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The optimal diet for women with polycystic ovary syndrome?

Published online by Cambridge University Press:  08 March 2007

Kate Marsh  and
Jennie Brand-Miller
Kate Marsh*
Affiliation:
Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, NSW Australia 2006
Jennie Brand-Miller
Affiliation:
Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, NSW Australia 2006
*
*Corresponding author: Kate Marsh, fax +61 2 9415 1446, email [email protected]
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Abstract

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An optimal diet is one that not only prevents nutrient deficiencies by providing sufficient nutrients and energy for human growth and reproduction, but that also promotes health and longevity and reduces the risk of diet-related chronic diseases. The composition of the optimal diet for women with polycystic ovary syndrome (PCOS) is not yet known, but such a diet must not only assist short term with weight management, symptoms and fertility, but also specifically target the long-term risks of type 2 diabetes, CVD and certain cancers. With insulin resistance and compensatory hyperinsulinaemia now recognised as a key factor in the pathogenesis of PCOS, it has become clear that reducing insulin levels and improving insulin sensitivity are an essential part of management. Diet plays a significant role in the regulation of blood glucose and insulin levels, yet research into the dietary management of PCOS is lacking and most studies have focused on energy restriction rather than dietary composition per se. On the balance of evidence to date, a diet low in saturated fat and high in fibre from predominantly low-glycaemic-index-carbohydrate foods is recommended. Because PCOS carries significant metabolic risks, more research is clearly needed.

Keywords

Polycystic ovary syndromeInsulin resistanceGlycaemic index
Type
Review article
Information
British Journal of Nutrition , Volume 94 , Issue 2 , August 2005 , pp. 154 - 165
Copyright
Copyright © The Nutrition Society 2005

References

Agus, MS, Swain, JF, Larson, CL, Eckert, EA & Ludwig, DS (2000) Dietary composition and physiologic adaptations to energy restriction. Am J Clin Nutr 71, 901–907.CrossRefGoogle ScholarPubMed
Andersen, P, Seljeflot, I, Abdelnoor, M, Arnesen, H, Dale, PO, Lovik, A & Birkeland, K (1995) Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with polycystic ovary syndrome. Metabolism 44, 611–616.CrossRefGoogle ScholarPubMed
Appel, LJ, Moore, TJ & Obarzanek, E (1997) for the DASH Collaborative Research Group A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 336, 1117–1124.Google Scholar
Ard, JD, Grambow, SC, Liu, D, Slentz, CA, Kraus, WE & Svetkey, LP (2004) The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care 27, 340–347.Google Scholar
Astrup, A, Ryan, L, Grunwald, GK, Storgaard, M, Saris, W, Melanson, E & Hill, JO (2000) The role of dietary fat in body fatness: evidence from a preliminary meta-analysis of ad libitum low-fat dietary intervention studies. Br J Nutr 83, Suppl. 1, S25–S32.CrossRefGoogle ScholarPubMed
Asuncion, M, Calvo, RM, San Millan, JL, Sancho, J, Avila, S & Escobar-Morreale, HF (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 85, 2434–2438.Google Scholar
Atimo, WU, El-Mahdi, E & Hardiman, P (2003) Familial associations in women with polycystic ovary syndrome. Fertil Steril 80, 143–145.Google Scholar
Augustin, LS, Dal Maso, L, La Vecchia, C, Parpinel, M, Negri, E, Vaccarella, S, Kendall, CW, Jenkins, DJ & Francesch, S (2001) Dietary glycemic index and glycemic load, and breast cancer risk: a case-control study. Annals of Oncology 12, 1533–1538.Google Scholar
Augustin, LS, Gallus, S, Bosetti, C, Levi, F, Negri, E, Franceschi, S, Dal Maso, L, Jenkins, DJ, Kendall, CW & La Vecchia, C (2003) Glycemic index and glycemic load in endometrial cancer. Int J Cancer 105, 404–407.Google Scholar
Baba, NH, Sawaya, S, Torbay, N, Habbal, Z, Azar, S & Hashim, SA (1999) High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects. Int J Obes 23, 1202–1206.CrossRefGoogle ScholarPubMed
Berrino, F, Bellati, C, Secreto, G, Camerini, E, Pala, V, Panico, S, Allegro, G & Kaaks, R (2001) Reducing bioavailable sex hormones through a comprehensive change in diet: the diet and androgens (DIANA) randomised trial. Cancer Epidemiol Biomark Prev 10, 25–33.Google Scholar
Bjercke, S, Dale, PO, Tanbo, T, Storeng, R, Ertzeid, G & Abyholm, T (2002) Impact of insulin resistance on pregnancy complications and outcome in women with polycystic ovary syndrome. Gynecol Obstet Invest 54, 94–98.CrossRefGoogle ScholarPubMed
