Effectiveness of Lifestyle Modification in Polycystic Ovary Syndrome Patients with Obesity: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Eligibility Criteria and Selection Process
2.3. Variables and Data Collection
2.4. Risk of Bias Assessment
2.5. Analysis
3. Results
3.1. Study Characteristics
3.2. Effectiveness of Lifestyle Modification
3.2.1. Reproductive Index
3.2.2. Metabolic Index
3.2.3. Anthropometric Index
3.3. Subgroup Analysis
3.3.1. Effectiveness of Lifestyle Modification according to the Type of Intervention
3.3.2. Effectiveness of Lifestyle Modification according to the Degree of Weight Loss
4. Discussion
4.1. Lifestyle Modification Has a Positive Effect on Reproductive Outcomes in PCOS Patients with Obesity
4.2. Combination Therapy with Diet and Exercise Rather Than Monotherapy
4.3. Metabolic Index Improved When Moderate Weight Loss Was Achieved
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Name and Year | Country | Study Design | Inclusion Criteria | Intervention | N | Mean Age | ||
---|---|---|---|---|---|---|---|---|
Obesity | PCOS | Type | Group | |||||
Cochrane 2021 [8] | England | Clinical trial | BMI > 28.6 | Not specified | Exercise | Exercise | 11 | 30.1 ± 4.6 |
Control | 4 | 37.5 ± 4.0 | ||||||
Oberg 2019 [9] | Sweden | RCT | BMI ≥ 27 | Rotterdam | LSM | LSM | 30 | 31.0 ± 5.1 |
Control | 27 | 29.9 ± 5.7 | ||||||
Kirubamani 2018 [10] | India | One group (pre-post) | BMI ≥ 24.9, BMI < 29.9 | Clinical features and USG (not specified) | Exercise | Exercise | 50 | 16–35 (Range) |
Deepthi 2017 [11] | Malaysia | One group (pre-post) | BMI ≥ 24.9, BMI < 29.9 | USG (not specified) | Exercise | Exercise | 30 | 18–25 (Range) |
Marzouk 2015 [12] | Egypt | RCT | BMI > 30 | Clinical features | Diet | Diet | 30 | 19.3 ± 1.3 |
Control | 30 | 20.1 ± 1.8 | ||||||
Mahoney 2014 [13] | USA | One group (pre-post) | BMI > 27 | Rotterdam | LSM | LSM | 12 | 32.0 ± 5.3 |
Gaeini 2014 [14] | Iran | RCT | BMI > 25 | Not specified | Exercise | Exercise | 10 | 23.6 ± 5.0 |
Control | 10 | |||||||
Roessler 2013 [15] | Denmark | One group (pre-post) | BMI ≥ 25, BMI ≤ 40 | Rotterdam | Exercise | Exercise | 17 | 31.6 |
Nybacka 2013 [16] | Sweden | RCT | BMI > 27 | Rotterdam | LSM | Diet | 19 | 29.9 ± 5.5 |
Exercise | 19 | 31.3 ± 4.8 | ||||||
LSM | 19 | 31.8 ± 4.9 | ||||||
Lass 2012 [17] | Germany | Prospective (longitudinal) | 97th BMI percentile by age for German adolescents | National Institutes of Health | LSM | LSM (weight loss+) | 26 | 31.8 ± 4.9 |
LSM (weight loss-) | 33 | 15.0 ± 0.7 | ||||||
Redman 2011 [18] | USA | Prospective | BMI ≥ 25 | Not specified | Exercise | Exercise | 8 | 18–30 (range) |
Ornstein 2011 [19] | USA | Clinical trial | 85th BMI percentile by age | Clinical features | Diet | Diet (LC) | 12 | 15.8 ± 2.2 |
Diet (LF) | 12 | |||||||
Thomson 2009 [20] | Australia | Prospective | Mean BMI 36.2 ± 0.8 | Rotterdam | Diet | Diet (R) | 52 | 29.2 ± 0.9 |
Diet (R-) | ||||||||
Thomson 2008 [21] | Australia | Clinical trial | BMI ≥ 25 | Rotterdam | LSM | Diet | 30 | 29.3 ± 0.7 |
LSM (DA) | 31 | |||||||
LSM (DC) | 33 | |||||||
Palomba 2008 [22] | Italy | Clinical trial | BMI > 30, BMI ≤ 35 | Rotterdam and National Institutes of Health | LSM | Diet | 20 | 26.8 ± 5.1 |
Exercise | 20 | 25.8 ± 4.5 | ||||||
