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Review
. 2022 Jan 25;19(3):1336.
doi: 10.3390/ijerph19031336.

Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

Jim Parker  1 , Claire O'Brien  2 , Jason Hawrelak  3 , Felice L Gersh  4
Affiliations
Review

Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

Jim Parker et al. Int J Environ Res Public Health. .

Abstract

Polycystic ovary syndrome (PCOS) is increasingly recognized as a complex metabolic disorder that manifests in genetically susceptible women following a range of negative exposures to nutritional and environmental factors related to contemporary lifestyle. The hypothesis that PCOS phenotypes are derived from a mismatch between ancient genetic survival mechanisms and modern lifestyle practices is supported by a diversity of research findings. The proposed evolutionary model of the pathogenesis of PCOS incorporates evidence related to evolutionary theory, genetic studies, in utero developmental epigenetic programming, transgenerational inheritance, metabolic features including insulin resistance, obesity and the apparent paradox of lean phenotypes, reproductive effects and subfertility, the impact of the microbiome and dysbiosis, endocrine-disrupting chemical exposure, and the influence of lifestyle factors such as poor-quality diet and physical inactivity. Based on these premises, the diverse lines of research are synthesized into a composite evolutionary model of the pathogenesis of PCOS. It is hoped that this model will assist clinicians and patients to understand the importance of lifestyle interventions in the prevention and management of PCOS and provide a conceptual framework for future research. It is appreciated that this theory represents a synthesis of the current evidence and that it is expected to evolve and change over time.

Keywords: diet; endocrine-disrupting chemicals; environment; evolution; infertility; insulin resistance; lifestyle; polycystic ovary syndrome; toxins.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evolutionary model of the pathogenesis of polycystic ovary syndrome. Adapted with permission from Ref. [12]. 2021 Journal of ACNEM.
Figure 2
Figure 2
Nutritional and environmental influences throughout the life course and the perpetuation of the transgenerational inheritance of polycystic ovary syndrome. Reprinted from Ref. [28].
Figure 3
Figure 3
Impact of the unified theory on the management of polycystic ovary syndrome. Reprinted from Ref. [28].
See this image and copyright information in PMC

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References

    1. Bodai B.I., Nakata T.E., Wong W.T., Clark D.R., Lawenda S., Tsou C., Liu R., Shiue L., Cooper N., Rehbein M., et al. Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. Perm. J. 2017;22:17–25. doi: 10.7812/TPP/17-025. - DOI - PMC - PubMed
    1. McMacken M., Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J. Geriatr. Cardiol. 2017;14:342–354. doi: 10.11909/j.issn.1671-5411.2017.05.009. - DOI - PMC - PubMed
    1. Gakidou E., Afshin A., Abajobir A.A., Abate K.H., Abbafati C., Abbas K.M., Abd-Allah F., Abdulle A.M., Abera S.F., Aboyans V., et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1345–1422. doi: 10.1016/S0140-6736(17)32366-8. - DOI - PMC - PubMed
    1. Parker J. NEM: A New Paradigm for Understanding the Common Origins of the Chronic Disease Epidemic. ACNEM J. 2018;37:6–11.
    1. Glastras S.J., Valvi D., Bansal A. Editorial: Developmental programming of metabolic diseases. Front. Endocrinol. 2021;12 doi: 10.3389/fendo.2021.781361. - DOI - PMC - PubMed