randomized Clinical Trial. Reprod. Biol. Endocrinol.; 2022; 20, 110. [DOI: https://dx.doi.org/10.1186/s12958-022-00982-7]
82. Fordham, T.M.; Morelli, N.S.; Garcia-Reyes, Y.; Ware, M.A.; Rahat, H.; Sundararajan, D.; Fuller, K.N.Z.; Severn, C.; Pyle, L.; Malloy, C.R. et al. Metabolic Effects of an Essential Amino Acid Supplement in Adolescents with PCOS and Obesity. Obesity; 2024; 32, pp. 678-690. [DOI: https://dx.doi.org/10.1002/oby.23988] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38439205]
83. Asemi, Z.; Esmaillzadeh, A. DASH Diet, Insulin Resistance, and Serum Hs-CRP in Polycystic Ovary Syndrome: A Randomized Controlled Clinical Trial. Horm. Metab. Res.; 2015; 47, pp. 232-238. [DOI: https://dx.doi.org/10.1055/s-0034-1376990]
84. Azadi-Yazdi, M.; Karimi-Zarchi, M.; Salehi-Abargouei, A.; Fallahzadeh, H.; Nadjarzadeh, A. Effects of Dietary Approach to Stop Hypertension Diet on Androgens, Antioxidant Status and Body Composition in Overweight and Obese Women with Polycystic Ovary Syndrome: A Randomised Controlled Trial. J. Hum. Nutr. Diet.; 2017; 30, pp. 275-283. [DOI: https://dx.doi.org/10.1111/jhn.12433] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28466507]
85. Asemi, Z.; Samimi, M.; Tabassi, Z.; Shakeri, H.; Sabihi, S.S.; Esmaillzadeh, A. Effects of DASH Diet on Lipid Profiles and Biomarkers of Oxidative Stress in Overweight and Obese Women with Polycystic Ovary Syndrome: A Randomized Clinical Trial. Nutrition; 2014; 30, pp. 1287-1293. [DOI: https://dx.doi.org/10.1016/j.nut.2014.03.008]
86. Kazemi, M.; Hadi, A.; Pierson, R.A.; Lujan, M.E.; Zello, G.A.; Chilibeck, P.D. Effects of Dietary Glycemic Index and Glycemic Load on Cardiometabolic and Reproductive Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv. Nutr.; 2021; 12, pp. 161-178. [DOI: https://dx.doi.org/10.1093/advances/nmaa092]
87. Unluhizarci, K.; Karaca, Z.; Kelestimur, F. Role of Insulin and Insulin Resistance in Androgen Excess Disorders. World J. Diabetes; 2021; 12, 616. [DOI: https://dx.doi.org/10.4239/wjd.v12.i5.616] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33995849]
88. Radulian, G.; Rusu, E.; Dragomir, A.; Posea, M. Metabolic Effects of Low Glycaemic Index Diets. Nutr. J.; 2009; 8, 5. [DOI: https://dx.doi.org/10.1186/1475-2891-8-5]
89. Sordia-Hernández, L.H.; Rodríguez, P.A.; Rodriguez, D.S.; Guzmán, S.T.; Zenteno, E.S.S.; González, G.G.; Patiño, R.I. Effect of a Low Glycemic Diet in Patients with Polycystic Ovary Syndrome and Anovulation—A Randomized Controlled Trial. Clin. Exp. Obstet. Gynecol.; 2016; 43, pp. 555-559. [DOI: https://dx.doi.org/10.12891/ceog3037.2016]
90. Szczuko, M.; Zapalowska-Chwyć, M.; Drozd, R. A Low Glycemic Index Decreases Inflammation by Increasing the Concentration of Uric Acid and the Activity of Glutathione Peroxidase (GPX3) in Patients with Polycystic Ovary Syndrome (PCOS). Molecules; 2019; 24, 1508. [DOI: https://dx.doi.org/10.3390/molecules24081508]
91. Zhu, H.; Bi, D.; Zhang, Y.; Kong, C.; Du, J.; Wu, X.; Wei, Q.; Qin, H. Ketogenic Diet for Human Diseases: The Underlying Mechanisms and Potential for Clinical Implementations. Signal Transduct. Target. Ther.; 2022; 7, 11. [DOI: https://dx.doi.org/10.1038/s41392-021-00831-w]
92. Kirkpatrick, C.F.; Bolick, J.P.; Kris-Etherton, P.M.; Sikand, G.; Aspry, K.E.; Soffer, D.E.; Willard, K.E.; Maki, K.C. Review of Current Evidence and Clinical Recommendations on the Effects of Low-Carbohydrate and Very-Low-Carbohydrate (Including Ketogenic) Diets for the Management of Body Weight and Other Cardiometabolic Risk Factors: A Scientific Statement from the National Lipid Association Nutrition and Lifestyle Task Force. J. Clin. Lipidol.; 2019; 13, pp. 689-711.e1. [DOI: https://dx.doi.org/10.1016/J.JACL.2019.08.003] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31611148]
93. Masood, W.; Annamaraju, P.; Suheb, M.Z.K.; Uppaluri, K.R. Ketogenic Diet. StatPearls [Internet]; StatPearls Publishing: St. Petersburg, FL, USA, 2023.
