Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women
Open accessAbstract
BACKGROUND: Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. OBJECTIVE AND RATIONALE: We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. SEARCH METHODS: Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). OUTCOMES: Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: −21.46, 95% CI: −41.03 to −1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: −1.08, 95% CI: −2.19 to 0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: −0.95, 95% CI: −1.67 to −0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: −0.38, 95% CI: −0.72 to −0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. WIDER IMPLICATIONS: Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.
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Women with PCOS have lower overall diet quality, poorer quality of consumed foods, and lower total physical activity compared to women without PCOS.
“A comparison between women with PCOS and a healthy control group revealed that women with PCOS have a lower overall diet quality, poorer quality of consumed foods (e.g., higher cholesterol levels), and a lower total level of physical activity compared to women without PCOS [30].”
From Dietary Patterns and Metabolic and Hormonal Parameters in Women with Suspected PCOS (2025) · cites this paper as [30]
A systematic review and meta-analysis of 39,471 women with PCOS found that individuals with PCOS overall had comparable total energy, carbohydrate, fat, and protein intakes than individuals without PCOS.
“a systematic review and meta-analysis of 39,471 women with PCOS found that individuals with PCOS overall had comparable total energy, carbohydrate, fat, and protein intakes than individuals without PCOS [39].”
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 [39]
Women with PCOS have either poorer or comparable intakes of major food groups and micronutrients, suggesting room for improvement in overall dietary patterns.
“Overall, women with PCOS have either poorer or comparable intakes of major food groups, including grains, fruits, vegetables, proteins, seeds, nuts, and dairy [39], as well as micronutrients, calcium, zinc, iron, folic acid, and vitamin D [39], suggesting room for improvement in the overall dietary patterns of individuals with PCOS.”
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 [39]
Higher adherence to an anti-inflammatory dietary pattern is linked to lower PCOS risk.
“a higher adherence to an anti-inflammatory dietary pattern has been linked to lower PCOS risk [11,39,41].”
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 [39]
The literature tends to only include overweight or obese individuals as study participants.
“the literature tends to only include overweight or obese individuals as study participants [18,39,43,47].”
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 [39]
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“Similarly, the literature tends to only include overweight or obese individuals as study participants [18,39,43,47].”
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“Additionally, no statistically significant correlations were observed in women practicing calorie counting.”
- Authors
- Kazemi, M., Kim, J. Y., Wan, C., Xiong, J. D., Michalak, J., Xavier, I. B., Ganga, K., Tay, C. T., Grieger, J. A., Parry, S. A., Moran, L. J., & Lujan, M. E.
- Affiliations
- Cornell University (US)
- Monash University (AU)
- The University of Adelaide (AU)
- Corresponding author
- Kazemi, Maryam
- Lujan, Marla E
- ORCID
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-05-26
- Volume
- 28
- Issue
- 6
- Pages
- 910-955
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- PMC
- PMC9629501
- OpenAlex
- W4282929508
- Cited by
- 89
- References
- 30
- Citations by year
- 2026: 29 · 2025: 27 · 2024: 17 · 2023: 13 · 2022: 3
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Human Reproduction Update (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Division of Nutritional Sciences at Cornell University
- National Institutes of Health (R01-HD0937848)
- National Heart Foundation Future Leader Fellowship
- National Health and Medical Research Council Ideas (GNT 2000905)
- Canadian Institutes of Health Research Postdoctoral Fellowship (459075)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- polycystic ovary syndrome, dietary behavior, physical activity, diet quality, macronutrients, micronutrients, cholesterol, magnesium, zinc, sedentary behavior, weight gain, obesity, lifestyle modification, personalized nutrition, women's health, glycemic index, food groups, energy intake, lifestyle intervention, infertility, diabetes mellitus, cardiovascular disease, mental health
- MeSH terms
- Adolescent, Aged, Child, Cholesterol, Diet, Female, Humans, Magnesium, Obesity, Polycystic Ovary Syndrome, Zinc, Weight Gain, Exercise, Micronutrients
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