Metabolic health during a randomized controlled lifestyle intervention in women with PCOS
Open accessAbstract
Context: Women with polycystic ovary syndrome (PCOS) have an increased risk of metabolic syndrome (MetS). Both PCOS and MetS are associated with excess weight. Objective: To examine the effect of a three-component lifestyle intervention (LSI) with or without short message service (SMS+ or SMS−, respectively) on the prevalence and severity of MetS and metabolic parameters, compared to care as usual (CAU). Design: Randomized controlled trial. Methods: Women diagnosed with PCOS and a BMI >25 kg/m 2 ( n = 183) were either assigned to a 1-year three-component (cognitive behavioural therapy, diet, and exercise) LSI, with or without SMS support, or to CAU which provided weight-loss advice only. Main outcome measures included changes in the prevalence of MetS, the continuous MetS severity z-score (cMetS z-score), metabolic parameters, and the impact of weight loss. Results: After 1 year, the decrease in the cMetS z-score was greater in the SMS+ group than the CAU group (−0.39, P = 0.015). The prevalence of MetS changed with −21.6% ( P = 0.037), −16.5% ( P = 0.190), and +7.0% ( P = 0.509) in both LSI groups and CAU group, respectively. A post hoc analysis for both LSI groups combined vs CAU resulted in a MetS difference of −25.9% ( P = 0.046). Moreover, weight loss per se resulted in significantly favourable effects on all metabolic parameters. Conclusions: This three-component LSI was more successful in improving metabolic health compared to CAU. Therefore, we recommend this intervention to women with PCOS and excess weight, provided that a clinically relevant weight loss is being pursued.
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TL;DR
In women with PCOS and BMI >25 kg/m², a 1-year three-component lifestyle intervention improved metabolic health compared with care as usual, especially when SMS support was added. The benefit appeared largely mediated by weight loss, with greater improvements in MetS prevalence and severity among those who lost weight.
Key findings
- The continuous MetS severity z-score decreased more in SMS+ than CAU after 1 year (−0.39, P = 0.015); within-group decreases were significant in SMS+ (−0.42, P = 0.002) and SMS− (−0.21, P = 0.027), but not CAU (−0.03, P = 0.733).
- MetS prevalence changed by −21.6% in SMS− (P = 0.037), −16.5% in SMS+ (P = 0.190), and +7.0% in CAU (P = 0.509); post hoc pooling both LSI groups vs CAU showed a −25.9% difference (P = 0.046).
- Weight loss per se was associated with favourable metabolic changes: MetS prevalence decreased by −13.2% with 5% weight loss and −23.8% with 10% weight loss, while 5% weight gain increased MetS prevalence by +14.1% (estimate 0.114, s.e. 0.028, P < 0.001).
- Weight mediated the LSI–MetS relationship by 12.1% (mediation ratio 0.121, P = 0.037).
Methods
- Randomized controlled trial in 183 women with PCOS, BMI >25 kg/m², aged 18–38 years, actively trying to conceive; randomized 1:1:1 to SMS+ (n = 60), SMS− (n = 63), or CAU (n = 60).
- Intervention: 1-year three-component LSI (cognitive behavioural therapy, diet, exercise) with or without SMS support after 3 months; CAU received weight-loss advice only. Outcomes assessed every 3 months through 12 months.
- Main analyses used intention-to-treat multilevel logistic and linear regression models, with bootstrap procedures for non-normal distributions; post hoc analyses pooled LSI groups and examined weight change and mediation.
Limitations
- The paper states considerable dropout/discontinuation as a limitation; overall completion was 36.6% (27 SMS−, 16 SMS+, and 24 CAU completed), and study duration/intensity plus pregnancy-related discontinuation likely contributed.
- The paper notes that not many participants achieved 5–10% weight loss, which may explain small between-group effects on some metabolic parameters.
- Evident from the text: high missingness and low completion limit precision and generalizability, although multilevel modelling was chosen to handle missing data; several between-group comparisons were non-significant.
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Claims the paper makes
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- Findingown data
The proportion of women who achieved >10% weight reduction was 6.8% within the CAU group.
“The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively (32).”
Quote in the paperNot a substantial claim - Findingown data
Within the SMS− group, the prevalence of metabolic syndrome (MetS) decreased from 49.8% to 28.2% (−21.6%, P = 0.037) after 12 months.
“The prevalence of MetS decreased within SMS− from 49.8 to 28.2% (−21.6%, P = 0.037) after 12 months.”
Quote in the paperSubstantial claim - Findingown data
At 12 months, the difference in prevalence of blood pressure (BP) ≥ 129/84 mmHg between SMS− and CAU was 29.5% (P = 0.020).
“Subsequently, the prevalence of having a BP ≥ 129/84 mmHg as a diagnostic criterion for MetS decreased from 38.1% at baseline to 15.7% at 12 months in the SMS− group and increased from 29.0 to 36.2% in the CAU group, resulting in a significant difference of 29.5% (P = 0.020) between the groups at 12 months.”