Boeing, H, Weisgerber, UM, Jeckel, A, Rose, HJ & Kroke, A (2000) Association between glycated hemoglobin and diet and other lifestyle factors in a nondiabetic population: cross-sectional evaluation of data from the Potsdam cohort of the European Prospective Investigation into Cancer and Nutrition Study. Am J Clin Nutr 71, 1115–1122.Google Scholar
Bouche, C, Rizkalla, SW, Luo, J, Vidal, H, Veronese, A, Pacher, N, Fouquet, C, Lang, V & Slama, G (2002) Five week, low-glycemic index diet decreases total fat mass and improves plasma lipid profile in moderately overweight nondiabetic men. Diabetes Care 25, 822–828.Google Scholar
Brand-Miller, J, Hayne, S, Petocz, P & Colagiuri, S (2003) Low-glycemic index diets in the management of diabetes: a meta-analysis of randomised controlled trials. Diabetes Care 26, 2261–2267.CrossRefGoogle Scholar
Bray, G & Popkin, B (1998) Dietary fat intake does affect obesity!. Am J Clin Nutr 68, 1157–1173.CrossRefGoogle ScholarPubMed
Brynes, AE, Edwards, MC, Ghatei, MA, Dornhorst, A, Morgan, LM, Bloom, SR & Frost, GS (2003) A randomised four-intervention crossover study investigating the effect of carbohydrates on daytime profiles of insulin, glucose, non-esterified fatty acids and triacylglycerols in middle-aged men. Br J Nutr 89, 207–218.CrossRefGoogle ScholarPubMed
Byrne, CD, Wareham, NJ, Brown, DC, Clark, PM, Cox, LJ, Day, NE, Palmer, CR, Wang, TW, Williams, DR & Hales, CN (1994) Hypertriglycerideaemia in subjects with normal and abnormal glucose tolerance: relative contributions of insulin secretion, insulin resistance and suppression of plasma non-esterified fatty acids. Diabetologia 37, 889–896.Google Scholar
Carlsson, M, Westman, Y, Almgren, P & Groop, L (2000) High levels of nonesterified fatty acids are associated with increased familial risk of cardiovascular disease. Aterioscler Thromb Vasc Biol 20, 1588–1594.CrossRefGoogle ScholarPubMed
Chang, RJ, Nakamura, RM, Judd, HL & Kaplan, SA (1983) Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab 57, 356–359.CrossRefGoogle ScholarPubMed
Ciaraldi, TP, Morales, AJ, Hickman, MG, Odom-Ford, R, Olefsky, JM & Yen, SS (1997) Cellular insulin resistance in adipocytes from obese polycystic ovary syndrome subjects involves adenosine modulation of insulin sensitivity. J Clin Endocrinol Metab 82, 1421–1425.Google ScholarPubMed
Clapp, JL (1997) Diet, exercise and feto-placental growth. Arch Gynecol Obstet 261, 101–107.Google Scholar
Clark, AM, Ledger, W, Galletly, C, Tomlinson, L, Blaney, F, Wang, X & Norman, RJ (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 10, 2705–2712.Google Scholar
Clark, AM, Thornley, B, Tomlinson, L, Galletley, C & Norman, RJ (1998) Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 13, 1502–1505.CrossRefGoogle ScholarPubMed
Colagiuri, S & Brand Miller, J (2002) The ‘carnivore connection’ – evolutionary aspects of insulin resistance. Eur J Clin Nutr 56, Suppl. 1, S30–S35.CrossRefGoogle ScholarPubMed
Colditz, GA, Manson, JE, Stampfer, MJ, Rosner, B, Willett, WC & Seizer, FE (1992) Diet and risk of clinical diabetes in women. Am J Clin Nutr 55, 1018–1023.Google Scholar
Collette, C, Percheron, C, Pares-Herbute, N, Michel, F, Pham, T-C, Brillant, L, Descomps, B & Monnier, L (2003) Exchanging carbohydrate for monounsaturated fats in energy-restricted diets: effects on metabolic profile and other cardiovascular risk factors. Int J Obes 27, 648–656.Google Scholar
Conway, GS, Agrawal, R, Betteridge, DJ & Jacobs, HS (1992) Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol 37, 119–125.CrossRefGoogle ScholarPubMed
Coulam, CB, Annegers, JF & Kranz, JS (1983) Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol 71, 253–256.Google Scholar
Crave, JC, Fimbel, S, Lejeune, H, Cugnardey, N, Dechaud, H & Pugeat, M (1995) Effects of diet and metformin administration on sex hormone-binding globulin, androgens and insulin in hirsute and obese women. J Clin Endocrinol Metab 80, 2057–2062.Google ScholarPubMed
Crosignani, PG, Colombo, M, Vegetti, W, Somigliana, E, Gessati, A & Ragni, G (2003) Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 18, 1928–1932.CrossRefGoogle ScholarPubMed
Dahlgren, E, Janson, PO, Johansson, S, Lapidus, L, Lindstedt, G & Tengborn, L (1994) Hemostatic and metabolic variables in women with polycystic ovary syndrome. Fertil Steril 61, 455–460.CrossRefGoogle ScholarPubMed
Dahlgren, E, Janson, PO, Johansson, S, Lapidus, L & Oden, A (1992 a) Polycystic ovary syndrome and risk for myocardial infarction: evaluated from a risk factor model based on a prospective population study of women. Acta Obstet Gynecol Scand 71, 599–604.CrossRefGoogle ScholarPubMed
