Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome

Abstract

Background: Treatment of obesity improves all features of the polycystic ovary syndrome (PCOS). There is, however, a heterogeneous response to weight loss, and predictive factors are unknown.Objective: This follow-up study aimed to investigate obese women with PCOS treated with a long-term lifestyle program to evaluate responsiveness and predictability. Methods: One hundred PCOS women meeting the criteria for selection were invited to participate and 65 of them agreed. Lifestyle intervention had consisted of a 1200-1400 kcal/day diet for 6 months, followed by mild calorie restriction and physical activity. The protocol, which was similar at baseline and follow-up, included anthropometry, clinical evaluation, pelvic ultrasound, and laboratory investigations. The mean follow-up period was 20.4G12.5 months. Results: After the follow-up period, women were reclassified into three groups according to the persistence (group 1, 15.4%), partial (group 2, 47.7%), or complete (group 3, 36.9%) disappearance of the categorical features of PCOS (hyperandrogenism, menses, and ovulatory dysfunctions). Duration of the follow-up and extent of weight loss were similar among the three groups, as were fasting and glucose-stimulated insulin and indices of insulin resistance. Baseline waist circumference, waist to hip ratio (WHR), and androstenedione blood levels were negatively correlated with a better outcome in the univariate analysis. However, only basal androstenedione values persisted to a highly significant extent (P!0.001) in the multivariate analysis. Conclusions: Responsiveness to weight loss in overweight/obese PCOS women varies considerably and more than one third of women may achieve full recovery. These findings add new perspectives to the impact of obesity on the pathophysiology of PCOS.

Cardiometabolic and reproductive benefits of early dietary energy restriction and voluntary exercise in an obese PCOS-prone rodent model

“…This modest improvement in insulin sensitivity may be mediated by the effects of exercise on insulin signaling in skeletal muscle (Bradley et al 2008). Furthermore this animal model, like clinical PCOS phenotypes, is resistant to dietary and/or exercise improvements in metabolism, thus an 8-week intervention may not be adequate to facilitate marked shifts in insulin-glucose metabolism (Pasquali et al 2011, Altieri et al 2013.…”

MANAGEMENT OF ENDOCRINE DISEASE: Secondary polycystic ovary syndrome: theoretical and practical aspects

“…A long-term retrospective study performed in a relatively large group of obese PCOS patients treated with a hypocaloric diet (1200-1400 kcal/day) followed by mild caloric restriction and physical activity, with careful reinforcement at the periodical checkups and with a followup period of 20.4 ± 12.5 months reported that, in spite of similar weight loss, 15.4% had a persistence of the full PCOS phenotype, 47.7% had a partial improvement (still hirsute, discordant recovery in androgen blood levels) and, finally, 36.9% completely recovered from all features of PCOS (51). Figure 1 depicts the major findings on androgen blood levels, and ovarian morphology in PCOS women who completely recovered from PCOS.…”

Lifestyle Changes and Weight Loss: Effects in PCOS

“…It seems simple that by adopting a healthy lifestyle and weight loss, as with the patients who do not sufer from this pathology, it would improve the metabolic proile, reduce the risk of diabetes mellitus, cardiovascular disease or endometrial hyperplasia. Moreover, there are studies that discuss the complete or at least partial disappearance of the symptoms [24] and PCOS phenotype after weight loss.…”

“…Thus, in the case of some patients, a signiicant decrease in cholesterol levels will be observed while in others the change will be insigniicant [24]. However, in all cases there will be a signiicant increase of high density lipoprotein (HDL)-cholesterol levels (thus reducing the risk of cardiovascular disease) and a decrease of triglyceride levels [24].…”

“…Ovulatory menstrual cycles can be obtained for obese women with PCOS, even when the weight loss is relatively low [31], thus increasing considerably the chances of geting pregnant. However, not all patients equally respond to these measures even if their weight loss is similar [24]. Hollmann et al describe an 80% improvement in ovulation rate and 29% in the pregnancy rate in the case of a 10% weight loss [32].…”