Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome
Open accessAbstract
Background Polycystic ovary syndrome (PCOS), a common condition in women, improves with weight loss. Meal replacements in short-term weight loss and strategies for weight maintenance have not been investigated in PCOS.Objective We compared in overweight women with PCOS the effects of meal replacements in short-term weight-loss and longer-term carbohydrate- or fat-restriction strategies on weight maintenance and improvements in reproductive and metabolic variables.Design Overweight women with PCOS (n = 43; x +/- SD age: 32.1 +/- 5.2 y; weight: 96.1 +/- 18.4 kg) followed an 8-wk weight-loss regimen (2 meal replacements/d, 4904.4 +/- 127 kJ; phase 1) and then a 6-mo weight-maintenance carbohydrate- (<120 g/d) or fat- (<50 g/d) restriction regimen (phase 2).Results Thirty-four women completed phase 1, and 23 women completed phase 2; the proportion of dropouts was similar in the 2 groups. During phase 1, significant (P < 0.05) reductions in weight (5.6 +/- 2.4 kg), waist circumference (6.1 +/- 2.5 cm), body fat (4.1 +/- 2.2 kg), insulin (2.8 +/- 1.1 mU/L), total testosterone (0.3 +/- 0.7 nmol/L), and free androgen index (3.1 +/- 4.6) occurred; these changes were sustained during phase 2. No significant differences between diet groups were seen for any variables. At 6 mo, both approaches resulted in a net weight loss of 4.7 +/- 4.6 kg. Improvements in menstrual cyclicity occurred for 16 (57.1%) of 28 subjects.Conclusions Meal replacements are an effective strategy for the short-term management of PCOS. Advice on moderate fat or carbohydrate restriction was equally effective in maintaining weight reduction and improving reproductive and metabolic variables.
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In an energy-restricted meal replacement intervention, total cholesterol, triglyceride, LDL-C, and C-reactive protein concentrations significantly decreased after phase one but increased during phase two.
“While total cholesterol, triglyceride, LDL-C, and C-reactive protein concentrations significantly decreased after phase one, these variables increased during phase two.”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [93]
The fasting lipids and C-reactive protein section reports significant phase-one decreases in all four measures and phase-two increases in total cholesterol, triacylglycerols, and LDL cholesterol. It does not report a phase-two increase in CRP; Table 4 shows the same mean CRP concentration at week 8 and week 32 (2.8 mg/L). Page numbers were not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere was no difference in total cholesterol, triglyceride, LDL-C, and C-reactive protein concentrations from baseline to study completion.
“Thus, there was no difference in these variables from baseline to study completion [93]”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [93]
Weight regain was reported during phase two, but a significant weight loss was maintained from baseline.
“Weight regain was reported during phase two, but a significant weight loss was maintained from baseline [93]”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [93]
The high attrition rate and weight regain question the sustainability and acceptability of these diets.
“The high attrition rate and weight regain [93] question the sustainability and acceptability of these diets”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [93]
The study [93] lacked diversity in the sample and lacks generalizability to individuals across BMI ranges.
“A large limitation of the study [93] is the lack of diversity in the sample as well as the lack of generalizability to individuals across BMI ranges.”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [93]
Several weight loss interventions included in this review had high attrition rates, signaling that the interventions may not be sustainable in real-world scenarios.
“Several weight loss interventions included in this review had high attrition rates [63,64,65,89,92,93,100], signaling that the interventions may not be sustainable in real-world scenarios”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [93]
There was no difference between the diet-delivery methods for most anthropometric, QoL, and emotional wellbeing outcomes.
“There was no difference between the diet-delivery methods for most anthropometric, QoL, and emotional wellbeing outcomes.”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [152]
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Self-citationTomlinson, J., Millward, A., Stenhouse, E., & Pinkney, J. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.02994.x · Cited by 66 · see citing works
Moran, L. J., Noakes, M., Clifton, P., Buckley, J., Brinkworth, G., Thomson, R., & Norman, R. J. (2019) · Nutrients · doi:10.3390/nu11030492 · Cited by 57 · see citing works
Self-citationWeight management interventions in women with and without PCOS: a systematic review
Kataoka, J., Tassone, E., Misso, M., Joham, A., Stener-Victorin, E., Teede, H., & Moran, L. (2017) · Nutrients · doi:10.3390/nu9090996 · Cited by 58 · see citing works
Self-citationJiskoot, G., Timman, R., Beerthuizen, A., Dietz de Loos, A., Busschbach, J., & Laven, J. (2020) · Obesity · doi:10.1002/oby.22980 · Cited by 56 · see citing works
A randomized pilot study of dietary treatments for polycystic ovary syndrome in adolescents
Wong, J. M. W., Gallagher, M., Gooding, H., Feldman, H. A., Gordon, C. M., Ludwig, D. S., & Ebbeling, C. B. (2016) · Pediatric Obesity · doi:10.1111/ijpo.12047 · Cited by 50 · see citing works
“While some studies indicate benefit but no significant effect of macronutrient composition (24,26,27), others indicate no effect (28,29).”
Evolutionary origins of polycystic ovary syndrome: An environmental mismatch disorder
Charifson, M. A., & Trumble, B. C. (2019) · Evolution, Medicine, and Public Health · doi:10.1093/emph/eoz011 · Cited by 44 · see citing works
Turner-McGrievy, G., Davidson, C. R., & Billings, D. L. (2015) · Human Fertility · doi:10.3109/14647273.2014.922704 · Cited by 44 · see citing works
Weight gain and lifestyle factors in women with and without polycystic ovary syndrome
Awoke, M. A., Earnest, A., Joham, A. E., Hodge, A. M., Teede, H. J., Brown, W. J., & Moran, L. J. (2021) · Human Reproduction · doi:10.1093/humrep/deab239 · Cited by 30 · see citing works
Johnson, L. K., Holven, K. B., Nordstrand, N., Mellembakken, J. R., Tanbo, T., & Hjelmesæth, J. (2015) · Endocrine Connections · doi:10.1530/ec-15-0047 · Cited by 24 · see citing works
Herbert, S., & Woolf, K. (2023) · Nutrients · doi:10.3390/nu15245069 · Cited by 15 · see citing works
“Thus, there was no difference in these variables from baseline to study completion [93], perhaps highlighting that the cardiometabolic benefits from weight loss on meal replacements alone are difficult to maintain.”
BackgroundMethodInfluential
- Authors
- Moran, L. J., Noakes, M., Clifton, P. M., Wittert, G. A., Williams, G., & Norman, R. J.
- Affiliations
- Commonwealth Scientific and Industrial Research Organisation (AU)
- Corresponding author
- Moran, Lisa J
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2006-07
- Volume
- 84
- Issue
- 1
- Pages
- 77-87
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2166606476
- Cited by
- 141
- References
- 57
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 7 · 2023: 8 · 2022: 4 · 2021: 4 · 2020: 9 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 7 · 2012: 9
- FWCI
- 8.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- polycystic ovary syndrome, meal replacement, weight loss, weight maintenance, carbohydrate restriction, dietary fat restriction, insulin, testosterone, free androgen index, menstrual cyclicity, overweight women, waist circumference, fat mass
- MeSH terms
- Adult, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Female, Food, Formulated, Humans, Obesity, Polycystic Ovary Syndrome, Reproduction, Testosterone, Weight Loss, Diet, Fat-Restricted, Glycemic Index, Diet, Carbohydrate-Restricted
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