Dahlgren, E, Johansson, S, Lindstedt, G, Knutsson, F, Oden, A, Janson, PO, Mattson, LA, Crona, N & Lundberg, PA (1992 b) Women with polycystic ovary syndrome wedge resected in 1956 to 1965, a long-term follow-up focusing on natural history and circulating hormones. Fertil Steril 57, 505–513.Google Scholar
Dejager, S, Pichard, C, Giral, P, Bruckert, E, Federspield, MC, Beucler, I & Turpin, G (2001) Smaller LDL particle size in women with polycystic ovary syndrome compared to controls. Clin Endocrinol 54, 455–462.Google Scholar
Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346, 393–403.CrossRefGoogle Scholar
Dumesnil, JG, Turgeon, J & Tremblay, A (2001) Effect of a low-glycaemic index-low-fat-high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr 86, 557–568.CrossRefGoogle ScholarPubMed
Dunaif, A, Graf, M, Mandeli, J, Laumas, V & Dobrjansky, A (1987) Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance and/or hyperinsulinemia. J Clin Endocrinol Metab 65, 499–507.Google Scholar
Dunaif, A, Segal, KR, Futterweit, W & Dobrjansky, A (1989) Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 38, 1165–1174.CrossRefGoogle ScholarPubMed
Ebbeling, CB, Leidig, MM, Sinclair, KB, Hangen, JP & Ludwig, DS (2003) A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med 157, 773–779.CrossRefGoogle ScholarPubMed
Ehrmann, DA, Barnes, RB, Rosenfield, RL, Cavaghan, MK & Imperial, J (1999) Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 22, 141–146.CrossRefGoogle ScholarPubMed
Etling, MW, Korsen, TJ, Bezemer, PD & Schoemaker, J (2001) Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population. Hum Reprod 16, 556–560.Google Scholar
Fagot-Campagna, A, Balkau, B, Simon, D, Warnet, JM, Claude, JR, Ducimetiere, P & Eschwege, E (1998) High free fatty acid concentration: an independent risk factor for hypertension in the Paris Prospective Study. Int J Epidemiol 27, 809–813.Google Scholar
Farnsworth, E, Luscombe, ND, Noakes, M, Wittert, G, Argyiou, E & Clifton, PM (2003) Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsuilinemic men and women. Am J Clin Nutr 78, 31–39.Google Scholar
Febbraio, MA, Keenan, J, Angus, DJ, Campbell, SE & Garnham, AP (2000) Preexercise carbohydrate ingestion, glucose kinetics, and muscle glycogen use: effect of the glycaemic index. J Appl Physiol 89, 1845–1851.CrossRefGoogle Scholar
Fenkci, V, Fenkci, S, Yilmazer, M & Serteser, M (2003) Decreased total antioxidant status and increased oxidative stress in women with polycystic ovary syndrome may contribute to the risk of cardiovascular disease. Fetil Steril 80, 123–127.Google Scholar
Feskens, EJ & Kromhout, D (1990) Habitual dietary intake and glucose tolerance in euglycemic men: the Zutphen study. Int J Epidemiol 19, 953–959.Google Scholar
Foster, GD, Wyatt, HR, Hill, JO, McGuckin, BG, Brill, C, Mohammed, BS, Szapary, PO, Rader, DJ, Edman, JS & Klein, S (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348, 2082–2090.Google Scholar
Franceschi, S, Dal Maso, L, Augustin, L, Negri, E, Parpinel, M, Boyle, P, Jenkins, DJ, La Vecchia, C (2001) Dietary glycemic load and colorectal cancer risk. Ann Oncol 12, 173–178.CrossRefGoogle ScholarPubMed
Franks, S (1995) Polycystic ovary syndrome. N Engl J Med 333, 853–861.Google Scholar
Frost, G, Leeds, AA, Dore, CJ, Madeiros, S, Brading, S & Dornhurst, A (1999) Glycemic index as a determinant of serum HDL-cholesterol concentration. Lancet 353, 1045–1048.Google Scholar
Furberg, A & Thune, I (2003) Metabolic abnormalities (hypertension, hyperglycaemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 104, 669–676.Google Scholar
Gambineri, A, Pelusi, C & Genghini, S (2004) Effect of flutamide and metformin administered alone or in combination in dieting obese women polycystic ovary syndrome. Clin Endocrinol 60, 241–249.CrossRefGoogle ScholarPubMed
Gambineri, A, Pelusi, C, Vicennati, V, Pagotto, U & Pasquali, R (2002) Obesity and the polycystic ovary syndrome. Int J Obesity 26, 883–896.Google Scholar
Garg, A (1998) High monounsaturated fat diets for patients with diabetes mellitus: a meta-analysis. Am J Clin Nutr 67. Suppl. 577S–582S.CrossRefGoogle ScholarPubMed
Gerhard, GT, Ahmann, A, Meeuws, K, McMurry, MP, Duell, PB & Connor, WE (2004) Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes. Am J Clin Nutr 80, 668–673.Google Scholar
Glueck, CJ, Wang, P, Fontaine, RN, Sieve-Smith, L, Tracy, T & Moore, SK (1999) Plasminogen activator inhibitor activity: an independent risk factor for the high miscarriage rate during pregnancy in women with polycystic ovary syndrome. Metabolism 48, 1589–1595.Google Scholar
Goodman, MT, Wilkens, LR, Hankin, JN & Kolonel, LN (1997) The association of dietary phytoestrogens with the risk for endometrial cancer. Am J Epidemiol 146, 294–306.Google Scholar