94. Shahpasand, S.; Khatami, S.H.; Ehtiati, S.; Alehossein, P.; Salmani, F.; Toutounchi, A.H.; Zarei, T.; Shahmohammadi, M.R.; Khodarahmi, R.; Aghamollaii, V. et al. Therapeutic Potential of the Ketogenic Diet: A Metabolic Switch with Implications for Neurological Disorders, the Gut-Brain Axis, and Cardiovascular Diseases. J. Nutr. Biochem.; 2024; 132, 109693. [DOI: https://dx.doi.org/10.1016/j.jnutbio.2024.109693] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38880191]
95. Pietrzak, D.; Kasperek, K.; Rękawek, P.; Piątkowska-Chmiel, I. The Therapeutic Role of Ketogenic Diet in Neurological Disorders. Nutrients; 2022; 14, 1952. [DOI: https://dx.doi.org/10.3390/nu14091952] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35565918]
96. Patikorn, C.; Saidoung, P.; Pham, T.; Phisalprapa, P.; Lee, Y.Y.; Varady, K.A.; Veettil, S.K.; Chaiyakunapruk, N. Effects of Ketogenic Diet on Health Outcomes: An Umbrella Review of Meta-Analyses of Randomized Clinical Trials. BMC Med.; 2023; 21, 196. [DOI: https://dx.doi.org/10.1186/s12916-023-02874-y]
97. Xing, N.N.; Ren, F.; Yang, H. Effects of Ketogenic Diet on Weight Loss Parameters among Obese or Overweight Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trails. Food Nutr. Res.; 2024; 68, 9835. [DOI: https://dx.doi.org/10.29219/fnr.v68.9835]
98. Patel, S. Polycystic Ovary Syndrome (PCOS), an Inflammatory, Systemic, Lifestyle Endocrinopathy. J. Steroid Biochem. Mol. Biol.; 2018; 182, pp. 27-36. [DOI: https://dx.doi.org/10.1016/j.jsbmb.2018.04.008] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29678491]
99. Moghbeli, M.; Khedmatgozar, H.; Yadegari, M.; Avan, A.; Ferns, G.A.; Ghayour Mobarhan, M. Cytokines and the Immune Response in Obesity-Related Disorders. Adv. Clin. Chem.; 2021; 101, pp. 135-168. [DOI: https://dx.doi.org/10.1016/BS.ACC.2020.06.004]
100. Kawai, T.; Autieri, M.V.; Scalia, R. Adipose Tissue Inflammation and Metabolic Dysfunction in Obesity. Am. J. Physiol.-Cell Physiol.; 2021; 320, pp. C375-C391. [DOI: https://dx.doi.org/10.1152/ajpcell.00379.2020]
101. Mizgier, M.; Więckowska, B.; Formanowicz, D.; Lombardi, G.; Brożek, A.; Nowicki, M.; Durkalec-Michalski, K.; Kędzia, W.; Jarząbek-Bielecka, G. Effects of AIDiet Intervention to Improve Diet Quality, Immuno-Metabolic Health in Normal and Overweight PCOS Girls: A Pilot Study. Sci. Rep.; 2024; 14, 3525. [DOI: https://dx.doi.org/10.1038/s41598-024-54100-1]
102. Ebrahimi-Mamaghani, M.; Saghafi-Asl, M.; Pirouzpanah, S.; Asghari-Jafarabadi, M. Effects of Raw Red Onion Consumption on Metabolic Features in Overweight or Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Clinical Trial. J. Obstet. Gynaecol. Res.; 2014; 40, pp. 1067-1076. [DOI: https://dx.doi.org/10.1111/jog.12311] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24612081]
103. Saghafi-Asl, M.; Ebrahimi-Mameghani, M. The Effects of Raw Red Onion Consumption on Serum Levels of Adiponectin, Leptin, and Hs-CRP in Overweight/Obese Females with Polycystic Ovarian Syndrome: A Randomized Controlled-Clinical Trial. Iran. Red Crescent Med. J.; 2024; 19, pp. 1-8. [DOI: https://dx.doi.org/10.5812/ircmj.58674]
104. Pizzino, G.; Irrera, N.; Cucinotta, M.; Pallio, G.; Mannino, F.; Arcoraci, V.; Squadrito, F.; Altavilla, D.; Bitto, A. Oxidative Stress: Harms and Benefits for Human Health. Oxid. Med. Cell. Longev.; 2017; 2017, 8416763. [DOI: https://dx.doi.org/10.1155/2017/8416763] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28819546]
105. Uçkan, K.; Demir, H.; Turan, K.; Sarıkaya, E.; Demir, C. Role of Oxidative Stress in Obese and Nonobese PCOS Patients. Int. J. Clin. Pract.; 2022; 2022, 4579831. [DOI: https://dx.doi.org/10.1155/2022/4579831] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35685525]
106. Rahmatnezhad, L.; Moghaddam-Banaem, L.; Behrouzi Lak, T.; Shiva, A.; Rasuli, J. Free Androgen Index (FAI)’s Relations with Oxidative Stress and Insulin Resistance in Polycystic Ovary Syndrome. Sci. Rep.; 2023; 13, 5118. [DOI: https://dx.doi.org/10.1038/s41598-023-31406-0] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36991023]
107. Fenkci, V.; Fenkci, S.; Yilmazer, M.; Serteser, M. Decreased Total Antioxidant Status and Increased Oxidative Stress in Women with Polycystic Ovary Syndrome May Contribute to the Risk of Cardiovascular Disease. Fertil. Steril.; 2003; 80, pp. 123-127. [DOI: https://dx.doi.org/10.1016/S0015-0282(03)00571-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12849813]
