Women with polycystic ovary syndrome (PCOS) have a considerable risk of metabolic dysfunction. This review aims to present contemporary knowledge on obesity, insulin resistance and PCOS with emphasis on the diagnostic and methodological challenges encountered in research and clinical practice. Variable diagnostic criteria for PCOS and associated phenotypes are frequently published. Targeted searches were conducted to identify all available data concerning the association of obesity and insulin resistance with PCOS up to September 2016. Articles were considered if they were peer reviewed, in English and included women with PCOS. Obesity is more prevalent in women with PCOS, but studies rarely reported accurate assessments of adiposity, nor split the study population by PCOS phenotypes. Many women with PCOS have insulin resistance, though there is considerable variation reported in part due to not distinguishing subgroups known to have an impact on insulin resistance as well as limited methodology to measure insulin resistance. Inflammatory markers are positively correlated with androgen levels, but detailed interactions need to be identified. Weight management is the primary therapy; specific advice to reduce the glycaemic load of the diet and reduce the intake of pro-inflammatory SFA and advanced glycation endproducts have provided promising results. It is important that women with PCOS are educated about their increased risk of metabolic complications in order to make timely and appropriate lifestyle modifications. Furthermore, well-designed robust studies are needed to evaluate the mechanisms behind the improvements observed with dietary interventions.

Treatment of coeliac disease requires a strict gluten-free (GF) diet, however, a high proportion of patients do not adhere to a GF diet. The study explores the practical challenges of a GF diet and dietary adherence in Caucasian and South Asian adults with coeliac disease. Patients with biopsy- and serology-proven coeliac disease were recruited from a hospital database. Participants completed a postal survey (n = 375), including a validated questionnaire designed to measure GF dietary adherence. Half of Caucasians (53%) and South Asians (53%) were adhering to a GF diet. The quarter of patients (n = 97) not receiving GF foods on prescription had a lower GF dietary adherence score compared with those receiving GF foods on prescription (12.5 versus 16.0; p < 0.001). Not understanding food labelling and non-membership of Coeliac UK were also associated with lower GF dietary adherence scores. A higher proportion of South Asian patients, compared with Caucasians, reported difficulties understanding what they can eat (76% versus 5%; p < 0.001) and understanding of food labels (53% versus 4%; p < 0.001). We recommend retaining GF foods on prescription, membership of a coeliac society, and regular consultations with a dietitian to enable better understanding of food labels. Robust studies are urgently needed to evaluate the impact of reducing the amount of GF foods prescribed on adherence to a GF diet in all population groups.

Vitamin E absorption requires the presence of fat; however, limited information exists on the influence of fat quantity on optimal absorption. In the present study we compared the absorption of stable-isotope-labelled vitamin E following meals of varying fat content and source. In a randomised four-way cross-over study, eight healthy individuals consumed a capsule containing 150 mg 2 H-labelled RRRa-tocopheryl acetate with a test meal of toast with butter (17·5 g fat), cereal with full-fat milk (17·5 g fat), cereal with semi-skimmed milk (2·7 g fat) and water (0 g fat). Blood was taken at 0, 0·5, 1, 1·5, 2, 3, 6 and 9 h following ingestion, chylomicrons were isolated, and 2 H-labelled a-tocopherol was analysed in the chylomicron and plasma samples. There was a significant time (P,0·001) and treatment effect (P,0·001) in 2 H-labelled a-tocopherol concentration in both chylomicrons and plasma between the test meals.2 H-labelled a-tocopherol concentration was significantly greater with the higher-fat toast and butter meal compared with the low-fat cereal meal or water (P, 0·001), and a trend towards greater concentration compared with the high-fat cereal meal (P¼0·065). There was significantly greater 2 H-labelled a-tocopherol concentration with the high-fat cereal meal compared with the low-fat cereal meal (P,0·05). The 2 H-labelled atocopherol concentration following either the low-fat cereal meal or water was low. These results demonstrate that both the amount of fat and the food matrix influence vitamin E absorption. These factors should be considered by consumers and for future vitamin E intervention studies.

Background Polycystic ovary syndrome (PCOS) is a common endocrine condition associated with hyperandrogenism, infertility and metabolic dysfunction. Weight management through diet and lifestyle modifications are fundamental to its management, however, presently there are no official dietary guidelines. This study aimed to explore the dietary and lifestyle strategies followed by women with PCOS and the contribution of dietitians to its management. Methods A questionnaire was completed by 105 UK dietitians focused on the service provided and a patient questionnaire and 7-day food diary were completed by women with PCOS (n=206 and n=196 respectively). Food diaries were analysed for energy and macronutrient intake and the questionnaire focused on the dietary advice received. Results Advice provided by dietitians focused on a reduction in energy intake (78%) and dietary glycaemic index (77%), often in combination. Of the women with PCOS who were following a diet specifically for their PCOS (57%), regimes included low glycaemic index (34%), weight loss diets (16%) or a combination (26%). Of interest, 73% of overweight women were not following a diet to promote weight loss. Nutritional information predominately came from books, with only 15% of women having seen a dietitian. Eighty four percent of women with PCOS who had increased physical activity (48%) self reported an improvement in their symptoms. Conclusions Women with PCOS recognise the importance of diet, but few received dietary advice from a registered dietitian. The dietary information women with PCOS received was often from an unregulated source. A consensus statement of evidence based dietary advice for women with PCOS is needed and would be a useful resource for dietitians. Introduction:Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting up to 10% of women (Franks, 1995, Lindholm et al., 2008. The clinical and biochemical features of the syndrome are heterogeneous, including menstrual irregularity and fertility problems, excess hair and acne (Diamanti-Kandarakis, 2008). Women with PCOS are also more likely to be overweight and have an increased risk of metabolic syndrome, type 2 diabetes and cardiovascular disease (Dokras, 2008, Ehrmann et al., 1999. Approximately 33% of UK women with PCOS are obese (Barr et al., 2007) compared with 20% of women in the general population (Ruston et al., 2004).

Coeliac disease (CD) is an autoimmune gastrointestinal disorder whereby the ingestion of gluten, a storage protein found in wheat, barley and rye, causes damage to intestinal mucosa with resultant malabsorption, increased risk of anaemia and osteoporosis. Worldwide estimates suggest 1% of the population have CD. With no cure, the only treatment is a gluten-free diet (GFD). Adhering to a GFD can be very challenging; it requires knowledge, motivation and modified behaviours. Assessing adherence to a GFD is methodologically challenging. This review aims to provide an overview of the literature reporting adherence to a GFD in people with CD and the methodological challenges encountered. From six studies it has been reported that rates of adherence to a GFD range between 45 and 90% in patients of different ethnicities with CD. GF dietary adherence can be influenced by age at diagnosis, coexisting depression, symptoms on ingestion of gluten, nutrition counselling, knowledge of GF foods, understanding of food labels, cost and availability of GF foods, receiving GF foods on prescription and membership of a coeliac society. To date only five intervention studies in adults with CD have been undertaken to improve GF dietary adherence. These have included dietary and psychological counselling, and the use of online training programmes, apps, text messages and telephonic clinics. Future interventions should include people of all ethnicities, consider patient convenience and the cost-effectiveness for the healthcare environment.