The Effect of n-3 Polyunsaturated Fatty Acid Supplementation on Androgen Status in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials

Abstract

The anti-androgenic role of n-3 polyunsaturated fatty acids (PUFAs) among patients with polycystic ovary syndrome (PCOS) has recently been proposed. The present study aimed to systematically review clinical trials assessing the effects of n-3 PUFAs consumption on androgen status among adult females with PCOS. PubMed, ISI Web of Science, Google Scholar, and Scopus were searched up to December 2015. Clinical investigations assessing the effect of n-3 PUFAs on adult females with PCOS were included. Mean±standard deviation of change in serum total testosterone, sex hormone binding globulin (SHBG), and dehydroepiandrostrone sulfate (DHEAS) were extracted. Eight clinical trials with 298 participants were eligible. Meta-analysis showed that n-3 PUFAs supplementation marginally reduces total testosterone (mean difference [MD]: - 0.19 nmol/l; 95% CI: - 0.39 to 0.00; p=0.054), but not SHBG (MD: 1.75 nmol/l; 95% CI: -0.51 to 4.01; p=0.129) or serum DHEAS levels (Hedes' g: -0.11 nmol/l; 95% CI: -0.29 to 0.06; p=0.19) among adult females with PCOS. Subgroup analyses showed that only before-after studies (Hedges' g: 0.15; 95% CI: -0.27 to -0.04; p=0.01) and long-term interventions (>6 weeks) (Hedges' g: -0.17; 95% CI, -0.29 to -0.05; p=0.004) had reducing effects on serum DHEAS levels. The majority of long-term trials utilized a single group design (no control group). It does not appear that n-3 PUFAs supplementation significantly affects the androgenic profile of females with PCOS; however, some before-after and long-term intervention studies show reduced DHEAS levels. Future studies incorporating double blinded placebo controlled clinical trials with long follow-up periods are warranted.

The impact of a standardized micronutrient supplementation on PCOS-typical parameters: a randomized controlled trial

“…It has to be mentioned that previous meta-analyses questioned the effects of a supplementation with omega-3 fatty acids only [18, 19]. It seems obvious that the positive effect which was seen in the present study might be due to the multinutrient approach.…”

“…Notably, meta-analyses question the effects of an omega-3 fatty acid-only treatment [18, 19]. This raises the question whether single micronutrient supplementations would be of major impact.…”

Nutritional support and dietary interventions for women with polycystic ovary syndrome

“…[108][109][110][112][113][114][115][116][117][118] A recent meta-analysis of eight clinical trials with a total of 298 females with PCOS showed a slight reduction in serum total testosterone levels following n-3 PUFA supplementation among females with PCOS, without significant impact on SHBG and DHEAS levels. 119 Results from a cross-sectional study showed that increased plasma n-6 PUFAs or increased n-6:n-3 PUFA ratio was associated with greater circulating androgen concentrations, whereas increased long-chain n-3 PUFA in plasma was associated with decreased blood lipids in women with PCOS. 110 Subsequently, results from a crossover, placebo-controlled, RCT showed that long-chain n-3 PUFA supplementation (4×1 g capsules/ day, containing 2.4 g total long-chain n-3 PUFAs, 1.9 g EPA and DHA/day in a ratio of EPA to DHA of 1.49:1) resulted in increased plasma concentrations of n-3 PUFAs and had an antiandrogenic effect in women with PCOS.…”

Chromium supplementation in women with polycystic ovary syndrome: Systematic review and meta‐analysis

“…Fatty acid, vitamin D, and essential trace elements (selenium, calcium, zinc and chromium) have been explored. Two meta‐analyses, however, showed that both omega‐3 and n‐3 polyunsaturated fatty acids may not have significant beneficial effects in women with PCOS . Another supplement that has generated the most interest is chromium, which is significantly lower in the serum of PCOS women with IR compared with control women …”

“…Two meta-analyses, however, showed that both omega-3 and n-3 polyunsaturated fatty acids may not have significant beneficial effects in women with PCOS. 14,15 Another supplement that has generated the most interest is chromium, which is significantly lower in the serum of PCOS women with IR compared with control women. 16 Chromium is an essential element that is involved in the metabolism of carbohydrates and lipid.…”