108. Dubey, P.; Reddy, S.; Boyd, S.; Bracamontes, C.; Sanchez, S.; Chattopadhyay, M.; Dwivedi, A. Effect of Nutritional Supplementation on Oxidative Stress and Hormonal and Lipid Profiles in PCOS-Affected Females. Nutrients; 2021; 13, 2938. [DOI: https://dx.doi.org/10.3390/nu13092938] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34578816]
109. Mahmud, A.A.; Anu, U.H.; Foysal, K.A.; Hasan, M.; Sazib, S.M.; Ragib, A.A.; Taher, A.B.; Hossain, M.S.; Islam, M.S.; Hossain, M.S. et al. Elevated Serum Malondialdehyde (MDA), Insulin, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), and Thyroid-Stimulating Hormone (TSH), and Reduced Antioxidant Vitamins in Polycystic Ovarian Syndrome Patients. Narra J.; 2022; 2, e56. [DOI: https://dx.doi.org/10.52225/narra.v2i1.56]
110. Sassi, F.; Tamone, C.; D’amelio, P. Vitamin D: Nutrient, Hormone, and Immunomodulator. Nutrients; 2018; 10, 1656. [DOI: https://dx.doi.org/10.3390/nu10111656]
111. Maktabi, M.; Chamani, M.; Asemi, Z. The Effects of Vitamin D Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Horm. Metab. Res.; 2017; 49, pp. 493-498. [DOI: https://dx.doi.org/10.1055/s-0043-107242] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28679140]
112. Javed, Z.; Papageorgiou, M.; Deshmukh, H.; Kilpatrick, E.S.; Mann, V.; Corless, L.; Abouda, G.; Rigby, A.S.; Atkin, S.L.; Sathyapalan, T. A Randomized, Controlled Trial of Vitamin D Supplementation on Cardiovascular Risk Factors, Hormones, and Liver Markers in Women with Polycystic Ovary Syndrome. Nutrients; 2019; 11, 188. [DOI: https://dx.doi.org/10.3390/nu11010188] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30658483]
113. Seyyed Abootorabi, M.; Ayremlou, P.; Behroozi-Lak, T.; Nourisaeidlou, S. The Effect of Vitamin D Supplementation on Insulin Resistance, Visceral Fat and Adiponectin in Vitamin D Deficient Women with Polycystic Ovary Syndrome: A Randomized Placebo-Controlled Trial. Gynecol. Endocrinol.; 2018; 34, pp. 489-494. [DOI: https://dx.doi.org/10.1080/09513590.2017.1418311] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29271278]
114. Bahadur, A.; Yadav, A.; Mundhra, R.; Chawla, L.; Naithani, M.; Chaturvedi, J. Effect of Two Different Doses of Vitamin D Supplementation on Clinical, Metabolic, and Hormonal Profiles of Patients with Polycystic Ovary Syndrome (PCOS) with Insulin Resistance: A Randomized Controlled Trial. J. South Asian Fed. Obstet. Gynaecol.; 2022; 14, pp. 307-312. [DOI: https://dx.doi.org/10.5005/jp-journals-10006-2052]
115. Jamilian, M.; Samimi, M.; Mirhosseini, N.; Afshar Ebrahimi, F.; Aghadavod, E.; Talaee, R.; Jafarnejad, S.; Hashemi Dizaji, S.; Asemi, Z. The Influences of Vitamin D and Omega-3 Co-Supplementation on Clinical, Metabolic and Genetic Parameters in Women with Polycystic Ovary Syndrome. J. Affect. Disord.; 2018; 238, pp. 32-38. [DOI: https://dx.doi.org/10.1016/j.jad.2018.05.027] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29859385]
116. Cheshmeh, S.; Elahi, N.; Ghayyem, M.; Mosaieby, E.; Moradi, S.; Pasdar, Y.; Tahmasebi, S.; Moradinazar, M. Effect of Green Cardamom on the Expression of Genes Implicated in Obesity and Diabetes among Obese Women with Polycystic Ovary Syndrome: A Double Blind Randomized Controlled Trial. Genes Nutr.; 2022; 17, 17. [DOI: https://dx.doi.org/10.1186/s12263-022-00719-6]
117. Jamilian, M.; Asemi, Z. The Effects of Soy Isoflavones on Metabolic Status of Patients With Polycystic Ovary Syndrome. J. Clin. Endocrinol. Metab.; 2016; 101, pp. 3386-3394. [DOI: https://dx.doi.org/10.1210/jc.2016-1762] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27490918]
118. Di Pierro, F.; Sultana, R.; Eusaph, A.Z.; Abrar, S.; Bugti, M.; Afridi, F.; Farooq, U.; Iqtadar, S.; Ghauri, F.; Makhduma, S. et al. Effect of Berberine Phytosome on Reproductive, Dermatologic, and Metabolic Characteristics in Women with Polycystic Ovary Syndrome: A Controlled, Randomized, Multi-Centric, Open-Label Clinical Trial. Front. Pharmacol.; 2023; 14, 1269605. [DOI: https://dx.doi.org/10.3389/fphar.2023.1269605]
119. Jabarpour, M.; Amidi, F.; Aleyasin, A.; Nashtaei, M.S.; Marghmaleki, M.S. Randomized Clinical Trial of Astaxanthin Supplement on Serum Inflammatory Markers and ER Stress-Apoptosis Gene Expression in PBMCs of Women with PCOS. J. Cell. Mol. Med.; 2024; 28, e18464. [DOI: https://dx.doi.org/10.1111/jcmm.18464] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/39036884]