Moran 2006 [23] | Australia | RCT | BMI ≥ 25 | Rotterdam | Diet | Diet (CC) | 22 | 32.1 ± 5.5 |
Diet (FC) | 21 | 33.2 ± 4.8 | ||||||
Bruner 2006 [24] | Canada | RCT | BMI > 27 | Rotterdam | LSM | Diet | 5 | 28.4 ± 2.7 |
LSM | 7 | 32.3 ± 1.0 | ||||||
Tolino 2005 [25] | Italy | Prospective | BMI ≥ 25 | Clinical features, polycystic ovaries by USG | Diet | Diet (weight loss > 5%) | 78 | NR |
Diet (weight loss < 5%) | 17 | |||||||
Stamets 2004 [26] | USA | RCT | BMI ≥ 25 | Clinical features | Diet | Diet (HP) | 13 | 29 ± 4 |
Diet (HC) | 13 | 26 ± 4 | ||||||
van Dam 2004 [27] | USA | Prospective | BMI > 30 | Clinical features | Diet | Diet (R+) | 9 | 30 ± 2.5 |
Diet (R−) | 6 | 30 ± 1.8 | ||||||
Crosignani 2003 [28] | Italy | Prospective | BMI ≥ 25 | USG (not specified) | LSM | LSM | 33 | 30.7 ± 3.9 |
Moran 2003 [29] | Australia | Clinical trial | Mean BMI 37.7 ± 1.9 (LP) 37.9 ± 1.6 (HP) | Clinical features | LSM | LSM (LP) | 14 | 33 ± 1.2 |
LSM (HP) | 14 | 32 ± 1.2 | ||||||
Huber-buchholz 1999 [30] | Australia | Prospective | BMI ≥ 27, BMI ≤ 45 | Not specified | LSM | LSM (R+) | 7 | 28.7 ± 0.9 |
LSM (R−) | 6 | 28.7 ± 0.9 | ||||||
Guzick 1994 [31] | USA | RCT | 130–200% of ideal body weight | Not specified | LSM | LSM | 6 | 32.2 ± 4.9 |
Control | 6 | 31.2 ± 3.9 | ||||||
Kiddy 1992 [32] | UK | Prospective | Mean weight 91.5 ± 14.7 | Clinical features, polycystic ovaries by USG | Diet | Diet (weight loss > 5%) | 24 | NR |
Diet (weight loss < 5%) |
Name and Year | Type of Intervention | Type of Diet/Exercise | Composition of Diet/Exercise Program | Duration, Frequency, Time |
---|---|---|---|---|
Cochrane 2021 | Exercise | Aerobic | Aerobic, aquarobics, gym session | 12 weeks, 2 days/week, 60 min/day |
Oberg 2019 | LSM | Counseling | Personalized coaching for physical activity and diet | 4 months |
Kirubamani 2018 | Exercise | Aerobic | Walking, running (treadmill): warm up: 5 min, exercise: 35 min, cool down: 5 min | 16 weeks, 5 days/week, 45 min/day |
Deepthi 2017 | Exercise | Aerobic | Walking, running (treadmill): warm up: 5 min, exercise: 35 min, cool down: 5 min | 8 weeks, 3 days/week, 45 min/day |
Marzouk 2015 | Diet | Calorie reduction | 500 kcal deficit/day | 6 months |
Diet counseling | Increase in low-GI foods, decrease in high saturated fats Intake of multivitamin supplements | |||
Mahoney 2014 | LSM | Calorie reduction | Not specified | 12 weeks |
Diet counseling | Increase in low-GI foods, decrease in saturated fats | |||
Aerobic | Walking, cycling, aerobics | 12 weeks, 3–5 days/week, 30–60 min/day | ||
Resistance | Major muscle strength training (not specified) | 12 weeks, 2–3 days/week, 30–60 min/day | ||
Gaeini 2014 | Exercise | Aerobic | Running | 12 weeks, 3 days/week, 25–30 min/day |
Roessler 2013 | Exercise | Aerobic | Walking, running | 8 weeks, 1 day/week, 25–45 min/day |
Cycling | 8 weeks, 2 days/week, 35–55 min/day | |||
Nybacka 2013 | LSM | Calorie reduction | Reduction of 600 calories, compared to the prior intake | 4 months |
Diet composition | Carbohydrate (55–60%), fat (25–30%), protein (10–15%) | |||
Aerobic | Walking, jogging, aerobics, swimming | 4 months, 2–3 days/week, 45–60 min/day | ||
Resistance | Muscle strength training (not specified) | |||
Lass 2012 | LSM | Diet composition | Carbohydrate (55% with 5% sugar), fat (30%), protein (15%) | 3 months |
