Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians

Abstract

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).

Habitual dietary intake, eating pattern and physical activity of women with polycystic ovary syndrome

“…The current study suggests that women with PCOS may be more active than previously reported, with 74% self reporting that they did at least 30 min of moderate intensity activity per day, compared with Humphreys and Costarelli (2008), who reported that only 41% of women with PCOS reported undertaking moderate intensity exercise at least once per week. Additionally the Department of Health (2004) has reported that only 24% of women in the general population are sufficiently active to gain any health benefit, the higher rate of activity reported by the current study cohort may be explained by the reported benefits of physical activity improving some of their PCOS symptoms (Jeanes et al, 2009). However, of concern, 52% of overweight or obese women with PCOS were not achieving sufficient activity of 60 min per day to promote weight loss.…”

“…), weight (Is your weight stable?) and any PCOSrelated nutritional advice received (Supplementary Data 1; Jeanes et al 2009). Food diary data were entered into the dietary analysis software package Dietplan 6.3 (Forestfield Software, Horsham, UK) by a registered dietitian.…”

“…Key sources of dietary information for women with PCOS have been reported as the internet and books (Avery and BraunackMayer, 2007;Humphreys and Costarelli, 2008;Jeanes et al, 2009). It is of concern that many of these sources are unregulated; there are currently no official UK dietary guidelines available for healthcare professionals advising women with PCOS.…”

“…The referral rate to UK dietitians is also surprisingly low, with only 15% of women with PCOS having seen a dietitian (Jeanes et al, 2009;Sharma et al, 2010). Key sources of dietary information for women with PCOS have been reported as the internet and books (Avery and BraunackMayer, 2007;Humphreys and Costarelli, 2008;Jeanes et al, 2009).…”

“…Reducing dietary glycaemic index (GI) may be advantageous with demonstrated benefits of low GI diets in non-PCOS insulin resistant populations (McMillian-Price et al, 2006;Barclay et al, 2008). Low GI diets are popular with women with PCOS (Jeanes et al, 2009), yet there is a paucity of data describing the habitual diet and lifestyle of women with PCOS, with just two studies reporting dietary intake of women with PCOS in the United States and one comparison of US and Italian women with PCOS (Carmina et al, 2003;Wright et al, 2004;Douglas et al, 2006). There are no publications describing the habitual diet or snacking habits of UK women with PCOS.…”