TABLE 1.
Characteristics of studies included in the review assessing baseline diet and/or physical activity in women with and without PCOS1
| Study (reference) | Sample, assessments used | Outcomes2 | Limitations |
| Wright et al. 2004 (36) | Groups: n = 84, PCOS; n = 79, controls | No differences in daily food and nutrient intake or physical activity between PCOS and control groups | Diagnostic criteria used yielded a heterogeneous PCOS group |
| Age: 46.7 ± 5.8 y, PCOS; 48.2 ± 5.7 y, controls | Lower nutrient intake in normal weight PCOS (n = 21) vs. normal weight control (n = 33) groups*: total energy/d, CHO (g/d), protein (g/d), fat (g/d), SFAs (g/d), MUFAs (g/d), PUFAs (g/d), cholesterol (mg/d) | Population studied used medications known to influence endocrine profile (e.g., oral contraceptive, antiandrogens) | |
| BMI (kg/m2)3: 32.1 ± 9.3, PCOS; 29.0 ± 6.0, controls | No reported exclusion criteria on medications that may influence weight, appetite | ||
| Location: Pittsburgh, PA | Lower bread, cereal, rice, pasta, meat, fish, poultry, egg intake in normal weight PCOS vs. normal weight control groups (servings)* | Older, potentially perimenopausal, populations studied, heterogeneous control group used with 41% reporting oligoamenorrhea; low generalizability to younger women with PCOS | |
| Race: Caucasian: 83%, PCOS; 90%, controls; non-Caucasian: 13%, PCOS; 10%, controls | Lower milk product intake in overweight PCOS (n = 15) vs. overweight control (n = 19) groups (servings)* | Power analysis not provided for post hoc comparisons among BMI-matched groups | |
| PCOS definition: oligoamenorrhea plus either hirsutism, hyperandrogenism and/or elevated LH:FSH | Lower meat, fish, poultry, egg intake in obese PCOS (n = 48) vs. obese control (n = 27) groups (servings)* | Did not report energy expenditure or energy balance | |
| No specific exclusion criteria were applied | Higher carbohydrate and lower fat intakes in PCOS group vs. Reaven study recommendations (49) | ||
| Assessments: FFQ, physical activity questionnaire | Did not compare with U.S. DRI | ||
| Douglas et al. 2006 (35) | Groups n = 30, PCOS; n = 27, controls | No differences in nutrient intake between PCOS and control groups | Population studied used drugs known to influence endocrine profile |
| Age; 28.9 ± 6.3 y, PCOS; 28.9 ± 6.5 y, controls | Greater white bread intake in PCOS vs. control groups (servings)* | No reported exclusion criteria on other medications that may influence weight, appetite | |
| BMI (kg/m2): 29.1 ± 4.8, PCOS; 29.7 ± 4.8, controls | Comprehensive dietary intake not collected on all days of week | ||
| Location: Birmingham, AL | Overall study groups not matched for BMI | ||
| Race: Caucasian: 83%, PCOS; 85%, controls; black: 13%, PCOS; 11%, controls other: 4%, PCOS; 4% controls | Power analysis not provided | ||
| PCOS definition: oligoamenorrhea plus hirsutism and/or hyperandrogenism | Data on physical activity not collected | ||
| Exclusion criteria: diabetes, use of insulin sensitizers or glucose-lowering drugs and adherence to a modified diet | Did not compare with U.S. DRI | ||
| Assessments: 4-d food records (Wed/Thu/Sat/Sun) | |||
| Álvarez-Blasco et al. 2011 (42) | Groups: n = 22, PCOS; n = 59, controls | No differences in nutrient intake and physical activity between PCOS and control groups | Study groups not matched for age |
| Age3: 26.3 ± 7.6 y, PCOS; 32.2 ± 7.5 y, controls | PCOS group intake vs. U.S. dietary recommended intake*: | Power analysis not provided | |
