Are Dieting and Dietary Inadequacy a Second Hit in the Association with Polycystic Ovary Syndrome Severity?

Abstract

BackgroundThe composition of the diet is of increasing importance for the development and maturation of the ovarian follicles. In Polycystic Ovary Syndrome (PCOS) healthy dietary interventions improve the clinical spectrum. We hypothesized that dieting and diet inadequacy in the reproductive life course is associated with impaired programming of ovarian follicles and contributes to the severity of the PCOS phenotype.Methods and FindingsTo determine associations between the use of a self-initiated diet and diet inadequacy and the severity of the PCOS phenotype, we performed an explorative nested case control study embedded in a periconception cohort of 1,251 patients visiting the preconception outpatient clinic. 218 patients with PCOS and 799 subfertile controls were selected from the cohort and self-administered questionnaires, anthropometric measurements and blood samples were obtained. The Preconception Dietary Risk Score (PDR score), based on the Dutch dietary guidelines, was used to determine diet inadequacy in all women. The PDR score was negatively associated to cobalamin, serum and red blood cell folate and positively to tHcy. PCOS patients (19.9%), in particular the hyperandrogenic (HA) phenotype (22.5%) reported more often the use of a self-initiated diet than controls (13.1%; p = 0.023). The use of an inadequate diet was also significantly higher in PCOS than in controls (PDR score 3.7 vs 3.5; p = 0.017) and every point increase was associated with a more than 1.3 fold higher risk of the HA phenotype (adjusted OR 1.351, 95% CI 1.09–1.68). Diet inadequacy was independently associated with the anti-Müllerian Hormone (AMH) concentration (β 0.084; p = 0.044; 95% CI 0.002 to 0.165) and free androgen index (β 0.128; p = 0.013; 95% CI 0.028 to 0.229) in PCOS patients.ConclusionsThe use of a self-initiated diet and diet inadequacy is associated with PCOS, in particular with the severe HA phenotype. This novel finding substantiated by the association between diet inadequacy and AMH needs further investigation.

Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovary syndrome: A cohort study

“…Our study indicated that, despite significant differences in BMI and WHR, overall caloric intake and physical activity did not differ between women with and without PCOS, as have been observed in previous studies conducted in North America (Douglas et al, ; Wright et al, ). These findings demonstrate that obese women with PCOS are not in an energy surplus state supporting previous studies that suggest women with PCOS could indeed have an altered metabolism contributing to their obesity and IR (Georgopoulos et al, ; Huijgen et al, ; Robinson et al, ).…”

“…2006; Wright et al, 2004). These findings demonstrate that obese women with PCOS are not in an energy surplus state supporting previous studies that suggest women with PCOS could indeed have an altered metabolism contributing to their obesity and IR (Georgopoulos et al, 2009;Huijgen et al, 2015;Robinson et al, 1992).…”

Polycystic Ovary Syndrome: A Brain Disorder Characterized by Eating Problems Originating during Puberty and Adolescence

“…Interestingly, androgens stimulate appetite, food craving and recurrent binge eating, although the underlying mechanisms are not understood [21,46,47]. In an explorative study, we observed that women with PCOS were frequently dieting, very often consuming substandard foodstuffs relative to that consumed by the control population [48]. These substandard diets were characterized by low serum folate and elevated homocysteine concentrations, indicating a more general derangement in 1C metabolism associated with a hyperandrogenic status in these women.…”

Association of testosterone and antimüllerian hormone with time to pregnancy and pregnancy loss in fecund women attempting pregnancy

“…Though speculative and requiring direct exploration in studies with more in-depth metabolic measures, women among this group may experience normal menstrual cycles and fecundability for the very reason that they maintain higher insulin sensitivity, protecting them from their underlying “PCOS potential.” Indeed, prior evidence indicated no association between polycystic ovarian morphology and glucose tolerance or insulin sensitivity, lending evidence to the distinction of ovarian/follicular dysfunction from the metabolic factors which may exacerbate, as opposed to cause, the pathology (29). It is logical to suspect that women in the group of highest T and AMH may be more likely to develop PCOS if exposed to insulin resistance brought on through diet, excess adiposity, or other exposures, akin to a ‘second hit’ as described previously for exacerbating PCOS severity (30). Alternatively, some women in the high T/high AMH group may meet criteria for clinical PCOS diagnosis, but have not received such a diagnosis.…”