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Randomized Controlled Trial
. 2021 Nov 30;186(1):53-64.
doi: 10.1530/EJE-21-0669.

Metabolic health during a randomized controlled lifestyle intervention in women with PCOS

Alexandra Dietz de Loos  1 , Geranne Jiskoot  1   2 , Annemerle Beerthuizen  2 , Jan Busschbach  2 , Joop Laven  1
Affiliations
Randomized Controlled Trial

Metabolic health during a randomized controlled lifestyle intervention in women with PCOS

Alexandra Dietz de Loos et al. Eur J Endocrinol. .

Abstract

Context: Women with polycystic ovary syndrome (PCOS) have an increased risk of metabolic syndrome (MetS). Both PCOS and MetS are associated with excess weight.

Objective: To examine the effect of a three-component lifestyle intervention (LSI) with or without short message service (SMS+ or SMS-, respectively) on the prevalence and severity of MetS and metabolic parameters, compared to care as usual (CAU).

Design: Randomized controlled trial.

Methods: Women diagnosed with PCOS and a BMI >25 kg/m2 (n = 183) were either assigned to a 1-year three-component (cognitive behavioural therapy, diet, and exercise) LSI, with or without SMS support, or to CAU which provided weight-loss advice only. Main outcome measures included changes in the prevalence of MetS, the continuous MetS severity z-score (cMetS z-score), metabolic parameters, and the impact of weight loss.

Results: After 1 year, the decrease in the cMetS z-score was greater in the SMS+ group than the CAU group (-0.39, P = 0.015). The prevalence of MetS changed with -21.6% (P = 0.037), -16.5% (P = 0.190), and +7.0% (P = 0.509) in both LSI groups and CAU group, respectively. A post hoc analysis for both LSI groups combined vs CAU resulted in a MetS difference of -25.9% (P = 0.046). Moreover, weight loss per se resulted in significantly favourable effects on all metabolic parameters.

Conclusions: This three-component LSI was more successful in improving metabolic health compared to CAU. Therefore, we recommend this intervention to women with PCOS and excess weight, provided that a clinically relevant weight loss is being pursued.

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Figures

Figure 1
Figure 1
CONSORT flowchart.
Figure 2
Figure 2
Changes in the prevalence of the metabolic syndrome over time for the lifestyle intervention groups combined compared to the care as usual group. Note: Post hoc analysis. Differences were tested with multilevel logistic regression.
Figure 3
Figure 3
Changes in the continuous metabolic syndrome z-score over time for the lifestyle intervention groups combined compared to the care as usual group. Note: Post hoc analysis. Differences were tested with multilevel linear regression. *Indicates statistical significance (P < 0.001) for within-group changes. cMetS z-score, continuous metabolic syndrome z-score.
Figure 4
Figure 4
Mediation analysis demonstrating the effect of weight on the metabolic syndrome.
See this image and copyright information in PMC

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