Quote in the paperSubstantial claim - Findingown data
Weight loss per se resulted in significantly favourable effects on all metabolic parameters.
“Moreover, weight loss per se resulted in significantly favourable effects on all metabolic parameters.”
Quote in the paperSubstantial claim - Findingown data
At baseline, MetS was present in 41.4% of the SMS+ group.
“MetS was present in 41.4% in the SMS+ group, in 48.3% in the SMS− group, and in 38.5% in the CAU group.”
Quote in the paperNot a substantial claim
- Findingown data
At 12 months, the mean HDL serum level difference between SMS+ and CAU was 0.10 mmol/L in favour of CAU (P = 0.018).
“However, a difference in mean HDL serum levels of 0.10 mmol/L in favour of the CAU group (from 0.87 mmol/L at baseline to 0.93 mmol/L at 12 months) compared to the SMS+ group (from 0.94 mmol/L at baseline to 0.90 mmol/L at 12 months) was also observed (P = 0.018), see Table 2.”
Quote in the paperNot a substantial claim - Findingown data
The proportion of women who achieved >5% weight reduction was 85.7% within the SMS+ group.
“The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively (32).”
Quote in the paperSubstantial claim - Findingown data
The proportion of women who achieved >10% weight reduction was 12.2% within the SMS− group.
“The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively (32).”
Quote in the paperNot a substantial claim - Findingown data
Within the CAU group, the cMetS z-score change from baseline to 12 months was not significant (−0.03, P = 0.733).
“The cMetS severity z-score decreased within the SMS+ (−0.42, P = 0.002) and SMS− group (−0.21, P = 0.027) but not significant within CAU (−0.03, P = 0.733).”
Quote in the paperSubstantial claim - Findingown data
Mean weight loss after 1 year was 2.32 kg in the CAU group.
“Mean weight loss after 1 year was 7.87 kg in SMS+, 4.65 kg in SMS−, and 2.32 kg in CAU (within all groups, P < 0.001).”
Quote in the paperNot a substantial claim - Findingown data
At baseline, MetS was present in 38.5% of the CAU group.
“MetS was present in 41.4% in the SMS+ group, in 48.3% in the SMS− group, and in 38.5% in the CAU group.”
Quote in the paperNot a substantial claim - Findingown data
At 12 months, the SBP difference between SMS− and CAU was −6 mmHg (P = 0.013), favouring SMS−.
“The difference at 12 months was significant in favour of both the SMS+ (−7 mmHg, P = 0.039) and SMS− (−6 mmHg, P = 0.013) group when compared to CAU.”
Quote in the paperSubstantial claim - Findingown data
In the CAU group, the prevalence of BP ≥ 129/84 mmHg increased from 29.0% to 36.2% at 12 months.
“and increased from 29.0 to 36.2% in the CAU group”
Quote in the paperSubstantial claim - Findingown data
Within the SMS+ group, the prevalence of MetS decreased from 41.9% to 25.3% (−16.5%, P = 0.190) after 12 months.
“Within the SMS+ group, the prevalence of MetS decreased from 41.9 to 25.3% (−16.5%, P = 0.190) and increased in CAU from 37.9 to 44.8% (+7.0%, P = 0.509).”
Quote in the paperNot a substantial claim - Findingown data
The proportion of women who achieved >5% weight reduction was 21.8% within the CAU group.
“The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively (32).”
Quote in the paperNot a substantial claim - Findingown data
After 1 year, the decrease in the continuous metabolic syndrome severity z-score (cMetS z-score) was greater in the SMS+ group than in the care as usual (CAU) group, with a difference of −0.39 (P = 0.015).
“After 1 year, the decrease in the cMetS z-score was greater in the SMS+ group than the CAU group (−0.39, P = 0.015).”
- Also stated in: § Between-group estimates after 12 months (SMS+ vs CAU, SMS− vs CAU, and SMS+ vs SMS−) · plain
“The difference between SMS+ and CAU after 12 months was significant (−0.39, P = 0.015).”
Quote in the paperSubstantial claim - Also stated in: § Between-group estimates after 12 months (SMS+ vs CAU, SMS− vs CAU, and SMS+ vs SMS−) · plain
- Findingown data
At 12 months, the between-group difference in MetS prevalence for SMS+ versus CAU was −23.7% (P = 0.146).
“| Metabolic syndrome (%) | −23.7 | 0.146 | −28.6 | 0.052 | 5.1 | 0.808 |”
Quote in the paperNot a substantial claim - Findingown data
In the SMS− group, the prevalence of BP ≥ 129/84 mmHg decreased from 38.1% at baseline to 15.7% at 12 months.
