Table 1.
Characteristics of included studies.
| Study | Design | Country | PCOS Details at Baseline N (Completers) |
Non-PCOS Details at Baseline N (Completers) |
Attrition Rate | Current Medication | Specific Exclusion Criteria | Intervention | Outcomes | Risk of Bias |
|---|---|---|---|---|---|---|---|---|---|---|
| Diamanti-Kandarakis 2007 [30] | Comparative study | Greece | Age 27.5 ± 5.77 BMI 35.4 ± 5.31 ESHRE/ASRM n = 29 |
Age 32.1 ± 5.64 BMI 36.4 ± 6.47 n = 18 |
Not reported | Not reported | Galactorrhea | Duration: 24 weeks Normal protein diet, 600 kcal/day energy deficit, Orlistat (Xenical®, Roche) 120 mg × 3 times daily Aim of weight loss: not stated |
Anthropo-metric: BMI Reproductive: T, SHBG Metabolic: FG, 2HRG, FI |
Moderate |
| Moran 2007 [34] | Comparative study | Australia | Age 31.7 ± 6.2 BMI 35.7 ± 5.8 ESHRE/ASRM n = 15 |
Age 37.1 ± 4.7 BMI 35.5 ± 5.1 n = 17 |
PCOS 17% Non-PCOS 11% |
No hormonal or insulin-sensitising drugs pre study | Pregnancy, breastfeeding | Duration: 8 weeks Energy restricted diet (two meals daily replaced with commercially available meal replacements) Aim of weight loss: Yes |
Anthropo-metric: Weight, WC Reproductive: T, SHBG, FAI Metabolic: FI, lipids Others: IL-6, TNF-α |
Moderate |
| Hutchison 2011 [31] Harrison 2012 [32] |
Comparative study | Australia | BMI > 27 (37.4 ± 1.5) Age 20–40 (29.5 ± 1.4) NIH n = 13 |
BMI > 27 (35.7 ± 1.3) Age 20-40 (35.0 ± 1.1) n = 8 |
PCOS 35% Non-PCOS 43% |
No hormonal or insulin-sensitising drugs pre study | Diabetes, adrenal disorders, recent weight change, regular physical activity, pregnancy, breastfeeding, smoking | Duration: 12 weeks supervised intensified exercise training 60 min three times weekly Aim of weight loss: not stated |
Anthropo-metric: WC, Weight, BMI, VF, SCFAT Reproductive: T, SHBG, FAI Metabolic: FG, FI, lipids, BP |
Moderate |
| Cheang 2016 [43] | Comparative study | USA | Age 26.9 ± 4.6 BMI 36.6 ± 5.1 Modified ESHRE/ASRM n = 16 |
Age 27.5 ± 5.7 BMI 35.8 ± 4.8 n = 15 |
PCOS 53% Non-PCOS 44% |
No unstable medication use for 6 months for disorders such as hypertension or dyslipidemia | Weight loss attempts in 3 months pre study, diabetes, pulmonary, cardiac, renal, neurologic, hepatic, psychiatric, infectious, neoplastic, malignant disease, pregnancy Non-PCOS: history gestational diabetes, family history abnormal glucose tolerance, hypertension, dyslipidemia |
Duration: 8 weeks Standardized hypocaloric diet (50% carbohydrate, 20% protein, 30% fat) with 500–1000 kcal/day deficit. No modification of physical activity or other weight loss methods. Aim of weight loss: Yes |
Anthropometric: Weight, BMI Metabolic: FG, FI | Moderate |
| Kogure 2016 [44] | Comparative study | Brazil | Age 28.1 ± 5.4 BMI 28.4 ± 6.0 ESHRE/ASRM n = 45 |
Age 29.6 ± 5.2 BMI 26.2 ± 5.7 n = 52 |
PCOS 38% Non-PCOS 46% |
No hormonal contraceptive us drugs pre or during study | Systemic diseases, smoking, pregnancy | Duration: 4 months Progressive resistance training (PRT) for 1 h/day three times per week. Aim of weight loss: not stated |
Anthropometric: Weight, BMI, WC, TFFM, % body fat Reproductive: T, SHBG, FAI Metabolic: FG, FI, HOMA-IR |
Moderate |
| Villa 1999 [40] | Comparative study | Italy | Age 26.3 ± 5 BMI 27.5 ± 6.8 NIH n = 22 |
Age not reported BMI 27.4 ± 6.8 n = 14 |
Not reported | Not reported | Not reported | Duration: 4–5 weeks 50 mg Naltrexone daily Aim of weight loss: not stated |
Anthropo-metric: BMI Reproductive: T, SHBG, FAI Metabolic: FG, FI |
High |
| Kowalska 2001 [33] | Comparative study | Poland | Age 25.3 ± 4.8 BMI 34.7 ± 6.0 NIH n = 11 |
Age 27.9 ± 7.3 BMI 36.2 ± 6.0 n = 19 |
PCOS 27% Non-PCOS 40% |
Not reported | No additional | Duration: 4–5 months Hypocaloric diet (1200–1400 kcal/day), Metformin 500 mg three times daily Aim of weight loss: not stated |
Anthropo-metric: BMI, WC Reproductive: T, FAI, SHBG Metabolic: FI |
High |
| Panidis 2014 [35] Vosnakis 2013 [36] Panidis 2008 [37] |
Comparative study | Greece | Age 26.1 ± 6.4 BMI 34.5 ± 5.9 ESHRE/ASRM n = 101 |