Aerobic | Dancing, ball games, jogging, trampoline jumping | 1 year, 1 day/week | ||
Redman 2011 | Exercise | Aerobic | Aerobic exercise | 16 weeks, 5 days/week |
Ornstein 2011 | Diet | Calorie reduction | Not specified | 12 weeks |
Diet counseling | Increase in low-GI foods Intake of multivitamin supplements | |||
Diet composition 1 | Low carbohydrate: carbohydrate 40 g/day | |||
Diet composition 2 | Low fat: fat less than 50 g/day | |||
Thomson 2009 | Diet | Calorie reduction | 6000 kJ/day | 20 weeks |
Thomson 2008 | LSM | Calorie reduction | 5000–6000 kJ/day | 20 weeks |
Diet composition | High protein: carbohydrate (40%), fat (30%, saturated fat < 8%), protein (30%) | |||
Aerobic | Walking, jogging | 20 weeks, 3 days/week, 20–45 min/day | ||
Resistance | Bench press, lag pull down, leg press, knee extension, and sit-ups | 20 weeks, 2 days/week | ||
Palomba 2008 | LSM | Calorie reduction | 800 kcal deficit/day | 24 weeks |
Diet composition | High protein: carbohydrate (45%), fat (20%), protein (35%) | |||
Diet counseling | Taking the multivitamin/mineral supplement | |||
Aerobic | Cycling: warm up: 5 min, exercise: 35 min, cool down: 5 min | 24 weeks, 3 days/week, 45 min/day | ||
Moran 2006 | Diet | Calorie reduction | Meal replacement: 2 meals/day of a meal termed Slimfast | 0–8th weeks |
Diet composition 1 | Low carbohydrate: carbohydrate up to 120 g/day | 9th–32nd weeks | ||
Diet composition 2 | Low fat: fat up to 50 g/day | |||
Bruner 2006 | LSM | Diet counseling | Canada’s food guide to healthy eating | 12 weeks |
Aerobic | Walking and/or cycling: warm up: 10 min, exercise: 30 min | 12 weeks, 3 days/week, up to 90 min/day | ||
Resistance | biceps curl, lag pull down, leg curl, leg extension, shoulder press, chest press, hip abduction, hip adduction, hip flexion, hip extension, and back extension | |||
Tolino 2005 | Diet | Calorie reduction | 1000 kcal/day (patients with BMI ≤ 30) 500 kcal/day (patients with BMI > 30, initial 4 weeks) | 7 months |
Diet composition | Low fat (not specified) | |||
Stamets 2004 | Diet | Calorie reduction | 1000 kcal deficit/day | 1 month |
Diet composition 1 | High protein: carbohydrate (55%), fat (30%), protein (30%) | |||
Diet composition 2 | High carbohydrate: carbohydrate (45%), fat (20%), protein (15%) | |||
van Dam 2004 | Diet | Calorie reduction | Meal replacement: 470 kcal/day of a meal named Modifast | 7 days |
Diet composition | Carbohydrate (42%), fat (15%), protein (43%) | |||
Crosignani 2003 | LSM | Calorie reduction | 1200 kcal/day | 6 months |
Diet Composition | Carbohydrate (55%), fat (25%), protein (20%), fiber (30 g/week) | |||
Aerobic | Aerobic exercise | 6 months, 1–2 days/week | ||
Moran 2003 | Diet | Calorie reduction | 6000 kJ/day | 16 weeks |
Diet composition 1 | Low protein: carbohydrate (55%), fat (30%), protein (15%) | |||
Diet composition 2 | High protein: carbohydrate (40%), fat (30%), protein (30%) | |||
Huber-buchholz (1999) | LSM | Not specified | Not specified | Not specified |
Guzick 1994 | LSM | Calorie reduction | Meal replacement: 400 kcal/day of a meal named Optifast | 0–8th weeks |
4200–5040 kJ/day | 9th–12th weeks | |||
Aerobic | Walking | 12 weeks, 5 days/week | ||
Kiddy 1992 | Diet | Calorie reduction | 1000 kcal/day (patients with BMI ≤ 30) 330 kcal/day (patients with BMI > 30, initial 4 weeks) | 7 months |