120. Schiuma, N.; Costantino, A.; Bartolotti, T.; Dattilo, M.; Bini, V.; Aglietti, M.C.; Renga, M.; Favilli, A.; Falorni, A.; Gerli, S. Micronutrients in Support to the One Carbon Cycle for the Modulation of Blood Fasting Homocysteine in PCOS Women. J. Endocrinol. Investig.; 2020; 43, pp. 779-786. [DOI: https://dx.doi.org/10.1007/s40618-019-01163-x]
121. Albardan, L.; Platat, C.; Kalupahana, N.S. Role of Omega-3 Fatty Acids in Improving Metabolic Dysfunctions in Polycystic Ovary Syndrome. Nutrients; 2024; 16, 2961. [DOI: https://dx.doi.org/10.3390/nu16172961]
122. Prabhu, Y.D.; Valsala Gopalakrishnan, A. Can Polyunsaturated Fatty Acids Regulate Polycystic Ovary Syndrome via TGF-β Signalling?. Life Sci.; 2021; 276, 119416. [DOI: https://dx.doi.org/10.1016/j.lfs.2021.119416] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33774033]
123. Mohammadi, E.; Rafraf Phd, M.; Farzadi, L.; Asghari-Jafarabadi, M.; Sabour, S. Effects of Omega−3 Fatty Acids Supplementation on Serum Adiponectin Levels and Some Metabolic Risk Factors in Women with Polycystic Ovary Syndrome. Asia Pac. J. Clin. Nutr.; 2012; 21, pp. 511-518. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23017309]
124. Jamilian, M.; Shojaei, A.; Samimi, M.; Afshar Ebrahimi, F.; Aghadavod, E.; Karamali, M.; Taghizadeh, M.; Jamilian, H.; Alaeinasab, S.; Jafarnejad, S. et al. The Effects of Omega-3 and Vitamin E Co-Supplementation on Parameters of Mental Health and Gene Expression Related to Insulin and Inflammation in Subjects with Polycystic Ovary Syndrome. J. Affect. Disord.; 2018; 229, pp. 41-47. [DOI: https://dx.doi.org/10.1016/j.jad.2017.12.049]
125. Nadjarzadeh, A.; Dehghani-Firouzabadi, R.; Daneshbodi, H.; Lotfi, M.H.; Vaziri, N.; Mozaffari-Khosravi, H. Effect of Omega-3 Supplementation on Visfatin, Adiponectin, and Anthropometric Indices in Women with Polycystic Ovarian Syndrome. J. Reprod. Infertil.; 2015; 16, 212. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27110520]
126. Khani, B.; Mardanian, F.; Fesharaki, S.J. Omega-3 Supplementation Effects on Polycystic Ovary Syndrome Symptoms and Metabolic Syndrome. J. Res. Med. Sci.; 2017; 22, 64. [DOI: https://dx.doi.org/10.4103/jrms.JRMS_644_16] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28616051]
127. Giuntini, E.B.; Sardá, F.A.H.; de Menezes, E.W. The Effects of Soluble Dietary Fibers on Glycemic Response: An Overview and Futures Perspectives. Foods; 2022; 11, 3934. [DOI: https://dx.doi.org/10.3390/foods11233934]
128. Cutler, D.A.; Pride, S.M.; Cheung, A.P. Low Intakes of Dietary Fiber and Magnesium Are Associated with Insulin Resistance and Hyperandrogenism in Polycystic Ovary Syndrome: A Cohort Study. Food Sci. Nutr.; 2019; 7, pp. 1426-1437. [DOI: https://dx.doi.org/10.1002/fsn3.977] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31024716]
129. Talari, H.R.; Azad, Z.J.; Hamidian, Y.; Samimi, M.; Gilasi, H.R.; Afshar, F.E.; Ostadmohammadi, V.; Asemi, Z. Effects of Carnitine Administration on Carotid Intima-Media Thickness and Inflammatory Factors in Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Int. J. Prev. Med.; 2019; 10, 89. [DOI: https://dx.doi.org/10.4103/IJPVM.IJPVM_2_18] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31360336]
130. Jamilian, M.; Foroozanfard, F.; Mirhosseini, N.; Kavossian, E.; Aghadavod, E.; Bahmani, F.; Ostadmohammadi, V.; Kia, M.; Eftekhar, T.; Ayati, E. et al. Effects of Melatonin Supplementation on Hormonal, Inflammatory, Genetic, and Oxidative Stress Parameters in Women With Polycystic Ovary Syndrome. Front. Endocrinol.; 2019; 10, 273. [DOI: https://dx.doi.org/10.3389/fendo.2019.00273]
131. Juhász, A.E.; Stubnya, M.P.; Teutsch, B.; Gede, N.; Hegyi, P.; Nyirády, P.; Bánhidy, F.; Ács, N.; Juhász, R. Ranking the Dietary Interventions by Their Effectiveness in the Management of Polycystic Ovary Syndrome: A Systematic Review and Network Meta-Analysis. Reprod. Health; 2024; 21, 28. [DOI: https://dx.doi.org/10.1186/s12978-024-01758-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38388374]
132. Lara Romero, C.; López Bermudo, L.; Fernández Gómez, M.; Cornejo, A.; Berná, G.; Romero-Gómez, M. Non-Pharmacological Treatment Approach in Patients with Metabolic Dysfunction-Associated Liver Disease. Comprehensive Guide to Hepatitis Advances; Academic Press: Cambridge, MA, USA, 2023; pp. 343-367. [DOI: https://dx.doi.org/10.1016/B978-0-323-98368-6.00019-7]
133. Challa, H.J.; Ameer, M.A.; Uppaluri, K.R. DASH Diet To Stop Hypertension. StatPearls [Internet]; StatPearls Publishing: St. Petersburg, FL, USA, 2023.