| BMI (kg/m2): 35.2 ± 6.7, PCOS; 32.2 ± 6.1, controls | Above: total fat (g/d), SFAs (% of energy/d), MUFAs (% of energy/d), dietary cholesterol (mg/d), sodium (mg/d), vitamin C (mg/d), vitamin D (μg/d), calcium (mg/d), magnesium (mg/d) | Details on physical activity assessment tool not reported | |
| Location: Madrid, Spain | Below: fiber (g/d), potassium (mg/d), vitamin E (mg/d) | Did not report energy expenditure or energy balance | |
| Race not reported | |||
| PCOS definition: oligoamenorrhea plus hirsutism and/or hyperandrogenism | Did not compare intake with EFSA-recommended intake, which is established for European countries | ||
| Exclusion criteria: use of hormonal contraception and medications that interfere with metabolism, hypocaloric dieting, implausible energy intake, supplement use | |||
| Assessments: FFQ, exercise habits assessed using interview | |||
| Barr et al. 2011 (43) | Group n = 198, PCOS | Greater daily nutrient intake in PCOS vs. controls (national survey reference)*: total energy/d, CHO (g/d), protein (g/d), fat (g/d), fat (% of energy/d), SFAs (g/d), MUFAs (g/d), PUFAs (g/d), total sugar (g/d), fiber (g/d) | Diagnostic criteria for PCOS not provided, heterogeneous PCOS group studied |
| Age: 32.6 ± 6.3 y | |||
| BMI (kg/m2): 27.4 ± 7.3 | Recruitment based on self-reported diagnosis of PCOS | ||
| Location: London, UK | Lower daily nutrient intake in PCOS vs. controls (national survey reference)*: CHO (% of energy/d) | Reference population may contain women with PCOS | |
| Race: Caucasian: 97%, PCOS; unknown: 3%, PCOS | No reported exclusion criteria on medications that may influence endocrine profile | ||
| PCOS definition not provided | Lower daily glycemic index in normal weight (n = 80) vs. overweight PCOS (n = 100) groups* PCOS group intake vs. UK recommended intake*: | Older, potentially perimenopausal, women included | |
| Exclusion criteria: pregnancy, breastfeeding, eating disorders, and use of weight-loss medications | Above: total energy/d, protein (g/d), fat (g/d), SFAs (g/d), MUFAs (g/d), PUFAs (g/d) | Did not report energy expenditure or energy balance | |
| Assessments: 7-d food and activity record | Below: CHO (g/d), fiber (g/d) | ||
| Greater activity in moderate-intensity physical activity (min/d) in normal weight (n = 80) vs. overweight (n = 100) PCOS groups* | |||
| Toscani et al. 2011 (41) | Groups: n = 43, PCOS; n = 37, controls | No differences in nutrient intake between PCOS and control groups | Study groups not matched for age |
| Age3: 22.7 ± 5.6 y, PCOS; 29.7 ± 4.9 y, controls | PCOS group intake vs. U.S. recommended intake*: below: fiber (g/d), MUFAs (% of energy/d), PUFAs (% of energy/d) | No reported exclusion criteria on medications that may influence weight and appetite | |
| BMI (kg/m2): 30.9 ± 5.5, PCOS; 29.7 ± 5.2, controls | High reporting bias because participants may alter diet before scheduled visit | ||
| Location: Porto Alegre, Brazil | No associations between androgen status and nutrients | Data on physical activity not collected | |
| Race: Caucasian: 90%, PCOS; 74%, controls; African-European: 10%, PCOS; 26%, controls | Comparisons with U.S. recommended intake may not be appropriate for Brazilian populations | ||
| PCOS definition: oligoamenorrhea plus either hirsutism and/or hyperandrogenism | |||
| Exclusion criteria: medications known to interfere with hormone concentrations, BMI >40 kg/m2 and diabetes | |||
| Assessments: 24-h dietary recall | |||
| Tsai et al. 2012 (47) | Groups: n = 45, PCOS; n = 161, controls | Greater daily nutrient intake in PCOS vs. control groups*: fat (% of energy/d) | Diagnostic criteria used yielded heterogeneous PCOS group |