“the prevalence of having a BP ≥ 129/84 mmHg as a diagnostic criterion for MetS decreased from 38.1% at baseline to 15.7% at 12 months in the SMS− group”
Quote in the paperSubstantial claim - Findingown data
The proportion of women who achieved >10% weight reduction was 45.9% within the SMS+ group.
“The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively (32).”
Quote in the paperSubstantial claim - Findingown data
Within the CAU group, the prevalence of MetS increased from 37.9% to 44.8% (+7.0%, P = 0.509) after 12 months.
“Within the SMS+ group, the prevalence of MetS decreased from 41.9 to 25.3% (−16.5%, P = 0.190) and increased in CAU from 37.9 to 44.8% (+7.0%, P = 0.509).”
Quote in the paperNot a substantial claim - Findingown data
In a post hoc analysis combining both lifestyle intervention (LSI) groups versus CAU, the MetS difference was −25.9% (P = 0.046).
“A post hoc analysis for both LSI groups combined vs CAU resulted in a MetS difference of −25.9% (P = 0.046).”
Quote in the paperSubstantial claim - Findingown data
At 12 months, the systolic blood pressure (SBP) difference between SMS+ and CAU was −7 mmHg (P = 0.039), favouring SMS+.
“The difference at 12 months was significant in favour of both the SMS+ (−7 mmHg, P = 0.039) and SMS− (−6 mmHg, P = 0.013) group when compared to CAU.”
Quote in the paperSubstantial claim - Findingown data
Within the SMS+ group, the cMetS z-score decreased from baseline to 12 months (−0.42, P = 0.002).
“The cMetS severity z-score decreased within the SMS+ (−0.42, P = 0.002) and SMS− group (−0.21, P = 0.027) but not significant within CAU (−0.03, P = 0.733).”
Quote in the paperSubstantial claim - Findingown data
At baseline, MetS was present in 48.3% of the SMS− group.
“MetS was present in 41.4% in the SMS+ group, in 48.3% in the SMS− group, and in 38.5% in the CAU group.”
Quote in the paperNot a substantial claim - Findingown data
At 12 months, the between-group difference in MetS prevalence for SMS+ versus SMS− was 5.1% (P = 0.808).
“| Metabolic syndrome (%) | −23.7 | 0.146 | −28.6 | 0.052 | 5.1 | 0.808 |”
Quote in the paperNot a substantial claim - Findingown data
Mean weight loss after 1 year was 4.65 kg in the SMS− group.
“Mean weight loss after 1 year was 7.87 kg in SMS+, 4.65 kg in SMS−, and 2.32 kg in CAU (within all groups, P < 0.001).”
Quote in the paperNot a substantial claim - Findingown data
Within the SMS− group, the cMetS z-score decreased from baseline to 12 months (−0.21, P = 0.027).
“The cMetS severity z-score decreased within the SMS+ (−0.42, P = 0.002) and SMS− group (−0.21, P = 0.027) but not significant within CAU (−0.03, P = 0.733).”
Quote in the paperSubstantial claim - Findingown data
At 12 months, the between-group difference in MetS prevalence for SMS− versus CAU was −28.6% (P = 0.052).
“| Metabolic syndrome (%) | −23.7 | 0.146 | −28.6 | 0.052 | 5.1 | 0.808 |”
Quote in the paperNot a substantial claim - Findingown data
The proportion of women who achieved >5% weight reduction was 52.8% within the SMS− group.
“The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively (32).”
Quote in the paperNot a substantial claim - Findingown data
Mean weight loss after 1 year was 7.87 kg in the SMS+ group.
“Mean weight loss after 1 year was 7.87 kg in SMS+, 4.65 kg in SMS−, and 2.32 kg in CAU (within all groups, P < 0.001).”
Quote in the paperSubstantial claim - Findingown data
In the SMS+ group, waist circumference decreased by 8.4 cm after 12 months (P = 0.013).
“a decrease in WC within the SMS+ group (−8.4 cm, P = 0.013)”
Quote in the paperNot a substantial claim - Findingown data
In the SMS+ group, diastolic blood pressure decreased by 4 mmHg after 12 months (P = 0.034).
“a decrease in DBP within the SMS+ (−4 mmHg, P = 0.034)”
Quote in the paperNot a substantial claim - Findingown data
In the SMS− group, systolic blood pressure decreased by 5 mmHg after 12 months (P = 0.010).
“a decrease in SBP in the SMS− group (−5 mmHg, P = 0.010)”
Quote in the paperNot a substantial claim - Findingown data
In the SMS+ group, cholesterol decreased by 0.4 mmol/L after 12 months (P = 0.009).
“a decrease in cholesterol (−0.4 mmol/L, P = 0.009)”
Quote in the paperNot a substantial claim - Findingown data
In the SMS− group, diastolic blood pressure decreased by 3 mmHg after 12 months (P = 0.040).