Guzick, DS, Wing, R, Smith, D, Berga, SL & Winters, SJ (1994) Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril 61, 598–604.CrossRefGoogle ScholarPubMed
Hardiman, P, Pillay, OS & Atiomo, W (2003) Polycystic ovary syndrome and endometrial carcinoma. Lancet 361, 1810–1812.CrossRefGoogle ScholarPubMed
Hays, NP, Starling, RD, Liu, X, Sullivan, DH, Trappe, TA, Fluckey, JD & Evans, WJ (2004) Effects of an ad libitum low-fat, high carbohydrate diet in body fat distribution in older men and women. Arch Int Med 164, 210–217.CrossRefGoogle ScholarPubMed
Hoeger, KM, Kochman, L, Wixom, N, Craig, K, Miller, RK & Guzick, DS (2004) A randomized, 48-week, placebo-controlled trial of intensive lifestyle modification and/or metformin therapy in overweight women with polycystic ovary syndrome: a pilot study. Fertil Steril 82, 421–429.Google Scholar
Holte, J, Bergh, T, Berne, C, Wide, L & Lithell, H (1995) Restored insulin sensitivity but persistantly increased early insulin secretion after weight loss in obese women with PCOS. J Clin Endocrinol Metab 80, 2586–2593.Google Scholar
Holte, J, Gennarelli, G, Wide, L, Lithell, H & Berne, C (1998) High prevalence of polycystic ovaries and associated clinical, endocrine and metabolic features in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab 83, 1143–1150.CrossRefGoogle ScholarPubMed
Huber-Buchholz, MM, Carey, DGP & Norman, RJ (1999) Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 84, 1470–1474.Google Scholar
Jakubowicz, DJ & Nestler, JE (1997) 17α-Hydroxyprogesterone responses to leuprolide and serum androgens in obese women with and without polycystic ovary syndrome after dietary weight loss. J Clin Endocrinol Metab 82, 556–560.Google ScholarPubMed
Jarvi, AE, Karlstrom, BE, Granfeldt, YE, Bjorck, IE, Asp, NG & Vessby, BO (1999) Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients. Diabetes Care 22, 10–18.Google Scholar
Jenkins, DJ, Augustin, LS, Dal Maso, L (2003) Dietary glycemic index, glycemic load and ovarian cancer risk: a case-control study in Italy. Ann Oncol 14, 78–87.Google Scholar
Jenkins, DJ, Kendall, CW, Augustin, LS, Franceschi, S, Hamidi, M, Marchie, A, Jenkins, AL & Axelsen, M (2002) Glycemic index: overview of implications in health and disease. Am J Clin Nutr 76, 266S–273S.Google Scholar
Jenkins, DJ, Wolever, TM, Kalmusky, J, Giudici, S, Giordano, C, Patten, R, Wong, GS, Bird, JN, Hall, M & Buckley, G (1987) Low glycemic index diet in hyperlipidemia: use of traditional starchy foods. Am J Clin Nutr 46, 66–71.CrossRefGoogle ScholarPubMed
Jenkins, DJ, Wolever, TM, Kalmusky, J, Giudici, S, Giordano, C, Wong, GS, Bird, JN, Patten, R, Hall, M & Buckley, G (1985) Low glycemic index carbohydrate foods in the management of hyperlipidemia. Am J Clin Nutr 42, 604–617.Google Scholar
Jenkins, DJ, Wolever, TM, Taylor, RH, Barker, H, Fielden, H, Baldwin, JM, Bowling, AC, Newman, HC, Jenkins, AL & Goff, DV (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 34, 362–366.Google Scholar
Jialal, I, Naiker, P, Reddi, K, Moddley, J & Joubert, SM (1987) Evidence for insulin resistance in non-obese patients with polycystic ovarian disease. J Clin Endocrinol Metab 64, 1066–1072.Google Scholar
Jiang, R, Ma, J, Ascherio, A, Stampfer, MJ, Willett, WC & Hu, FB (2004) Dietary iron intake and blood donations in relation to risk of type 2 diabetes in men: a prospective cohort study. Am J Clin Nutr 79, 70–75.Google Scholar
Kasim-Karakas, SE, Almario, RU, Gregory, L, Wong, R, Todd, H & Lasley, BL (2004) Metabolic and endocrine effects of a polyunsaturated fatty acid-rich diet in polycystic ovary syndrome. J Clin Endocrinol Metab 89, 615–620.CrossRefGoogle ScholarPubMed
Kiddy, DS, Hamilton-Fairley, D, Bush, A, Short, F, Anyaoku, V, Reed, MJ & Franks, S (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol 36, 105–111.Google Scholar
Kirchengast, S & Huber, J (2001) Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod 16, 1225–1260.Google Scholar
Knockenhauer, ES, Key, TJ, Kahsar-Miller, M, Waggoner, W, Boots, LR & Azziz, R (1998) Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 83, 3078–3082.Google Scholar
Krebs, M, Krssak, M, Bernroider, E, Anderwald, C, Brehm, A, Meyerspeer, M, Nowotny, P, Roth, E, Waldhausl, W & Roden, M (2002) Mechanism of amino acid-induced skeletal muscle insulin resistance in humans. Diabetes 51, 599–605.CrossRefGoogle ScholarPubMed
Kris-Etherton, PM, Binkoski, AE, Zhao, G, Coval, SM, Clemmer, KF, Hecker, KD, Jacques, H & Etherton, TD (2002) Dietary fat: assessing the evidence in support of a moderate-fat diet; the benchmark based on lipoprotein metabolism. Proc Nutr Soc 61, 287–298.CrossRefGoogle ScholarPubMed