Diet composition | Low fat (not specified) |
Name and Year | Follow-Up | Reproductive Index | Groups | Before | After |
---|---|---|---|---|---|
Oberg 2019 | 4 months | No. of patients with improvement in menstrual cycle | LSM | 20/34 (58.8%) | |
Control | 8/34 (23.5%) † | ||||
No. of patients with ovulation | LSM | 7/34 (20.6%) | |||
Control | 7/34 (20.6%) | ||||
12 months | No. of patients who conceive | All | 11/68 (16.2%) | ||
Kirubamani 2018 | 16 weeks | No. of patients with irregular menstrual cycle | Exercise | 38.6 ± 6.7 | 14.4 ± 1.5 * |
No. of patients with ovulation | Exercise | 13.1 ± 1.5 | 30.3 ± 3.7 * | ||
Number of ovarian follicles | Exercise | 10–12 | 6–8 * | ||
Diameter ovarian follicle | Exercise | 7.4 | 7.1 | ||
Ovarian volume | Exercise | 11.2 | 9.2 * | ||
Deepthi 2017 | 8 weeks | No. of patients with regular menstrual cycle | Exercise | 28/30 (93.3%) | |
Number of ovarian follicles | Exercise | 16.7 | 14.2 * | ||
Marzouk 2015 | 6 months | No. of menstrual episodes | Diet | 2.4 ± 1.6 | 3.1 ± 1.2 † |
Control | 2.2 ± 1.3 | 2.3 ± 1.3 | |||
Mahoney 2014 | 12 weeks | No. of patients with improvement in menstrual cycle | LSM | 2/8 (25%) | |
Gaeini 2014 | 12 weeks | Number of ovarian follicles (left) | Exercise | 17 ± 2 | 12 ± 2 * |
Control | 17 ± 5 | 18 ± 3 | |||
Number of ovarian follicles (right) | Exercise | 16 ± 4 | 14 ± 2 * | ||
Control | 18 ± 4 | 18 ± 3 | |||
No. of patients with improvement in menstrual cycle | Exercise | 6/10 * | |||
Control | 3/10 | ||||
Roessler 2013 | 16 weeks | No. of patients with regular menstrual cycle | Exercise | 4/17 (23.5%) | |
Ovarian volume | Exercise | 12.7 ± 1.2 | 12.2 ± 1.2 | ||
Nybacka 2013 | 4 months | No. of patients with improvement in menstrual cycle | LSM | 30/43 (70%) | |
No. of patients with ovulation | LSM | 15/43 (35%) | |||
Number of ovarian follicles (mean) | Diet | 12.4 ± 3.9 | 9.4 ± 2.4 * | ||
Exercise | 13.2 ± 4.6 | 10.5 ± 3.2 * | |||
LSM | 12.8 ± 4.7 | 10.1 ± 3.4 * | |||
Ovarian volume | Diet | 9.6 | 7.7 | ||
Exercise | 9.6 | 10.9 | |||
LSM | 8.8 | 12.4 | |||
Lass 2012 | 1 year | No. of patients with irregular menstrual cycle (amenorrhea) | Success in weight loss | 18/26 (69%) | 7/26 (27%) * |
Failure in weight loss | 20/33 (61%) | 18/33 (55%) | |||
No. of patients with irregular menstrual cycle (oligomenorrhea) | Success in weight loss | 8/26 (31%) | 3/26 (12%) | ||
Failure in weight loss | 14/33 (39%) | 12/33 (36%) | |||
Redman 2011 | 16 weeks | Number of ovarian follicles | LSM | −15 ± 5 * | |
Number of follicles in polycystic ovary | LSM | −15 ± 6 * | |||
Ovarian volume | LSM | −6 ± 4 | |||
Ornstein 2011 | 12 weeks | No. of patients with menstrual cycle | Diet | 12/16 (75%) | |
No. of patients with regular menstrual cycle | Diet | 8/16 (50%) | |||
Average no. of bleeding episodes | Diet | 0.6 ± 0.6 | 1.6 ± 1.3 * | ||
Marsh 2010 | 1 year | No. of patients with improvement in menstrual cycle | Diet 1 | NR/NR (95%) † | |
Diet 2 | NR/NR (63%) | ||||
Thomson 2009 | 20 weeks | No. of patients with improvement in ovulation | Diet | 22/52 (42.3%) | |
No. of patients with improvement in menstrual cycle | Diet | 10/52 (19.2%) | |||
Thomson 2008 | 20 weeks | No. of patients with improvement in ovulation | Diet | 6/12 (50%) | |