“SMS− (−3 mmHg, P = 0.040) groups”
Quote in the paperNot a substantial claim - Findingown data
The prevalence of MetS increased by 14.1% when participants gained 5% in weight.
“The prevalence of MetS increased by +14.1% when participants gained 5% in weight.”
Quote in the paperSubstantial claim - Findingown data
Changes in the percentage of body weight had a statistically significant effect on the cMetS risk z-score (estimate 0.043, s.e. 0.005, P < 0.001).
“changes in the percentage of body weight also had a statistically significant effect on the cMetS risk z-score (estimate 0.043 s.e. 0.005, P < 0.001)”
Quote in the paperSubstantial claim - Findingown data
In the CAU group, HDL significantly improved by +0.06 mmol/L after 12 months (P = 0.022).
“and HDL (+0.06 mmol/L, P = 0.022) after 12 months.”
Quote in the paperNot a substantial claim - Findingown data
Improvement in metabolic status over time had a statistically significant positive effect on hyperandrogenism (estimate −0.812, s.e. 0.305, P = 0.008).
“the improvement in metabolic status over time resulted in a statistically significant positive effect on hyperandrogenism (estimate −0.812 s.e. 0.305, P = 0.008)”
Quote in the paperSubstantial claim - Findingown data
There was no significant effect on PCOM (estimate 0.395, s.e. 0.540, P = 0.466).
“there was no significant effect on PCOM (estimate 0.395 s.e. 0.540, P = 0.466)”
Quote in the paperNot a substantial claim - Findingown data
In the combined LSI groups, the prevalence of MetS decreased from 46.0% at baseline to 27.1% at 12 months (−18.9%).
“within the LSI (from 46.0% at baseline to 27.1% at 12 months, −18.9%)”
Quote in the paperSubstantial claim - Findingown data
In the CAU group, the cMetS risk z-score decreased from 0.39 at baseline to 0.36 at 12 months (−0.03).
“vs the CAU group (from 0.39 at baseline to 0.36 at 12 months, −0.03)”
Quote in the paperNot a substantial claim - Findingown data
The effect on hyperandrogenism could mainly be attributed to changes in biochemical hyperandrogenism (estimate −0.821, s.e. 0.259, P = 0.002).
“This effect could mainly be attributed to changes in biochemical hyperandrogenism (estimate −0.821 s.e. 0.259, P = 0.002)”
Quote in the paperSubstantial claim - Findingown data
Improvement of metabolic status had a non-significant decreasing effect on ovulatory dysfunction (estimate −0.442, s.e. 0.372, P = 0.237).
“although improvement of metabolic status showed a positively decreasing effect on ovulatory dysfunction, this was non-significant (estimate −0.442 s.e. 0.372, P = 0.237)”
Quote in the paperNot a substantial claim - Findingown data
In the CAU group, waist circumference significantly improved by −5.1 cm after 12 months (P = 0.016).
“The CAU group only significantly improved in WC (−5.1 cm, P = 0.016)”
Quote in the paperNot a substantial claim - Findingown data
Weight gain worsened metabolic parameters.
“Weight gain worsened these metabolic parameters, see Table 4.”
Quote in the paperSubstantial claim - Findingown data
In the combined LSI groups, the cMetS risk z-score decreased from 0.42 at baseline to 0.15 at 12 months (−0.28).
“within the LSI groups combined (from 0.42 at baseline to 0.15 at 12 months, −0.28)”
Quote in the paperSubstantial claim - Findingown data
In the SMS+ group, LDL decreased by 0.29 mmol/L after 12 months (P = 0.027).
“but also in LDL (−0.29 mmol/L, P = 0.027) within the SMS+ group”
Quote in the paperNot a substantial claim - Findingown data
The prevalence of MetS decreased by 13.2% when 5% weight loss was achieved.
“The prevalence of MetS decreased by −13.2% when 5% weight loss was achieved”
Quote in the paperSubstantial claim - Findingown data
The between-group difference in change in cMetS risk z-score after 12 months was −0.25 (P = 0.030), favoring the combined LSI groups over CAU.
“the cMetS risk z-score reduced −0.25 more (P = 0.030) within the LSI groups combined (from 0.42 at baseline to 0.15 at 12 months, −0.28) vs the CAU group (from 0.39 at baseline to 0.36 at 12 months, −0.03)”
Quote in the paperSubstantial claim - Findingown data
The between-group difference in change in MetS prevalence after 12 months was −25.9% (P = 0.046), favoring the combined LSI groups over CAU.
“the prevalence of MetS was statistically significant and more reduced with −25.9% (P = 0.046) within the LSI (from 46.0% at baseline to 27.1% at 12 months, −18.9%) compared to an increase in the CAU group (from 37.9% at baseline to 44.8% at 12 months, +7.0%)”
Quote in the paperSubstantial claim - Findingown data
Changes in clinical hyperandrogenism were non-significant (estimate −0.021, s.e. 0.262, P = 0.936).