Age 31.5 ± 4.7 BMI 34.9 ± 5.4 n = 29 |
Not reported | No hormonal or insulin-sensitising drugs pre or during study | Galactorrea | Duration: 6 months Normal protein, energy-restricted diet (600 kcal/day energy deficit, moderate intensity aerobic exercise, 1 h × 3 times/week, Orlistat 120 mg before each meal) Aim of weight loss: Yes |
Anthropo-metric: WC, BMI Reproductive: T, FAI, SHBG Metabolic: FG, lipids |
High |
| Kahal 2015 [41] | Comparative study | UK | Age 33.9 ± 6.7 BMI 37.9 ± 5.0 ESHRE/ASRM n = 13 |
Age 33.5 ± 7.1 BMI 36.5 ± 4.6 n = 12 |
PCOS 32% Non-PCOS 29% |
No medication | Alcohol intake >14 units/week Non-PCOS: history of hirsutism or menstrual irregularities |
Duration: 6 months Liraglutide 0.6 mg o.d subcutaneous injection for 1 week, 1.2 mg o.d for 1 week, and 1.8 mg o.d thereafter for 6 months. No diet or exercise advice given. Aim of weight loss: Yes |
Anthropometric: Weight, BMI | High |
| Nikokavora 2015 [42] | Comparative study | UK | Age 35.7 ± 8.9 BMI 40.0 ± 6.3 Diagnostic criteria not reported n = 137 |
Age 35.8 ± 8.9 BMI 40.0 ± 6.3 n = 137 |
PCOS 73% Non-PCOS 73% |
Not reported | Type 1 diabetes, porphyria, lactose intolerance, major cardio- or cerebrovascular disease, history of renal or hepatic disease, cancer, epilepsy, major psychological or eating disorders, breastfeeding, pregnant, birth or miscarriage prior 3 months | Duration: 12 weeks Commercial weight management program (LighterLife Total), 600 kcal (36% protein, 36% carbohydrate, 28% fat) as food packs alongside behavior change program Aim of weight loss: Yes |
Anthropometric: Weight, BMI | High |
| Bhandari 2016 [45] | Comparative study | India | Age 27.8 ± 4.50 BMI 42.5 ± 5.71 ESHRE/ASRM n = 43 |
Age 29.3 ± 4.96 BMI 45.0 ± 6.11 n = 32 |
Not reported | No hormonal, fertility or insulin-sensitising drugs pre or during study | Systemic diseases like hypothyroidism or hyperprolactinaemia, surgical complications intra or post operatively | Duration: 6 months post-surgery Sleeve gastrectomy (bariatric surgery) Aim of weight loss: Yes |
Anthropometric: Weight, BMI Other: Abnormal menstrual cycles |
High |
| Al-Eisa 2017 [46] | Comparative study | Egypt | Age 27.9 ± 4.1 BMI 33.5 ± 2.75 ESHRE/ASRM n = 30 |
Age 27.6 ± 5.7 BMI 31.7 ± 3.8 n = 30 |
Not reported | No hormonal drugs pre or during study | Normal BMI, other diseases such as diabetes or viral infections | Duration: 12 weeks treadmill walking, 45 min three times per week for 12 weeks. Aim of weight loss: Yes |
Anthropometric: Weight, BMI, WC Metabolic: FG, FI |
High |
| Pasquali 2000 [38] | RCT | Italy | BMI > 28 WHR > 0.80 NIH n = 18 |
BMI > 28 WHR > 0.80 n = 17 |
Diet: PCOS 0% Non-PCOS 25% Metform-in: PCOS 17% Non-PCOS 0% |
No hormonal or insulin-sensitising drugs pre study | Diabetes, renal or liver dysfunction | Duration: 6 months One month hypocaloric diet (1200–1400 kcal daily), Metformin 850 mg twice daily. Aim of weight loss: Yes |
Anthropo-metric: Weight, BMI, SAT, VAT Reproductive: T, SHBG Metabolic: FG, FI |
Moderate |
| Toscani 2011 [39] | RCT | Brazil | Age 22.7 + 5.68 Most participants BMI ≥ 25 NIH n = 18 |
Age 29.4 + 5.74 Most participants BMI ≥ 25 n = 22 |
Not reported | No hormonal drugs pre study | Diabetes, renal dysfunction | Duration: 2 months Diet 1: HP (30% protein, 40% carbohydrate, 30% fat) Diet 2: NP (15% protein, 55% carbohydrate, 30% fat) Aim of weight loss: Yes |
Anthropo-metric: Weight, WC, BMI Reproductive: T, SHBG, FAI Metabolic: BP, FG, 2HRG, FI, 2HRI, lipids |
High |
2HRG: 2 h glucose; 2HRI: 2 h insulin; BMI, body mass index; BMR, basal metabolic rate; BP, blood pressure; FAI, free androgen index; FG, fasting glucose; FI, fasting insulin; IL-6, interleukin-6; PCOS, polycystic ovary syndrome; SAT, subcutaneous abdominal tissue; SCFAT, subcutaneous fat; SHBG, sexual-hormone binding globulin; T, total testosterone; TFFM, total fat free mass; TFM, total fat mass; TNF-α, tumor necrosis factor-α; VAT, visceral abdominal tissue; VF, visceral fat; WC, waist circumference.