Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS

Abstract

Objective To determine if consumption of a reduced-carbohydrate (CHO) diet would result in preferential loss of adipose tissue under eucaloric conditions, and whether changes in adiposity were associated with changes in postprandial insulin concentration. Methods In a crossover-diet intervention, 30 women with PCOS consumed a reduced-CHO diet (41:19:40%energy from CHO:protein:fat) for 8 weeks and a standard diet (55:18:27) for 8 weeks. Body composition by DXA and fat distribution by CT were assessed at baseline and following each diet phase. Insulin AUC was obtained from a solid meal test (SMT) during each diet phase. Results Participants lost 3.7% and 2.2% total fat following the reduced-CHO diet and STD diet, resp. (p<0.05 for difference between diets). The reduced-CHO diet induced a decrease in subcutaneous-abdominal, intra-abdominal, and thigh-intermuscular adipose tissue (−7.1%, −4.6%, and −11.5%, resp.), and the STD diet induced a decrease in total lean mass. Loss of fat mass following the reduced CHO diet arm was associated with lower insulin AUC (p<0.05) during the SMT. Conclusions In women with PCOS, consumption of a diet lower in CHO resulted in preferential loss of fat mass from metabolically harmful adipose depots, whereas a diet high in CHO appeared to promote repartitioning of lean mass to fat mass.

Nutritional support and dietary interventions for women with polycystic ovary syndrome

“…49,58,74,75 Negative energy balance and PCOS Several studies assessing the effects of caloric restriction along with modified dietary macronutrient composition on multiple health outcomes and biochemical indices have shown that there is no optimal dietary macronutrient composition or dietary pattern for PCOS. 38,41,76 Overall, there is little variation in weight loss with different diets, and this variation may be due to the differences in compliance and not how the body handles different macro-or micronutrients. Negative energy balance (with a deficit of 350-1000 kcal/day) seems to be the key factor leading to successful body weight and fat loss and amelioration of menstrual cycle and insulin sensitivity, irrespectively of the adopted dietary pattern.…”

“…85 One trial included a diet with <30% carbohydrates, six trials included diets with 40% carbohydrates and four studies with 41-45% carbohydrates. 41,42,76,83,[86][87][88][89][90][91][92] Douglas et al 92 compared the effects of three eucaloric diets: 1) standard (16% protein, 56% carbohydrate, 31% fat), 2) moderately low-carbohydrate (15% protein, 43% carbohydrate, 45% fat) and 3) high monounsaturated fatty acid (MUFA) diets (15% protein, 55% carbohydrate, 33% fat) on glucose and insulin responses in women with PCOS and reported greater reductions in fasting insulin (-3 mIU/L) and lower acute insulin response to glucose (-98 mIU/L × 10 minutes) with the moderately low-carbohydrate diet compared to other two diets. In contrast, results from two clinical trials reported no significant differences in glucose or energy metabolism with moderately low-carbohydrate diets.…”

“…76,78,[90][91][92]105,106,152 Moderately low-carbohydrate, high-fat diets have been shown to decrease fasting insulin and AUC for insulin and to increase insulin sensitivity in three trials in women with PCOS. [90][91][92] In one trial, a high-fat, moderately low-carbohydrate eucaloric diet resulted in greater reductions in body fat, intra-abdominal adipose tissue, subcutaneous abdominal adipose tissue and intermuscular adipose tissue compared to a control diet.…”

“…[90][91][92] In one trial, a high-fat, moderately low-carbohydrate eucaloric diet resulted in greater reductions in body fat, intra-abdominal adipose tissue, subcutaneous abdominal adipose tissue and intermuscular adipose tissue compared to a control diet. 76 Results from another trial comparing two isocaloric diets -a low-fat, low-saturated fat, high-carbohydrate (~15% protein, 60% carbohydrate, 25% fat, 7% saturated fat) or a high-fat, low-saturated fat, moderately low-carbohydrate diet (~15% protein, 40% carbohydrate, 45% fat, 7% saturated fat) -showed a 30% greater reduction in AUC for insulin and blood lipids with the high-fat, low-saturated fat, moderately low-carbohydrate diet, in the absence of weight loss. 90 Results from a short-term, crossover trial showed that a moderately low-carbohydrate (43%), high unsaturated fatty acids (mono- …”

“…92 Results from another crossover clinical trial showed that a high-fat and moderately low-carbohydrate (~41% carbohydrate, 19% protein and 40% fat) diet induced significant glucose metabolism improvements (decreased basal β-cell response, fasting insulin, fasting glucose and IR), hormonal responses (lower testosterone) and decreased blood lipids and adipose tissue (intra-abdominal adipose tissue [-7.1%], subcutaneous abdominal adipose tissue [-4.6%] and intermuscular adipose tissue [-11.5%]). 76,91 DASH diet is a low-GI, low-energy-density, high in complex carbohydrates, high fiber diet (~18% protein, 52% carbohydrate, 30% fat), which has been shown to produce significantly lower blood pressure and glycemic responses. 99,107 Asemi and Esmaillzadeh 78 demonstrated that adherence to DASH eating pattern, compared to a control diet based on Iranian traditional foods, resulted in greater reductions in body weight, BMI, WC, hip circumference (HC), serum insulin levels, IR, hsCRP and TG compared to the control diet in women with PCOS.…”