“whereas changes in clinical hyperandrogenism were non-significant (estimate −0.021 s.e. 0.262, P = 0.936)”
Quote in the paperNot a substantial claim - Findingown data
The prevalence of MetS decreased by 23.8% when 10% weight loss was achieved.
“and by −23.8% when participants achieved a 10% weight loss (estimate 0.114 s.e. 0.028, P < 0.001)”
Quote in the paperSubstantial claim - Findingown data
In the CAU group, the prevalence of MetS increased from 37.9% at baseline to 44.8% at 12 months (+7.0%).
“compared to an increase in the CAU group (from 37.9% at baseline to 44.8% at 12 months, +7.0%)”
Quote in the paperSubstantial claim - Findingcitation
Few participants in the RCT achieved a 5-10% weight loss.
“Not many participants in our RTC achieved a 5–10% weight loss (32)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32] Jiskoot G Timman R Beerthuizen A Dietz de Loos A Busschbach J Laven J. Weight reduction Through a cognitive behavioral therapy lifestyle intervention in PCOS: the primary outcome of a randomized controlled trial. Obesity 2020 28 2134– 2141. (10.1002/oby.22980) 32969197 PMC7702123
Not checked in the free run.
- Study design and conductcitation
PCOS was diagnosed according to the Rotterdam 2003 consensus criteria.
“a diagnosis of PCOS according to the Rotterdam 2003 consensus criteria (23).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility 2004 81 19– 25. (10.1016/j.fertnstert.2003.10.004) 14711538
Not checked in the free run.
- Study design and conductown data
In the SMS−, SMS+, and CAU groups, 27, 16, and 24 women completed the study, respectively.
“Eventually, 27, 16, and 24 women completed the study for the SMS−, SMS+, and CAU groups respectively, overall resulting in a 36.6% completion rate.”
Quote in the paperNot a substantial claim - Premisecitation
Obesity exacerbates many of the metabolic abnormalities already associated with PCOS, such as insulin resistance and lipid abnormalities.
“Moreover, obesity exacerbates many of the metabolic abnormalities that are already associated with PCOS, such as insulin resistance and lipid abnormalities (1, 8, 9).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [1] Teede HJ Misso ML Costello MF Dokras A Laven J Moran L Piltonen T Norman RJ & International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility 2018 110 364– 379. (10.1016/j.fertnstert.2018.05.004) 30033227 PMC6939856
Not checked in the free run.
- cites [8] Sam S Obesity and polycystic ovary syndrome. Obesity Management 2007 3 69– 73. (10.1089/obe.2007.0019) 20436797 PMC2861983
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- cites [9] Lim SS Kakoly NS Tan JWJ Fitzgerald G Bahri Khomami M Joham AE Cooray SD Misso ML Norman RJ Harrison CL Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obesity Reviews 2019 20 339– 352. (10.1111/obr.12762) 30339316
Not checked in the free run.
- Premisecitation
Weight management by a three-component (diet, exercise, and behavioural therapy) lifestyle intervention is currently the first-line treatment for women with PCOS.
“Weight management by a three-component (diet, exercise, and behavioural therapy) lifestyle intervention (LSI) is currently the first-line treatment for women with PCOS (1), despite the well-known difficulties with adherence in LSI.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Teede HJ Misso ML Costello MF Dokras A Laven J Moran L Piltonen T Norman RJ & International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility 2018 110 364– 379. (10.1016/j.fertnstert.2018.05.004) 30033227 PMC6939856
Not checked in the free run.
- Premisecitation
Dropout is common, with discontinuation rates varying between 12 and 47% in LSI studies in overweight and obese women with PCOS.
“Dropout is a common phenomenon, and discontinuation rates varying between 12 and 47% in LSI studies in overweight and obese women with PCOS have been reported (20).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Lie Fong S Douma A Verhaeghe J. Implementing the international evidence-based guideline of assessment and management of polycystic ovary syndrome (PCOS): how to achieve weight loss in overweight and obese women with PCOS? Journal of Gynecology Obstetrics and Human Reproduction 2021 50 101894. (10.1016/j.jogoh.2020.101894) 32814159
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- Interpretationown data
The three-component LSI was more successful in improving metabolic health compared to CAU.
“This three-component LSI was more successful in improving metabolic health compared to CAU.”
Quote in the paperSubstantial claim- Rests on an assumption: Evidence is lacking on changes in the prevalence and severity of MetS in overweight and obese women with PCOS as a result of long-term three-component LSIs.
- Premisecitation
Previous short-term one or two-component LSIs in women with PCOS have described improvements in metabolic features such as WC, total cholesterol, LDL cholesterol, and fasting insulin.
