NUTRITION AND METABOLIC HEALTH CHANGES IN POLYCYSTIC OVARY SYNDROME: A NARRATIVE REVIEW OF DIETARY PATTERNS, TARGETED SUPPLEMENTATION, AND THE DIET–MICROBIOTA–METABOLISM AXIS

Abstract

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine–metabolic disorder characterized by insulin resistance, dyslipidaemia, and an increased long-term cardiometabolic risk. This is a narrative review of evidence regarding diet, dietary supplements and diet-gut microbiota-methabolism in PCOS. Qualitative synthesis of evidence was carried out from clinical trials, systematic reviews, meta-analyses and international guidelines. There is no single dietary composition that is clearly superior, but more sustainable individual dietary approaches may offer benefits for insulin sensitivity and metabolic health. There are reports of benefits for certain outcomes with low-glycaemic-index, Mediterranean, DASH, and low-carbohydrate diets. For those with overweight or obesity, energy restriction and haste weight loss may be beneficial, but lifestyle interventions can have health benefits without weight loss. Myo-inositol and omega-3 fatty acids may provide metabolic benefits, and the use of vitamin D supplementation may apply to those who are deficient. The effect of probiotics, prebiotics and synbiotics on metabolic markers has been found to be inconsistent. Association of diet with PCOS related metabolic dysfunctions could be linked to gut microbial composition, short chain fatty acids, intestinal barrier function, inflammation and bile acid signalling, but there is limited evidence for causality. Nutrient management should focus on diet quality, diet adequacy, diet sustainability and personal dietary requirements. Additional long-term, well-designed studies are needed to better understand efficacy and mechanisms of interventions.