Lanzone, A, Caruso, A, Di Simone, N, De Carolis, S, Fulghesu, AM & Mancuso, S (1995) Polycystic ovary disease. A risk factor for gestational diabetes. J Reprod Med 40, 312–316.Google Scholar
Lariviere, F, Chiasson, J, Taverroff, A & Hoffer, L (1994) Effects of dietary protein restriction on glucose and insulin metabolism in normal and diabetic humans. Metabolism 43, 462–467.Google Scholar
Lee, DH, Folsom, AR, Jacobs, DR Jr (2004) Dietary iron intake and type 2 diabetes incidence in postmenopausal women: the Iowa Women's Health Study. Diabetologia 47, 185–194.Google Scholar
Legro, RS (2003) Polycystic ovary syndrome and cardiovascular disease: a premature association?. Endocrine Rev 24, 302–312.Google Scholar
Legro, RS, Kunselman, AR, Dodson, WC & Dunaif, A (1999) Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Endocrinol Metab 84, 165–169.Google Scholar
Legro, RS, Kunselman, AR & Dunaif, A (2001) Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 111, 607–613.Google Scholar
Lesser, KB & Garcia, FA (1997) Association between polycystic ovary syndrome and glucose intolerance during pregnancy. J Matern Fetal Med 6, 303–307.Google ScholarPubMed
Liese, AD, Roach, AK, Sparks, KC, Marquart, L, D'Agostino, RB Jr & Mayer-Davis, EJ (2003) Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Am J Clin Nutr 78, 965–971.Google Scholar
Linn, T, Geyer, R, Prassek, S & Laube, H (1996) Effect of dietary protein intake on insulin secretion and glucose metabolism in insulin-dependant diabetes mellitus. J Clin Endocrinol Metab 81, 3938–3943.Google Scholar
Linn, T, Grönemeyer, D, Aygen, S, Scholz, N, Busch, M & Bretzel, R (2000) Effect of long-term dietary protein intake on glucose metabolism in humans. Diabetologia 43, 1257–1265.CrossRefGoogle ScholarPubMed
Littman, AJ, Beresford, SA & White, E (2001) The association of dietary fat and plant foods with endometrial cancer (United States). Cancer Causes Control 12, 691–702.CrossRefGoogle ScholarPubMed
Liu, S, Willett, WC, Mason, JE, Hu, FB, Rosner, B & Colditz, G (2003) Relation between changes in intake of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. Am J Clin Nutr 78, 920–927.Google Scholar
Liu, S, Willett, WC, Stampfer, MJ, Hu, FB, Franz, M, Sampson, L, Hennekens, CH & Manson, JE (2000) A prospective study of dietary glycemic load, carbohydrate intake and risk of coronary heart disease in US women. Am J Clin Nutr 71, 1455–1461.Google Scholar
Lord, JM, Flight, IHK & Norman, RJ (2003) Metformin in polycystic ovary syndrome: systematic review and meta-analysis. Br Med J 327, 951–966.Google Scholar
Lovejoy, J & DiGirolamo, M (1992) Habitual dietary intake and insulin sensitivity in lean and obese adults. Am J Clin Nutr 55, 1174–1179.Google Scholar
Ludwig, DS (2000) Dietary glycemic index and obesity. J Nutr 130, 280S–283S.Google Scholar
Ludwig, DS, Majzoub, JA, AI-Zahrani, A, Dallal, GE, Blanco, I & Roberts, SB (1999 a) High glycemic index foods, overeating, and obesity. Pediatrics 103, E261–E266.CrossRefGoogle ScholarPubMed
Ludwig, DS, Pereira, MA, Kroenke, CH, Hilner, JE, Van Horn, L, Slattery, ML, Jacobs, DR Jr (1999 b) Dietary fibre, weight gain and cardiovascular risk factors in young adults. J Am Med Assoc 282, 1539–1546.Google Scholar
McCann, SE, Freudenheim, JL, Marshall, JR & Brasure, JR (2000) Diet in the epidemiology of endometrial cancer in Western New York (United States). Cancer Causes Control 11, 965–974.CrossRefGoogle ScholarPubMed
McKeown, NM, Meigs, JB, Liu, S, Saltzman, E, Wilson, PWF & Jacques, PF (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27, 538–546.Google Scholar
Marckmann, P (2000) Dietary treatment of thrombogenic disorders related to the metabolic syndrome. Br J Nutr 83, Suppl. 1, S121–S126.CrossRefGoogle ScholarPubMed
Marshall, JA, Bessesen, SH & Hamman, RF (1997) High saturated fat and low starch and fibre are associated with hyperinsulinemia in a non-diabetic population – the San Luis Valley Diabetes Study. Diabetologia 40, 430–438.Google Scholar
Marshall, JA, Hamman, RF & Baxter, J (1991) High-fat, low carbohydrate diet and the etiology of non-insulin dependent diabetes mellitus. The San Luis Diabetes Study. Am J Epidemiol 134, 590–603.Google Scholar
Marshall, JA, Hoag, S, Shetterley, S & Hamman, RF (1994) Dietary fat predicts conversion from impaired glucose tolerance to NIDDM – The San Luis Valley Diabetes Study. Diabetes Care 17, 50–56.Google Scholar
Mather, KJ, Kwan, F & Corenblum, B (2000) Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity. Fertil Steril 73, 150–156.CrossRefGoogle ScholarPubMed
Mayer, EJ, Newman, B, Quesenberry, CP Jr & Selby, JV (1993) Usual dietary fat intake and insulin concentrations in women twins. Diabetes Care 16, 1459–1469.CrossRefGoogle ScholarPubMed