| Age: 32.7 ± 4.2 y, PCOS; 34.7 ± 3.6 y, controls | Control group comprised infertile women with various etiologies including unexplained infertility | ||
| BMI (kg/m2)3: 23.0 ± 4.4, PCOS; 21.3 ± 2.9, controls | Lower daily nutrient intake in PCOS vs. control groups*: total energy/d, CHO (g/d), CHO (% of energy/d) | Study groups not matched for BMI | |
| Location: Taipei, Taiwan | No reported exclusion criteria on medications that may influence weight and appetite | ||
| Race not reported | Positive associations among hormones and nutrients in PCOS*: FSH and CHO (g/d), FSH and CHO (% of energy/d) | Power analysis not provided for post hoc comparisons between PCOS phenotypes | |
| PCOS definition: 2 of 3 symptoms: 1) oligoamenorrhea, 2) hirsutism and/or hyperandrogenemia, 3) polycystic ovaries | Data on physical activity not collected | ||
| Exclusion criterion: hormonal therapy | No differences in daily nutrient intake between hyperandrogenic (n = 21) and nonandrogenic (n = 24) PCOS groups | ||
| Assessments: 3-d food record (2 weekdays, 1 weekend day) | |||
| Altieri et al. 2013 (40) | Groups: n = 100, PCOS; n = 100, controls | Greater daily nutrient intake in PCOS vs. control groups*: fiber (g/d) | Diagnostic criteria used yielded a heterogeneous PCOS group |
| Age: 27.7 ± 5.2 y, PCOS; 28.4 ± 5.8 y, controls | Data on physical activity not collected | ||
| BMI (kg/m2): 34.7 ± 5.5, PCOS; 34.8 ± 5.4, controls | Lower daily nutrient intake in PCOS vs. control groups*: lipids (% of energy/d) | Did not compare intake with EFSA-recommended intake, which is established for European countries | |
| Location: Bologna, Italy | Greater starchy sweets (g/d), cheese (g/d), oil (g/d) in PCOS vs. control groups* | ||
| Race not reported | Lower cooking fats (g/d) in PCOS vs. control groups* | ||
| PCOS definition: 2 of 3 symptoms: 1) oligoamenorrhea, 2) hirsutism and/or hyperandrogenemia, 3) polycystic ovaries | Positive associations between hormones and nutrients in PCOS*: A4 and total energy, A4 and protein (g/d), A4 and cholesterol (mg/d) | ||
| Exclusion criteria: endocrine or metabolic disorders; medications that influence appetite, reproduction, glucose, or lipid concentrations; psychoactive drugs; eating disorders; intensive lifestyle interventions | Negative associations between hormones and nutrients in PCOS*: SHBG and total energy/d, SHBG and CHO (g/d), SHBG and CHO (% of energy/d), SHBG and oligosaccharides (g/d) | ||
| Assessments: 7-d food records | |||
| Moran et al. 2013 (44) | Groups: n = 409, PCOS; n = 7057, controls | Greater daily nutrient intake in PCOS vs. control Groups*: total energy/d, fiber (g/d), folate (μg/d), iron (mg/d), magnesium (mg/d), phosphorus (mg/d), vitamin E (mg/d), sodium (mg/d)3, zinc (mg/d)3, calcium (mg/d)3, potassium (mg/d)3, niacin (mg/d)3 | Recruitment based on self-reported diagnosis of PCOS |
| Age3: 33.5 ± 1.4 y, PCOS; 33.7 ± 1.5 y, controls | Control group may contain undiagnosed women with PCOS | ||
| BMI (kg/m2)3: 29.3 ± 7.5, PCOS; 25.6 ± 5.8, controls | Lower daily nutrient intake in PCOS vs. control groups*: SFAs (% of energy/d), glycemic index, retinol (μg/d) | No reported exclusion criteria on medications that may influence weight, appetite, or reproduction | |
| Location: Australia (national survey) | Groups included women who are pregnant women and using hormones | ||
| Race not reported | PCOS group reported higher diet quality than control group | Study groups not matched for age or BMI | |