134. Campbell, A.P. DASH Eating Plan: An Eating Pattern for Diabetes Management. Diabetes Spectr.; 2017; 30, pp. 76-81. [DOI: https://dx.doi.org/10.2337/ds16-0084] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28588372]
135. Campbell, T.M.; Campbell, E.K.; Attia, J.; Ventura, K.; Mathews, T.; Chhabra, K.H.; Blanchard, L.M.; Wixom, N.; Faniyan, T.S.; Peterson, D.R. et al. The Acute Effects of a DASH Diet and Whole Food, Plant-Based Diet on Insulin Requirements and Related Cardiometabolic Markers in Individuals with Insulin-Treated Type 2 Diabetes. Diabetes Res. Clin. Pract.; 2023; 202, 110814. [DOI: https://dx.doi.org/10.1016/j.diabres.2023.110814] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37419391]
136. Akhlaghi, M. Dietary Approaches to Stop Hypertension (DASH): Potential Mechanisms of Action against Risk Factors of the Metabolic Syndrome. Nutr. Res. Rev.; 2020; 33, pp. 1-18. [DOI: https://dx.doi.org/10.1017/S0954422419000155] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31358075]
137. Corrie, L.; Awasthi, A.; Kaur, J.; Vishwas, S.; Gulati, M.; Kaur, I.P.; Gupta, G.; Kommineni, N.; Dua, K.; Singh, S.K. Interplay of Gut Microbiota in Polycystic Ovarian Syndrome: Role of Gut Microbiota, Mechanistic Pathways and Potential Treatment Strategies. Pharmaceuticals; 2023; 16, 197. [DOI: https://dx.doi.org/10.3390/ph16020197]
138. Shoaei, T.; Heidari-Beni, M.; Tehrani, H.G.; Feizi, A.; Esmaillzadeh, A.; Askari, G. Effects of Probiotic Supplementation on Pancreatic β-Cell Function and C-Reactive Protein in Women with Polycystic Ovary Syndrome: A Randomized Double-Blind Placebo-Controlled Clinical Trial. Int. J. Prev. Med.; 2015; 6, 27. [DOI: https://dx.doi.org/10.4103/2008-7802.153866] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25949777]
139. Heshmati, J.; Farsi, F.; Yosaee, S.; Razavi, M.; Rezaeinejad, M.; Karimie, E.; Sepidarkish, M. The Effects of Probiotics or Synbiotics Supplementation in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Probiotics Antimicrob. Proteins; 2019; 11, pp. 1236-1247. [DOI: https://dx.doi.org/10.1007/s12602-018-9493-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30547393]
140. Hadi, A.; Moradi, S.; Ghavami, A.; Khalesi, S.; Kafeshani, M. Effect of Probiotics and Synbiotics on Selected Anthropometric and Biochemical Measures in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Eur. J. Clin. Nutr.; 2020; 74, pp. 543-547. [DOI: https://dx.doi.org/10.1038/s41430-019-0434-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31053754]
141. Patel, H.; Alkhawam, H.; Madanieh, R.; Shah, N.; Kosmas, C.E.; Vittorio, T.J. Aerobic vs Anaerobic Exercise Training Effects on the Cardiovascular System. World J. Cardiol.; 2017; 9, 134. [DOI: https://dx.doi.org/10.4330/wjc.v9.i2.134]
142. Nystoriak, M.A.; Bhatnagar, A. Cardiovascular Effects and Benefits of Exercise. Front. Cardiovasc. Med.; 2018; 5, 135. [DOI: https://dx.doi.org/10.3389/fcvm.2018.00135] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30324108]
143. Amaravadi, S.K.; Maiya, G.A.; Vaishali, K.; Shastry, B.A. Effectiveness of Structured Exercise Program on Insulin Resistance and Quality of Life in Type 2 Diabetes Mellitus—A Randomized Controlled Trial. PLoS ONE; 2024; 19, e0302831. [DOI: https://dx.doi.org/10.1371/journal.pone.0302831] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38771888]
144. Singh, B.; Koneru, Y.C.; Zimmerman, H.; Kanagala, S.G.; Milne, I.; Sethi, A.; Jain, R. A Step in the Right Direction: Exploring the Effects of Aerobic Exercise on HbA1c Reduction. Egypt. J. Intern. Med.; 2023; 35, 58. [DOI: https://dx.doi.org/10.1186/s43162-023-00247-8]
145. Shele, G.; Genkil, J.; Speelman, D. A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome. J. Funct. Morphol. Kinesiol.; 2020; 5, 35. [DOI: https://dx.doi.org/10.3390/jfmk5020035] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33467251]
146. Samadi, Z.; Bambaeichi, E.; Valiani, M.; Shahshahan, Z. Evaluation of Changes in Levels of Hyperandrogenism, Hirsutism and Menstrual Regulation After a Period of Aquatic High Intensity Interval Training in Women with Polycystic Ovary Syndrome. Int. J. Prev. Med.; 2019; 10, 187. [DOI: https://dx.doi.org/10.4103/IJPVM.IJPVM_360_18] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31807257]
147. Ribeiro, V.B.; Pedroso, D.C.C.; Kogure, G.S.; Lopes, I.P.; Santana, B.A.; de Souza, H.C.D.; Ferriani, R.A.; Calado, R.T.; Furtado, C.L.M.; Dos Reis, R.M. Short-Term Aerobic Exercise Did Not Change Telomere Length While It Reduced Testosterone Levels and Obesity Indexes in PCOS: A Randomized Controlled Clinical Trial Study. Int. J. Environ. Res. Public Health; 2021; 18, 11274. [DOI: https://dx.doi.org/10.3390/ijerph182111274]
148. Philbois, S.V.; Ribeiro, V.B.; Tank, J.; Reis, R.M.d.; Gerlach, D.A.; Souza, H.C.D. Cardiovascular Autonomic Modulation Differences between Moderate-Intensity Continuous and High-Intensity Interval Aerobic Training in Women with PCOS: A Randomized Trial. Front. Endocrinol.; 2022; 13, 1024844. [DOI: https://dx.doi.org/10.3389/fendo.2022.1024844] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36568110]