Mayer-Davis, EJ, Monaco, JH, Hoen, HM, Carmichael, S, Vitolins, MZ, Rewers, MJ, Haffner, SM, Ayad, MF, Bergman, RN & Karter, AJ (1997) Dietary fat and insulin sensitivity in a triethnic population. The role of obesitas. The Insulin Resistance Atherosclerosis Study (IRAS). Am J Clin Nutr 65, 79–87.Google Scholar
Meyer, KA, Kushi, LH, Jacobs, DR, Slavin, J, Sellers, TA & Folsom, AR (2000) Carbohydrates, dietary fibre and incident type 2 diabetes in older women. Am J Clin Nutr 71, 921–930.Google Scholar
Montonen, R, Knekt Jarvinen, R, Aromaa, A & Reunanen, A (2003) Whole-grain and fiber intake and the incidence of type 2 diabetes. Am J Clin Nutr 77, 622–629.Google Scholar
Moran, LJ, Noakes, M, Clifton, PM, Tomlinson, L & Norman, RJ (2003) Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 88, 812.Google Scholar
Moran, LJ, Noakes, M, Clifton, PM, Wittert, GA, Tomlinson, L, Galletly, C, Luscombe, ND & Norman, RJ (2004) Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. J Clin Endocrinol Metab 89, 3337–3344.Google Scholar
Norman, RJ, Masters, L, Milner, CR, Wang, JX & Davies, MJ (2001) Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod 16, 1995–1998.CrossRefGoogle ScholarPubMed
Öhrvall, M, Berglund, L, Salminen, I, Lithell, H, Aro, A & Vessby, B (1996) The serum cholesterol ester fatty acid composition but not the serum concentration of alpha tocopherol predicts the development of myocardial infarction in 50-year-old men, 19 years follow up. Atherosclerosis 127, 65–71.Google Scholar
Pan, XR, Li, GW, Hu, YH, Wang, JX, Yang, WY & An, ZX (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20, 537–544.Google Scholar
Paolisso, G, Tataranni, PA, Foley, FE, Bogardus, C, Howard, BV & Ravussin, E (1995) A high concentration of fasting plasma non-esterified fatty acids is a risk factor for the development of NIDDM. Diabetologia 38, 1213–1217.CrossRefGoogle ScholarPubMed
Paradisi, G, Fulghesu, AM, Ferrazzani, S, Moretti, S, Proto, C, Soranna, L, Caruso, A & Lanzone, A (1998) Endocrino-metabolic features in women with polycystic ovary syndrome during pregnancy. Hum Reprod 13, 542–546.Google Scholar
Parker, B, Noakes, M, Luscombe, N & Clifton, P (2002) Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 25, 425–430.Google Scholar
Parker, DR, Weiss, ST, Troisi, R, Cassano, PA, Vokones, PS & Landsberg, L (1993) Relationship of dietary saturated fatty acids and body habitus to serum insulin concentrations, the normative aging study. Am J Clin Nutr 58, 129–136.Google Scholar
Pasquali, R, Antenucci, D, Casimirri, F, Venturoli, S, Paradisi, R, Fabbri, R, Balestra, V, Melchionda, N & Barbara, L (1989) Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 68, 173–179.Google Scholar
Pasquali, R & Casimirri, F (1993) The impact of obesity on hyperandrogensim and polycystic ovary syndrome in premenopausal women. Clin Endocrinol 39, 1–16.Google Scholar
Pasquali, R, Casimirri, F, Cantobelli, S, Labate, AM, Venturoli, S, Paradisi, R & Zannarini, L (1993) Insulin and androgen relationships with abdominal body fat distribution in women with and without hyperandrogensim. Horm Res 39, 179–187.Google Scholar
Pasquali, R, Casimirri, F, Venturoli, S, Antonio, M, Morselli, L, Reho, S, Pezzoli, A & Paradisi, R (1994) Body fat distribution has weight-independent effects on clinical, hormonal and metabolic features of women with polycystic ovary syndrome. Metabolism 43, 706–713.Google Scholar
Pasquali, R, Gambineri, A, Biscotti, D, Vicennati, V, Gagliardi, L, Colitta, D, Fiorini, S, Cognigni, GE, Filicori, M & Morselli-Labate, AM (2000) Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J Clin Endocrinol Metab 85, 2767–2774.Google Scholar
Pawlak, D, Kushner, J & Ludwig, D (2004) Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals. Lancet 364, 778–785.Google Scholar
Pawlak, DB, Denyer, GS & Brand-Miller, JC (2000) Low post-prandial fat oxidation after a high glycemic index meal leads to increased body fat in chronically fed rats. Obes Res 8, 128S Abstr.Google Scholar
Pereira, MA, Jacobs, DR, Pins, JJ, Raatz, SK, Gross, MD, Slavin, JL & Seaquist, ER (2002) Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr 75, 848–855.CrossRefGoogle ScholarPubMed
Petridou, E, Kedikoglou, S, Koukoulomatis, P, Dessypris, N & Tricholpoulous, D (2002) Diet in relation to endometrial cancer risk: a case-control study in Greece. Nutr Cancer 44, 16–22.Google Scholar
Pierpoint, T, McKeigue, PM, Isaacs, AJ, Wild, SH & Jacobs, HS (1998) Mortality of women with polycystic ovaries at long-term follow-up. J Clin Epidemiol 51, 581–586.Google Scholar
Pirwany, IR, Fleming, R, Greer, IA, Packard, CJ & Sattar, N (2001) Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters. Clin Endocrinol 54, 447–453.Google Scholar