“Nevertheless, previous short-term one or two-component LSIs in women with PCOS have described improvements in metabolic features such as WC, total cholesterol, LDL cholesterol, and fasting insulin (21).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Lim SS Hutchison SK Van Ryswyk E Norman RJ Teede HJ Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2019 3 CD007506. (10.1002/14651858.CD007506.pub4) PMC6438659 30921477
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- Premisecitation
Scores above 0 on the cMetS z-score are associated with an increased risk for future cardiometabolic disease.
“Scores above 0 are associated with an increased risk for future cardiometabolic disease (25, 26, 27, 28).”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [25] Gurka MJ Lilly CL Oliver MN DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. Metabolism: Clinical and Experimental 2014 63 218– 225. (10.1016/j.metabol.2013.10.006) 24290837 PMC4071942
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- cites [26] DeBoer MD Gurka MJ. Clinical utility of metabolic syndrome severity scores: considerations for practitioners. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2017 10 65– 72. (10.2147/DMSO.S101624) PMC5325095 28255250
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- cites [27] Gurka MJ Golden SH Musani SK Sims M Vishnu A Guo Y Cardel M Pearson TA DeBoer MD. Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk in Communities Study and Jackson Heart Study. Diabetologia 2017 60 1261– 1270. (10.1007/s00125-017-4267-6) 28378033 PMC5481783
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- cites [28] DeBoer MD Gurka MJ Golden SH Musani SK Sims M Vishnu A Guo Y Pearson TA. Independent associations Between metabolic syndrome severity and future coronary heart disease by sex and race. Journal of the American College of Cardiology 2017 69 1204– 1205. (10.1016/j.jacc.2016.10.088) 28254184 PMC5481721
Not checked in the free run.
- Premisecitation
Mixed modelling can efficiently deal with missing data and unbalanced time points.
“Mixed modelling can efficiently deal with missing data and unbalanced time points (31).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Little R Rubin D. Statistical Analysis with Missing Data. New York: John Wiley and Sons, 1987. (10.1002/9781119013563)
Not checked in the free run.
- Interpretationnone given
The cMetS z-score was used for the first time in a cohort of reproductive-aged women with PCOS.
“Another strength of this study is that we used the cMetS z-score for the first time in a cohort of reproductive-aged women with PCOS.”
Quote in the paperSubstantial claim - Study design and conductown data
The RCT suffered from considerable discontinuation rates.
“our RCT also suffered from considerable discontinuation rates, which is a limitation.”
Quote in the paperNot a substantial claim - Interpretationnone given
This is the largest three-component lifestyle intervention study cohort of women with PCOS to date.
“A major strength of our study is that this is the largest three-component LSI study cohort of women with PCOS to date.”
Quote in the paperNot a substantial claim - Premisecitation
The traditional MetS criteria would have labelled individuals with elevations just below cut-off values as low-risk.
“The traditional MetS criteria would have labelled these individuals as low-risk (25).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] Gurka MJ Lilly CL Oliver MN DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. Metabolism: Clinical and Experimental 2014 63 218– 225. (10.1016/j.metabol.2013.10.006) 24290837 PMC4071942
Not checked in the free run.
- Premisereasoning
An advantage of the cMetS z-score is the identification of individuals who are at high risk for developing MetS.
“An advantage of the cMetS z-score is the identification of individuals who are at high risk for developing MetS.”
Quote in the paperSubstantial claim - Premisecitation
Women with PCOS present more often with pregnancy-related complications such as gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, and preterm birth.
“women with PCOS present more often with pregnancy-related complications such as gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, and preterm birth (36).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] Boomsma CM Eijkemans MJ Hughes EG Visser GH Fauser BC Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Human Reproduction Update 2006 12 673– 683. (10.1093/humupd/dml036) 16891296
Not checked in the free run.
- Premisecitation
Guize and colleagues observed a statistically significant high risk of all-cause mortality for MetS diagnoses in which elevated WC and elevated BP play key roles.
“Guize and colleagues investigated combinations of the different metabolic components and observed a statistically significant high risk of all-cause mortality for MetS diagnoses in which elevated WC and elevated BP play key roles (34).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Guize L Thomas F Pannier B Bean K Jego B Benetos A. All-cause mortality associated with specific combinations of the metabolic syndrome according to recent definitions. Diabetes Care 2007 30 2381– 2387. (10.2337/dc07-0186) 17563336
Not checked in the free run.
- Interpretationown data
The small between-group effects with regard to changes in metabolic parameters may possibly be explained by the small number of participants achieving 5-10% weight loss.
“which may possibly explain the small between-group effects with regard to changes in metabolic parameters.”
Quote in the paperSubstantial claim - Premisecitation
Study duration seems to be a factor with a particularly negative effect on adherence.
“Especially, study duration seems to be a factor with a particularly negative effect on adherence (37).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Mutsaerts MA Kuchenbecker WK Mol BW Land JA Hoek A. Dropout is a problem in lifestyle intervention programs for overweight and obese infertile women: a systematic review. Human Reproduction 2013 28 979– 986. (10.1093/humrep/det026) 23427235
Not checked in the free run.