LSM (DA) | 3/6 (50%) | ||||
LSM (DC) | 3/7 (42.9%) | ||||
No. of patients with improvement in menstrual cycle | Diet | 3/14 (21.4%) | |||
LSM (DA) | 9/21 (42.9%) | ||||
LSM (DC) | 8/18 (44.4%) | ||||
Palomba 2008 | 24 weeks | Frequency of menstruation (no. observed menses/no. expected cycles) | Diet | 18/118 (15.3%) | |
Exercise | 28/107 (26.2%) † | ||||
Ovulation rate (no. ovulatory cycles/no. observed cycles) | Diet | 18/119 (15.1%) | |||
Exercise | 28/113 (24.8%) † | ||||
Pregnancy rate (no. pregnancy/no. observed cycles) | Diet | 2/119 (1.7%) | |||
Exercise | 7/113 (6.2%) | ||||
Cumulative ovulation rate (no. of patients with ovulation) | Diet | 5/20 (25.0%) | |||
Exercise | 13/20 (65.0%) † | ||||
Cumulative pregnancy rate (no. of patients who conceived) | Diet | 2/20 (10.0%) | |||
Exercise | 7/20 (35.0%) | ||||
Moran 2006 | 32 weeks | No. of patients with improvement in menstrual cycle | Diet | 16/28 (57.1%) | |
Bruner 2006 | 12 weeks | No. of patients who conceived | LSM | 1/12 (8.3%) | |
Number of ovarian follicles (left) | Diet | 33 ± 4 | 39 ± 7 | ||
LSM | 35 ± 5 | 39 ± 6 | |||
Number of ovarian follicles (right) | Diet | 47 ± 8 | 46 ± 8 | ||
LSM | 49 ± 7 | 44 ± 5 | |||
Tolino 2005 | 7 months | No. of patients with improvement in ovulation | Diet (>5% loss) | 6/66 (9.09%) | |
No. of patients with improvement in menstrual cycle | Diet (>5% loss) | 18/66 (27.3%) | |||
No. of patients who conceived | Diet (>5% loss) | 30/66 (45.5%) | |||
van Dam 2004 | until 10% weight loss | No. of patients with improvement in ovulation | Diet | 9/15 (60%) | |
Crosignani 2003 | 1 year | No. of patients who conceived | LSM | 10/33 (30%) | |
6 months | No. of patients with improvement in menstrual cycle | LSM | 18/33 (54.5%) | ||
Ovarian follicle number | 5% loss | 23.5 ± 11.5 | 19.9 ± 9.9 * | ||
10% loss | 23.5 ± 11.5 | 18.3 ± 7.5 * | |||
Moran 2003 | No. of patients with improvement in menstrual cycle | Diet | 11/25 (44.0%) | ||
Huber-buchholz (1999) | 6 months | No. of patients who conceived | LSM | 2/15 (13.3%) | |
No. of patients with ovulation | LSM | 9/15 (60%) | |||
Guzick 1994 | 12 weeks | No. of patients with ovulation | LSM | 4/6 (66.7%) | |
Control | 1/6 (16.7%) | ||||
Kiddy 1992 | 7 months | No. of patients with improvement in reproductive function | Diet (>5% loss) | 9/11 (81.8%) † | |
Diet (<5% loss) | 1/8 (12.5%) |
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Kim, C.-H.; Lee, S.-H. Effectiveness of Lifestyle Modification in Polycystic Ovary Syndrome Patients with Obesity: A Systematic Review and Meta-Analysis. Life 2022, 12, 308. https://doi.org/10.3390/life12020308
Kim C-H, Lee S-H. Effectiveness of Lifestyle Modification in Polycystic Ovary Syndrome Patients with Obesity: A Systematic Review and Meta-Analysis. Life. 2022; 12(2):308. https://doi.org/10.3390/life12020308
Chicago/Turabian StyleKim, Chan-Hee, and Seon-Heui Lee. 2022. "Effectiveness of Lifestyle Modification in Polycystic Ovary Syndrome Patients with Obesity: A Systematic Review and Meta-Analysis" Life 12, no. 2: 308. https://doi.org/10.3390/life12020308
APA StyleKim, C. -H., & Lee, S. -H. (2022). Effectiveness of Lifestyle Modification in Polycystic Ovary Syndrome Patients with Obesity: A Systematic Review and Meta-Analysis. Life, 12(2), 308. https://doi.org/10.3390/life12020308