149. Elbandrawy, A.M.; Yousef, A.M.; Morgan, E.N.; Ewais, N.F.; Eid, M.M.; Elkholi, S.M.; Abdelbasset, W.K. Effect of Aerobic Exercise on Inflammatory Markers in Polycystic Ovary Syndrome: A Randomized Controlled Trial. Eur. Rev. Med. Pharmacol. Sci.; 2022; 26, pp. 3506-3513. [DOI: https://dx.doi.org/10.26355/EURREV_202205_28845]
150. Benham, J.L.; Booth, J.E.; Corenblum, B.; Doucette, S.; Friedenreich, C.M.; Rabi, D.M.; Sigal, R.J. Exercise Training and Reproductive Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Randomized Controlled Trial. Clin. Endocrinol.; 2021; 95, pp. 332-343. [DOI: https://dx.doi.org/10.1111/cen.14452] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33638879]
151. Thomson, R.L.; Buckley, J.D.; Brinkworth, G.D. Perceived Exercise Barriers Are Reduced and Benefits Are Improved with Lifestyle Modification in Overweight and Obese Women with Polycystic Ovary Syndrome: A Randomised Controlled Trial. BMC Women’s Health; 2016; 16, 14. [DOI: https://dx.doi.org/10.1186/s12905-016-0292-8] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26960762]
152. Almenning, I.; Rieber-Mohn, A.; Lundgren, K.M.; Løvvik, T.S.; Garnæs, K.K.; Moholdt, T. Effects of High Intensity Interval Training and Strength Training on Metabolic, Cardiovascular and Hormonal Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Study. PLoS ONE; 2015; 10, e0138793. [DOI: https://dx.doi.org/10.1371/journal.pone.0138793] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26406234]
153. Nasiri, M.; Monazzami, A.; Alavimilani, S.; Asemi, Z. The Effect of High Intensity Intermittent and Combined(Resistant and Endurance) Trainings on Some Anthropometric and Aerobic Performance in Women with Polycystic Ovary: A Randomized Controlled Clinical Trial Study. Int. J. Fertil. Steril.; 2022; 16, 268. [DOI: https://dx.doi.org/10.22074/IJFS.2022.551096.1279] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36273312]
154. Costa, E.C.; De Sá, J.C.F.; Stepto, N.K.; Costa, I.B.B.; Farias, L.F.; Moreira, S.D.T.; Soares, E.M.M.; Lemos, T.; Browne, R.A.V.; Azevedo, G.D. Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome. Med. Sci. Sports Exerc.; 2018; 50, pp. 1357-1366. [DOI: https://dx.doi.org/10.1249/MSS.0000000000001579] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29443823]
155. Mohammadi, S.; Monazzami, A.; Alavimilani, S. Effects of Eight-Week High-Intensity Interval Training on Some Metabolic, Hormonal and Cardiovascular Indices in Women with PCOS: A Randomized Controlled Trail. BMC Sports Sci. Med. Rehabil.; 2023; 15, 47. [DOI: https://dx.doi.org/10.1186/s13102-023-00653-z]
156. Bonab, S.B.; Parvaneh, M. Effect of 12-Week of Aerobic Exercise on Hormones and Lipid Profile Status in Adolescent Girls with Polycystic Ovary Syndrome: A Study during COVID-19. Sci. Sports; 2023; 38, pp. 565-573. [DOI: https://dx.doi.org/10.1016/j.scispo.2022.11.001] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37362083]
157. Kiel, I.A.; Lionett, S.; Parr, E.B.; Jones, H.; Roset, M.A.H.; Salvesen, O.; Hawley, J.A.; Vanky, E.; Moholdt, T. High-Intensity Interval Training in Polycystic Ovary Syndrome: A Two-Center, Three-Armed Randomized Controlled Trial. Med. Sci. Sport. Exerc.; 2022; 54, pp. 717-727. [DOI: https://dx.doi.org/10.1249/MSS.0000000000002849] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35019901]
158. Ribeiro, V.B.; Kogure, G.S.; Lopes, I.P.; Silva, R.C.; Pedroso, D.C.C.; de Melo, A.S.; de Souza, H.C.D.; Ferriani, R.A.; Furtado, C.L.M.; dos Reis, R.M. Effects of Continuous and Intermittent Aerobic Physical Training on Hormonal and Metabolic Profile, and Body Composition in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Clin. Endocrinol.; 2020; 93, pp. 173-186. [DOI: https://dx.doi.org/10.1111/cen.14194] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32286711]
159. Santos, I.K.; Pichini, G.S.; Ferreira, C.D.D.; Dantas, P.B.; Browne, R.A.; de Queiros, V.; Soares, G.M.; Gonçalves, A.K.; Cabral, B.G.; Maranhao, T.M.O. et al. Effects of High-Intensity Interval Training in Combination with Detraining on Mental Health in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Front. Physiol.; 2022; 13, 948414. [DOI: https://dx.doi.org/10.3389/fphys.2022.948414] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36246128]
160. Butt, M.S.; Saleem, J.; Zakar, R.; Aiman, S.; Khan, M.Z.; Fischer, F. Benefits of Physical Activity on Reproductive Health Functions among Polycystic Ovarian Syndrome Women: A Systematic Review. BMC Public Health; 2023; 23, 882. [DOI: https://dx.doi.org/10.1186/s12889-023-15730-8]
161. Abdolahian, S.; Tehrani, F.R.; Amiri, M.; Ghodsi, D.; Yarandi, R.B.; Jafari, M.; Majd, H.A.; Nahidi, F. Effect of Lifestyle Modifications on Anthropometric, Clinical, and Biochemical Parameters in Adolescent Girls with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. BMC Endocr. Disord.; 2020; 20, 71. [DOI: https://dx.doi.org/10.1186/s12902-020-00552-1] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32429890]
162. Himelein, M.J.; Thatcher, S.S. Polycystic Ovary Syndrome and Mental Health: A Review. Obstet. Gynecol. Surv.; 2006; 61, pp. 723-732. [DOI: https://dx.doi.org/10.1097/01.ogx.0000243772.33357.84]
