The effectiveness and safety of the Ketogenic Diet on overweight and obese women with Polycystic Ovary Syndrome on anthropometric, endocrine and metabolic parameters: A Systematic Review

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is a multifaceted endocrine disorder that affects reproductive-aged women. This condition is frequently associated with obesity, hyperinsulinemia, and insulin resistance. The ketogenic diet (KD), a high-fat, low-carbohydrate dietary approach, has gained interest for its potential effects, not only in the treatment of obesity but also in related metabolic disorders. Objective: The current systematic review aimed to evaluate the effectiveness of KD on body mass index (BMI) and body weight (BW), as well as endocrine parameters including menstrual cycle, testosterone (TST), luteinizing hormone (LH), follicle- stimulating hormone (FSH), LH/FSH, and metabolic parameters such as triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and the safety of KD in women with PCOS. Methodology: A systematic search of four databases Embase (Ovid), NUsearch, ScienceDirect and PubMed for full-text publications published in English between 2005 and 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Randomised controlled trials and cohort studies that investigated the effects of KD on women with PCOS aged 18–45 with a BMI > 25 were eligible. Result: Seven trials were identified and evaluated. All studies showed significant BMI and BW (the mean weight loss was -13.02%) reductions with the KD. Among the analysed studies, four reported favourable outcomes in terms of ameliorating menstrual cycle regularity through KD utilisation. Changes in TST were significant in three investigations, while three others revealed no such effect. Three studies reported significant changes in LH, FSH, and LH/FSH ratios, while one study found none. Changes in TG, LDL, and HDL were observed in two trials, only one study reported a change in TG. No significant metabolic parameters were found in two studies. All three trials concluded that the KD was safe for obese women with PCOS. Conclusion: Women with PCOS who are classified as overweight or obese had a change in both BW and BMI, subsequently, improving the menstrual cycle, as well as the TST, LH, FSH, and LH/FSH ratio and metabolic markers showed potential improvements with no reported adverse effects.