Radon, PA, McMahon, MJ & Meyer, WR (1999) Impaired glucose tolerance in pregnant women with polysystic ovary syndrome. Obstet Gynecol 94, 194–197.Google Scholar
Riccardi, G & Rivellese, AA (2000) Dietary treatment of the metabolic syndrome – the optimal diet. Br J Nutr 83, Suppl. 1, S143–S148.CrossRefGoogle ScholarPubMed
Roberts, SB (2000) High-glycemic index foods, hunger, and obesity: is there a connection?. Nutr Rev 58, 163–169.Google Scholar
Robinson, S, Henderson, AD, Gelding, SV, Kiddy, D, Niththyananthan, R, Bush, A, Richmond, W, Johnston, DG & Franks, S (1996) Dyslipidaemia is associated with insulin resistance in women with polycystic ovarian syndrome. Clin Endcrinol 44, 277–284.Google Scholar
Rossetti, L, Rothman, D, DeFronzo, R & Shulman, G (1989) Effect of dietary protein on in vivo insulin and liver glycogen repletion. Am J Physiol 257, E212–E219.Google Scholar
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81, 19–25.Google Scholar
Sabate, J (2003) The contribution of vegetarian diets to health and disease: a paradigm shift?. Am J Clin Nutr 78, Suppl.502S–507S.Google Scholar
Sabuncu, T, Vural, H & Harma, M (2001) Oxidative stress in polycystic ovary syndrome and its contribution to the risk of cardiovascular disease. Clin Biochem 34, 401–413.Google Scholar
Saldana, TM, Siega-Riz, AM & Adair, LS (2004) Effect of macronutrient intake on the development of glucose intolerance during pregnancy. Am J Clin Nutr 79, 479–486.Google Scholar
Salmeron, J, Ascherio, A, Rimm, EB, Colditz, GA, Spiegelman, D, Jenkins, DJ, Stampfer, MJ, Wing, AL & Willett, WC (1997 a) Dietary fibre, glycaemic load and risk of NIDDM in men. Diabetes Care 20, 545–550.Google Scholar
Salmeron, J, Manson, JE, Stampfer, MJ, Colditz, GA, Wing, AL & Willett, WC (1997 b) Dietary fibre, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. J Am Med Assoc 277, 472–477.Google Scholar
Salomaa, V, Ahola, I, Tuomilehto, J, Aro, A, Pietinen, P, Korhonen, HJ & Penttila, I (1990) Fatty acid composition of serum cholesterol esters in different degree of glucose intolerance. Metabolism 39, 1285–1291.Google Scholar
Samaha, FF, Iqbal, N, Seshadri, P, Chicano, KL, Daily, DA, McGrory, J, Williams, T, Williams, M, Gracely, EJ & Stern, L (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 348, 2074–2081.Google Scholar
Sampson, M, Kong, C, Patel, A, Unwin, R & Jacobs, HS (1996) Ambulatory blood pressure profiles and plasminogen activator inhibitor (PAI-1) activity in lean women with and without the polycystic ovary syndrome. Clin Endocrinol 45, 623–629.Google Scholar
Schulze, MB, Manson, JE, Willett, WC & Hu, FB (2003) Processed meat intake and incidence of type 2 diabetes in younger and middle-aged women. Diabetologia 46, 1465–1473.Google Scholar
Skov, AR, Toubro, S, Ronn, B, Holm, L & Astrup, A (1999) Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes 23, 528–536.Google Scholar
Slabber, M, Barnard, HC, Kuyl, JM, Dannhauser, A & Schall, R (1994) Effects of a low-insulin response, energy-restricted diet on weight loss and plasma insulin concentrations in hyperinsulinemic obese females. Am J Clin Nutr 60, 48–53.Google Scholar
Song, Y, Manson, JE, Buring, JE & Liu, S (2004) A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women: the Women's Health Study. Diabetes Care 27, 2108–2115.Google Scholar
Spieth, LE, Harnish, JD, Lenders, CM, Raezer, LB, Pereira, MA, Hangen, SJ & Ludwig, DS (2000) A low-glycemic index diet in the treatment of pediatric obesity. Arch Pediatr Adolesc Med 154, 947–951.Google Scholar
Stamets, K, Taylor, DS, Kunselman, A, Demers, LM, Pelkman, CL & Legro, RS (2004) A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Fertil Steril 81, 630–637.Google Scholar
Stern, L, Iqbal, N, Seshadri, P, Chicano, KL, Daily, DA, McGrory, J, Williams, M, Gracely, EJ & Samaha, FF (2004) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Int Med 140, 778–785.Google Scholar
Strowitzki, T, Halser, B & Demant, T (2002) Body fat distribution, insulin sensitivity, ovarian dysfunction and serum lipoproteins in patients with polycystic ovary syndrome. Gynecol Endocrinol 16, 45–51.Google Scholar
Swinburn, BA, Metcalf, PA & Ley, SJ (2001) Long term (5 year) effects of a reduced-fat diet intervention in individuals with glucose intolerance. Diabetes Care 24, 619–624.Google Scholar
Talbott, E, Clerici, A, Berga, SL, Kuller, L, Guzick, D, Detre, K, Daniels, T & Engberg, RA (1998) Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol 51, 415–422.CrossRefGoogle ScholarPubMed
Talbott, E, Guzick, D, Clerici, A, Berga, S, Detre, K, Weimer, K & Kuller, L (1995) Coronary heart disease risk factors in women with polycystic ovary syndrome. Arterioscler Thromb Vasc Biol 15, 821–826.CrossRefGoogle ScholarPubMed