163. Almhmoud, H.; Alatassi, L.; Baddoura, M.; Sandouk, J.; Alkayali, M.Z.; Najjar, H.; Zaino, B. Polycystic Ovary Syndrome and Its Multidimensional Impacts on Women’s Mental Health: A Narrative Review. Medicine; 2024; 103, e38647. [DOI: https://dx.doi.org/10.1097/MD.0000000000038647] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38905372]
164. Alur-Gupta, S.; Dokras, A.; Cooney, L.G. Management of Polycystic Ovary Syndrome Must Include Assessment and Treatment of Mental Health Symptoms. Fertil. Steril.; 2024; 121, pp. 384-399. [DOI: https://dx.doi.org/10.1016/j.fertnstert.2024.01.018] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38244713]
165. Hajivandi, L.; Noroozi, M.; Mostafavi, F.; Ekramzadeh, M. Assessing the Impact of an Educational Intervention Program Based on the Theory of Planned Behavior on the Nutritional Behaviors of Adolescents and Young Adults with PCOS in Iran: A Field Trial Study. BMC Pediatr.; 2021; 21, 316. [DOI: https://dx.doi.org/10.1186/s12887-021-02784-z] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34261468]
166. Brennan, L.; Teede, H.; Skouteris, H.; Linardon, J.; Hill, B.; Moran, L. Lifestyle and Behavioral Management of Polycystic Ovary Syndrome. J. Women’s Health; 2017; 26, pp. 836-848. [DOI: https://dx.doi.org/10.1089/jwh.2016.5792] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28570835]
167. Oberg, E.; Gidlöf, S.; Jakson, I.; Mitsell, M.; Tollet Egnell, P.; Hirschberg, A.L. Improved Menstrual Function in Obese Women with Polycystic Ovary Syndrome after Behavioural Modification Intervention-A Randomized Controlled Trial. Clin. Endocrinol.; 2019; 90, pp. 468-478. [DOI: https://dx.doi.org/10.1111/cen.13919]
168. ZareMobini, F.; Farajzadegan, Z.; Kazemi, A.; Salehi, M. Effect of Using 5A’s Model for Lifestyle Counseling on Psychological Symptoms in Women with Polycystic Ovary Syndrome: A Randomized Field Trial. Sci. Rep.; 2022; 12, 21847. [DOI: https://dx.doi.org/10.1038/s41598-022-26274-z]
169. Gour, A.; Dubey, P.; Goel, A.; Halder, A. Remote Assessment and Reinforcement of Patient Awareness of Role of Lifestyle Modification and Treatment Adherence in Polycystic Ovary Syndrome Using an Online Video Based Educational Module. J. Turk.-Ger. Gynecol. Assoc.; 2022; 23, pp. 1-7. [DOI: https://dx.doi.org/10.4274/jtgga.galenos.2021.2021-9-29] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35263832]
170. Young, C.C.; Monge, M.; Minami, H.; Rew, L.; Conroy, H.; Peretz, C.; Tan, L. Outcomes of a Mindfulness-Based Healthy Lifestyle Intervention for Adolescents and Young Adults with Polycystic Ovary Syndrome. J. Pediatr. Adolesc. Gynecol.; 2022; 35, pp. 305-313. [DOI: https://dx.doi.org/10.1016/j.jpag.2021.10.016] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34742935]
171. Wang, L.; Liu, Y.; Tan, H.; Huang, S. Transtheoretical model-based mobile health application for PCOS. Reprod. Health; 2022; 19, 117. [DOI: https://dx.doi.org/10.1186/s12978-022-01422-w] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35549736]
172. Majidzadeh, S.; Mirghafourvand, M.; Farvareshi, M.; Yavarikia, P. The effect of cognitive behavioral therapy on depression and anxiety of women with polycystic ovary syndrome: A randomized controlled trial. BMC Psychiatry; 2023; 23, 332. [DOI: https://dx.doi.org/10.1186/s12888-023-04814-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37170227]
173. Jiskoot, G.; de Loos, A.D.; Timman, R.; Beerthuizen, A.; Laven, J.; Busschbach, J. Changes in eating behavior through lifestyle treatment in women with polycystic ovary syndrome (PCOS): A randomized controlled trial. J. Eat. Disord.; 2022; 10, 69. [DOI: https://dx.doi.org/10.1186/s40337-022-00593-y] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35581616]
174. Taylor, F.C.; Dunstan, D.W.; Fletcher, E.; Townsend, M.K.; Larsen, R.N.; Rickards, K.; Maniar, N.; Buman, M.; Dempsey, P.C.; Joham, A.E. et al. Interrupting Prolonged Sitting and Endothelial Function in Polycystic Ovary Syndrome. Med. Sci. Sports Exerc.; 2021; 53, pp. 479-486. [DOI: https://dx.doi.org/10.1249/MSS.0000000000002513] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32925494]
175. Moradi, F.; Ghadiri-Anari, A.; Dehghani, A.; Vaziri, S.R.; Enjezab, B. The effectiveness of counseling based on acceptance and commitment therapy on body image and self-esteem in polycystic ovary syndrome: An RCT. Int. J. Reprod. Biomed.; 2020; 18, 243. [DOI: https://dx.doi.org/10.18502/ijrm.v13i4.6887]
176. Dashti, S.; Hamid, H.A.; Saini, S.M.; Tusimin, M.; Ismail, M.; Jafarzadeh Esfehani, A.; Ching, S.M.; Lee, K.W.; Ismail, N.; Wong, J.L. et al. A randomised controlled trial on the effects of a structural education module among women with polycystic ovarian syndrome on nutrition and physical activity changes. BMC Women’s Health; 2022; 22, 277. [DOI: https://dx.doi.org/10.1186/s12905-022-01861-4] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35794564]
177. Hamzehgardeshi, Z.; Elyasi, F.; Moosazadeh, M.; Ahmadi, I.; Jahanfar, S.; Ahmadian, M.; Ansari, F. The effect of social network based motivational interviewing on health behaviors among infertile women with polycystic ovary syndrome: A randomized controlled trial. Sci. Rep.; 2024; 14, 12049.