- Interpretationown data
Positive changes were more evident within the LSI groups.
“However, positive changes were more evident within the LSI groups.”
Quote in the paperSubstantial claim - Study design and conductcitation
The authors selected multilevel regression modelling specifically designed to deal with missing values.
“we selected a statistical method, for example multilevel regression modelling, specifically designed to deal with such missing values (31).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Little R Rubin D. Statistical Analysis with Missing Data. New York: John Wiley and Sons, 1987. (10.1002/9781119013563)
Not checked in the free run.
- Interpretationown data
This three-component lifestyle RCT demonstrated statistically significant and clinically relevant improvements in metabolic health.
“This three-component lifestyle RCT demonstrated statistically significant and clinically relevant improvements in metabolic health.”
Quote in the paperSubstantial claim - Interpretationcitation
Within-group decreases in BP and WC may prevent severe future metabolic complications such as cardiovascular disease and/or events.
“the within-group decreases in our study, especially those in BP and WC, may prevent severe future metabolic complications such as cardiovascular disease and/or events.”
Quote in the paperSubstantial claim
- May combine two claims. 11
- Classified as probably not a substantial claim. 18
May combine two claims.
Findingown dataWeight change had a statistically significant interaction with the NCEP diagnostic criteria for elevated WC, BP, and TGs, and with the prevalence of insulin resistance.
“The separate NCEP diagnostic criteria for elevated WC, BP, and TGs also demonstrated a statistically significant interaction, as well as the prevalence of insulin resistance with results further specified in Table 4.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWeight mediated the effect of the LSI on the prevalence of MetS, with a mediation ratio of 0.121 (P = 0.037), accounting for 12.1% of the effect.
“Weight resulted in mediation (mediation ratio 0.121, P = 0.037) with pathways further specified in Fig. 4. This indicates that weight mediated the pathway between the LSI and MetS by 12.1%.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataBP, WC, cholesterol, and LDL decreased, and HDL increased within all groups.
“BP, WC, cholesterol, and LDL decreased, and HDL increased within all groups.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe trial was approved by the Medical Research Ethics Committee of the Erasmus MC in Rotterdam (MEC2008-337) and registered by clinical trial number NTR2450.
“which was approved by the Medical Research Ethics Committee of the Erasmus MC in Rotterdam (MEC2008-337) and registered by clinical trial number: NTR2450 (www.trialregister.nl).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe overall completion rate of the study was 36.6%.
“Eventually, 27, 16, and 24 women completed the study for the SMS−, SMS+, and CAU groups respectively, overall resulting in a 36.6% completion rate.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe cMetS z-score was derived from a confirmatory factor analysis that examined the weighted contribution of each of the five MetS components and allowed correlations between MetS components to differ by sex and ethnicity.
“The MetS z-score was derived from a confirmatory factor analysis which examined the weighted contribution of each of the five components of the MetS. This analysis also allowed for the correlations between MetS components to be different by sex and ethnicity.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [25] Gurka MJ Lilly CL Oliver MN DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. Metabolism: Clinical and Experimental 2014 63 218– 225. (10.1016/j.metabol.2013.10.006) 24290837 PMC4071942
Not checked in the free run.
- cites [26] DeBoer MD Gurka MJ. Clinical utility of metabolic syndrome severity scores: considerations for practitioners. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2017 10 65– 72. (10.2147/DMSO.S101624) PMC5325095 28255250
Not checked in the free run.
- cites [27] Gurka MJ Golden SH Musani SK Sims M Vishnu A Guo Y Cardel M Pearson TA DeBoer MD. Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk in Communities Study and Jackson Heart Study. Diabetologia 2017 60 1261– 1270. (10.1007/s00125-017-4267-6) 28378033 PMC5481783
Not checked in the free run.
- cites [28] DeBoer MD Gurka MJ Golden SH Musani SK Sims M Vishnu A Guo Y Pearson TA. Independent associations Between metabolic syndrome severity and future coronary heart disease by sex and race. Journal of the American College of Cardiology 2017 69 1204– 1205. (10.1016/j.jacc.2016.10.088) 28254184 PMC5481721
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe sample size was calculated based on an expected dropout proportion of 40%, resulting in a minimum of 60 participants in each group.
“The sample size was calculated based on an expected dropout proportion of 40%, resulting in a minimum of 60 participants in each group.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductcitationMetS was defined according to the National Cholesterol Education Programme (NCEP) definition when at least three of the following features were present: WC ≥ 88 cm, fasting glucose ≥ 6.1 mmol/L, BP > 129/84 mmHg, HDL < 1.3 mmol/L, and TG ≥ 1.7 mmol/L.