| PCOS definition not provided | PCOS group intake vs. U.S. DRI*: above: SFAs (% of energy) | Did not compare intake with Australian nutrient reference values | |
| No specific exclusion criteria were applied | No differences in self-reported physical activity between PCOS and control groups | ||
| Assessments: FFQ, physical activity 1-wk recall | PCOS group reported greater amount of sitting time compared with controls* | ||
| Graff et al. 2013 (46) | Groups n = 61, PCOS; n = 44, controls | Greater daily nutrient intake in PCOS vs. control Groups*: total energy/d, glycemic index3, glycemic load3, sodium (mg/d)3 | Diagnostic criteria used yielded a heterogeneous PCOS group |
| Age: 22.7 ± 6.2 y, PCOS; 25.0 ± 6.3 y, controls | Included both adolescents and adults with PCOS | ||
| BMI (kg/m2): 28.9 ± 5.6, PCOS; 27.1 ± 5.7, controls | Greater energy intake/d and glycemic index diet between classic PCOS (n = 39) and control (n = 44) groups* | No reported exclusion criteria on medications that may influence weight and appetite | |
| Location: Porto Alegre, Brazil | Higher glycemic index diet between classic PCOS (n = 39) and ovulatory PCOS (n = 22) groups* | Power analysis not provided for post hoc comparisons between PCOS phenotypes | |
| Race: Caucasian: 88% of sample; African-European: 12% of sample | No differences in total energy intake and glycemic index diet between ovulatory PCOS (n = 22) and control (n = 44) groups | Pedometer may not comprehensively capture physical activity data | |
| PCOS definition: 1) classic PCOS: oligoamenorrhea, hirsutism and/or hyperandrogenemia with or without polycystic ovaries; 2) ovulatory PCOS: hirsutism and polycystic ovaries in the presence of regular menstrual cycles and normal androgens | No differences in physical activity between PCOS and control groups | Did not report energy expenditure or energy balance | |
| Exclusion criteria: diabetes, medications that alter hormone concentrations, pregnancy, BMI ≥40 kg/m2 | |||
| Assessments: FFQ, 6-d pedometer use | |||
| Ahmadi et al. 2013 (45) | Groups: n = 65, PCOS; n = 65, controls | Greater daily nutrient intake in PCOS vs. control groups*: total kcal/d, fat (% of energy/d), SFAs (g/d), PUFAs (g/d) | Diagnostic criteria used yielded a heterogeneous PCOS group |
| Age: 25.1 ± 6.1 y, PCOS; 26.1 ± 6.5 y, controls | Power analysis not provided for post hoc comparisons among PCOS groups | ||
| BMI (kg/m2): 23.4 ± 3.6, PCOS; 23.1 ± 3.8, controls | No significant self-reported physical activity differences between PCOS and control groups | Details on physical activity assessment tool not reported | |
| Location: Shiraz, Iran | No differences in daily nutrient intake between normal weight (n = 49) and overweight (n = 16) PCOS groups | Did not report energy expenditure or energy balance | |
| Race not reported | |||
| PCOS definition: 2 of 3 symptoms: 1) oligoamenorrhea, 2) hirsutism and/or hyperandrogenemia, 3) polycystic ovaries | |||
| Exclusion criteria: liver, kidney, and heart disease; hormone use; medications that influence metabolism or body composition; incomplete FFQ; implausible energy intake; and intensive lifestyle interventions | |||
| Assessments: Three 24-h recalls (2 weekdays, 1 weekend day), exercise habits assessed by using demographic questionnaire |
1
*P < 0.05. A4, androstenedione; CHO, carbohydrate; EFSA, European Food Safety Authority; FSH, follicle-stimulating hormone; LH, luteinizing hormone; PCOS, polycystic ovary syndrome; SHBG, sex hormone–binding globulin.
2
Only data pertaining to diet and/or physical activity are reported.
3
NS after adjustment for energy intake or age and BMI.