178. Dietz de Loos, A.; Jiskoot, G.; van den Berg-Emons, R.; Louwers, Y.; Beerthuizen, A.; van Busschbach, J.; Laven, J. The Effect of Tailored Short Message Service (SMS) on Physical Activity: Results from a Three-Component Randomized Controlled Lifestyle Intervention in Women with PCOS. J. Clin. Med.; 2023; 12, 2466. [DOI: https://dx.doi.org/10.3390/jcm12072466]
179. de Loos, D.; Jiskoot, G.; Beerthuizen, A.; Busschbach, J.; Laven, J. Metabolic health during a randomized controlled lifestyle intervention in women with PCOS. Eur. J. Endocrinol.; 2022; 186, pp. 53-64. [DOI: https://dx.doi.org/10.1530/EJE-21-0669]
180. Guo, Y.; Liu, Y.; Yan, X.; Ding, R.; Wang, L.H. Effects of multidimensional life management on healthy behavior in polycystic ovary syndrome patients: A randomized controlled trial. Front. Psychol.; 2022; 13, 918991. [DOI: https://dx.doi.org/10.3389/fpsyg.2022.918991] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36059725]
181. Lee, H.E.; Lee, S.H. Effectiveness of an Integrated Mobile Application for Lifestyle Modifications in Overweight Women with Polycystic Ovarian Syndrome: A Randomized Controlled Trial. Life; 2023; 13, 1533. [DOI: https://dx.doi.org/10.3390/life13071533] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37511908]
182. Mani, H.; Chudasama, Y.; Hadjiconstantinou, M.; Bodicoat, D.H.; Edwardson, C.; Levy, M.J.; Gray, L.J.; Barnett, J.; Daly, H.; Howlett, T.A. et al. Structured Education Programme for Women with Polycystic Ovary Syndrome: A Randomised Controlled Trial. Endocr. Connect.; 2018; 7, pp. 26-35. [DOI: https://dx.doi.org/10.1530/EC-17-0274]
183. Jiskoot, G.; Timman, R.; Beerthuizen, A.; de Loos, A.D.; Busschbach, J.; Laven, J. Weight Reduction Through a Cognitive Behavioral Therapy Lifestyle Intervention in PCOS: The Primary Outcome of a Randomized Controlled Trial. Obesity; 2020; 28, pp. 2134-2141. [DOI: https://dx.doi.org/10.1002/oby.22980]
184. Kong, L.; Dong, J.; Lu, W.; Wu, Y.; Liu, L.; Tang, M. Exposure Effects of Inhaled Nickel Nanoparticles on the Male Reproductive System via Mitochondria Damage. NanoImpact; 2021; 23, 100350. [DOI: https://dx.doi.org/10.1016/j.impact.2021.100350] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35559828]
185. Xie, M.; Yang, Y.; Zhang, J. The Effects of Behavioral Intervention on Anthropometric, Clinical, and Biochemical Parameters in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front. Endocrinol.; 2024; 15, 1297841. [DOI: https://dx.doi.org/10.3389/fendo.2024.1297841]
186. Tang, R.; Yang, J.; Yu, Y.; Fang, Y. The Effects of Cognitive Behavioral Therapy in Women with Polycystic Ovary Syndrome: A Meta-Analysis. Front. Psychol.; 2022; 13, 796594. [DOI: https://dx.doi.org/10.3389/fpsyg.2022.796594] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36389484]
187. Nybacka, Å.; Hellström, P.M.; Hirschberg, A.L. Increased Fibre and Reduced Trans Fatty Acid Intake Are Primary Predictors of Metabolic Improvement in Overweight Polycystic Ovary SyndromeSubstudy of Randomized Trial between Diet, Exercise and Diet plus Exercise for Weight Control. Clin. Endocrinol.; 2017; 87, pp. 680-688. [DOI: https://dx.doi.org/10.1111/cen.13427] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28727165]
188. Verma, P.; Maan, P.; Gautam, R.; Arora, T. Unveiling the Role of Artificial Intelligence (AI) in Polycystic Ovary Syndrome (PCOS) Diagnosis: A Comprehensive Review. Reprod. Sci.; 2024; 31, pp. 2901-2915. [DOI: https://dx.doi.org/10.1007/s43032-024-01615-7] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/38907128]
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Abstract
Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among reproductive-aged women. It is characterized by hyperandrogenism, anovulation, and polycystic ovaries. Lifestyle changes are suggested as first-line interventions in managing PCOS. This systematic review aims to assess the scientific evidence regarding the role of lifestyle modifications (dietary changes, physical activity, and behavioral changes) in improving reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS. Dietary interventions such as foods with low glycemic index scores; caloric restrictions; high-fiber, omega three fatty acid-rich diets; ketogenic diets; Mediterranean diets; antioxidant-rich food; and anti-inflammatory diets improve insulin sensitivity and hormonal balance in women with PCOS. Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS. Further, behavioral and education modules can also be used to improve awareness, adherence, and the effectiveness of conventional treatment and to manage mental health issues related to PCOS. Collectively, lifestyle modifications not only improve the biochemical, hormonal, and anthropometric parameters in PCOS patients but also reduce the long-term risks of metabolic and cardiovascular diseases.
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
Details
; Jyoti, Anshu 2
; Kumar, Anshu 2 ; Malhotra, Neena 2 ; Arora, Taruna 1
1 Division of Reproductive Child Health and Nutrition, Indian Council of Medical Research (ICMR), New Delhi 110029, India;
2 Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;