Talbott, EO, Zborowski, JV, Guzick, DS , et al. (2000) Increased PAI-1 levels in women with polycystic ovary syndrome: Evidence for a specific ‘PCOS’ effect independent of age and BMI. In Programs and Abstracts of the 40th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, p. 13. San Diego, CA: American Heart Association.Google Scholar
Tsunehara, CH, Leonetti, DL & Fujimoto, WY (1991) Animal fat and cholesterol intake is high in men with IGT progressing to NIDDM. Diabetes 40, Suppl., 427A.Google Scholar
Tuomilehto, J, Lindstrom, J & Eriksson, JG (2001) Prevention of type 2 diabetes by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344, 1343–1350.Google Scholar
Van Dam, EW, Roelfsema, F, Veldhuis, JD, Helmerhorst, FM, Frolich, M, Meinders, AE, Krans, HM & Pijl, H (2002) Increase in daily LH secretion in response to short-term calorie restriction in obese women with PCOS. Am J Physiol 282, E865–E872.Google Scholar
Vessby, B (2000) Dietary fat and insulin action in humans. Br J Nutr 83, Suppl. 1, S91–S96.Google Scholar
Vessby, B, Aro, A, Skarfors, E, Berglund, L, Salminen, I & Lithell, H (1994 a) The risk to develop NIDDM is related to the fatty acid composition of the serum cholesterol esters. Diabetes 43, 1353–1357.Google Scholar
Vessby B for the Kanwu Study Group (1999) Effect of dietary fat on insulin sensitivity and insulin secretion. The Kanwu Study. Diabetologia 42, Suppl. 1, A46.Google Scholar
Vessby, B, Tengblad, S & Lithell, H (1994 b) The insulin sensitivity is related to the fatty acid composition of the serum lipids and the skeletal muscle phospholipids in 70 year old men. Diabetologia 37, 1044–1050.Google Scholar
Wahrenberg, H, Ek, I, Reynisdottir, S, Carlström, K, Bergqvist, A & Arner, P (1999) Divergent effects of weight reduction and oral anticonception treatment on adrenergic lipolysis regulation in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 84, 2182–2187.Google Scholar
Wang, L, Folsom, AR, Zheng, Z-J, Pankow, JS & Eckfeldt, JH (2003) ARIC Study Investigators. Plasma fatty acid composition and incidence of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 78, 91–98.Google Scholar
Weerakiet, S, Srisombut, C, Bunnag, P, Sangtong, S, Chuangsoongnoen, N & Rojansakul, A (2001) Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome. Int J Gyneacol Obstet 75, 177–184.Google Scholar
Wijeyarante, CN, Nirantharakumar, K, Balen, AH, Barth, JH, Sheriff, R & Belchetz, PE (2004) Plasma homocysteine in polycystic ovary syndrome: does it correlate with insulin resistance and ethnicity? Clin Endocrinol 60, 560–567.Google Scholar
Wild, RA (1995) Obesity, lipids, cardiovascular risk, and androgen excess. Am J Med 98, S27–S32.Google Scholar
Wild, RA, Alaupovic, P & Parker, LJ (1992) Lipid and apolipoprotein abnormalities in hirsute women I. The association with insulin resistance. Am J Obstet Gynecol 166, 1191–1196.Google Scholar
Wild, S, Pierpoint, T, McKeigue, P & Jacobs, HS (2000) Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol 52, 595–600.Google Scholar
Wolever, TM (1992) Beneficial effect of a low glycemic index diet in type 2 diabetes. Diabet Med 9, 451–458.Google Scholar
Wolever, TM, Jenkins, DJ, Vuskan, V, Jenkins, AL, Wong, GS & Josse, RG (1992) Beneficial effect of low-glycemic index diet overweight NIDDM subjects. Diabetes Care 15, 562–564.Google Scholar
Wolever, TMS & Mehling, C (2002) Long-term effect of varying the source or amount of dietary carbohydrate on postprandial plasma glucose, insulin, triacylglyerol, and free fatty acid concentrations in subjects with impaired glucose tolerance. Am J Clin Nutr 77, 612–621.Google Scholar
World Cancer Research Fund (1997) Food, Nutrition and Cancer: a Global Perspective. Washington, DC: American Institute of Cancer Research.Google Scholar
Wu, CL, Nicholas, C, Williams, C, Took, A & Hardy, L (2003) The influence of high-carbohydrate meals with different glycaemic indices on substrate utilization during subsequent exercise. Br J Nutr 90, 1049–1056.Google Scholar
Yang, EJ, Kerver, JM, Park, YK, Kayitsinga, J, Allison, DB & Song, WO (2003) Carbohydrate intake and biomarkers of glycemic control among US adults: the third National Health and Nutrition Examination Survey (NHANES III). Am J Clin Nutr 77, 1426–1433.Google Scholar
Yildirim, B, Sabir, N & Kaleli, B (2003) Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome. Fertil Steril 79, 1358–1364.Google Scholar
Zheng, W, Kushi, LH, Potter, JD, Sellers, TA, Doyle, TJ, Bostick, RM & Folsom, AR (1995) Dietary intake of energy and animal foods and endometrial cancer. Am J Epidemiol 142, 388–394.Google Scholar