“MetS was defined according to the National Cholesterol Education Programme (NCEP) definition when at least three of the following features were present: WC ≥ 88 cm, fasting glucose ≥ 6.1 mmol/L, BP > 129/84 mmHg, HDL < 1.3 mmol/L, and TG ≥ 1.7 mmol/L (11).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment Panel III). JAMA 2001 285 2486– 2497. (10.1001/jama.285.19.2486) 11368702
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductown dataThe study was a randomized controlled trial.
“Randomized controlled trial.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductown dataBetween-group and within-group analyses on MetS prevalence, metabolic parameters, and cMetS z-score were performed with multilevel logistic and linear regression models based on the intention-to-treat principle.
“Between-group (SMS+ vs CAU, SMS− vs CAU, and SMS+ vs SMS−) and within-group analyses on the prevalence of MetS, metabolic parameters, and cMetS z-score were performed with multilevel logistic and linear regression models based on the intention-to-treat principle.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenRandomization was performed using a computer-generated random numbers table.
“Randomization was performed using a computer-generated random numbers table.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningLifestyle adjustments are necessary to improve the metabolic status of women with PCOS.
“In general, we can conclude that lifestyle adjustments are necessary to improve the metabolic status of women with PCOS.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAll five components of MetS are alleviated in the general population by even modest amounts of weight loss achieved with diet and exercise.
“All five components of MetS are alleviated in the general population by even modest amounts of weight loss achieved with diet and exercise (19).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Wagh A Stone NJ. Treatment of metabolic syndrome. Expert Review of Cardiovascular Therapy 2004 2 213– 228. (10.1586/14779072.2.2.213) 15151470
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationWomen with PCOS have more than a three-fold increase in MetS prevalence compared to women without PCOS.
“Overall, women with PCOS have more than a three-fold increase in MetS prevalence compared to women without PCOS (9, 11).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [9] Lim SS Kakoly NS Tan JWJ Fitzgerald G Bahri Khomami M Joham AE Cooray SD Misso ML Norman RJ Harrison CL Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obesity Reviews 2019 20 339– 352. (10.1111/obr.12762) 30339316
Not checked in the free run.
- cites [11] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment Panel III). JAMA 2001 285 2486– 2497. (10.1001/jama.285.19.2486) 11368702
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationInsulin resistance and hyperandrogenism are believed to affect the lipid profile among women with PCOS, causing dyslipidemia even in non-obese women with PCOS.
“Insulin resistance and hyperandrogenism are believed to affect the lipid profile among women with PCOS, causing dyslipidemia even in non-obese women with PCOS (14).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] Palomba S Falbo A Chiossi G Muscogiuri G Fornaciari E Orio F Tolino A Colao A La Sala GB Zullo F. Lipid profile in nonobese pregnant women with polycystic ovary syndrome: a prospective controlled clinical study. Steroids 2014 88 36– 43. (10.1016/j.steroids.2014.06.005) 24945113
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationPhysical activity is believed to improve insulin resistance, cardiovascular, and metabolic diseases.
“Physical activity is also believed to improve insulin resistance, cardiovascular, and metabolic diseases (17, 18).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [17] Greenwood EA Noel MW Kao CN Shinkai K Pasch LA Cedars MI Huddleston HG. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure. Fertility and Sterility 2016 105 486– 493. (10.1016/j.fertnstert.2015.10.020) 26551442
Not checked in the free run.
- cites [18] Orio F Muscogiuri G Ascione A Marciano F Volpe A La Sala G Savastano S Colao A Palomba S. Effects of physical exercise on the female reproductive system. Minerva Endocrinologica 2013 38 305– 319. 24126551
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDropout during lifestyle interventions is a common phenomenon.
“Dropout during LSIs is unfortunately a common phenomenon”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Mutsaerts MA Kuchenbecker WK Mol BW Land JA Hoek A. Dropout is a problem in lifestyle intervention programs for overweight and obese infertile women: a systematic review. Human Reproduction 2013 28 979– 986. (10.1093/humrep/det026) 23427235
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPositive effects of lifestyle interventions on total cholesterol, LDL, and fasting insulin levels have been demonstrated before.
“Similarly, positive effects of LSIs on total cholesterol, LDL, and fasting insulin levels have been demonstrated before (21).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] Lim SS Hutchison SK Van Ryswyk E Norman RJ Teede HJ Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2019 3 CD007506. (10.1002/14651858.CD007506.pub4) PMC6438659 30921477
Not checked in the free run.
May combine two claims.
PremisecitationThe cMetS severity score has proven predictive ability for future coronary heart disease and type 2 diabetes mellitus in the general population.
“The cMetS severity score has also proven to possess predictive ability for future coronary heart disease (28) and type 2 diabetes mellitus (27) in the general population.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [28] DeBoer MD Gurka MJ Golden SH Musani SK Sims M Vishnu A Guo Y Pearson TA. Independent associations Between metabolic syndrome severity and future coronary heart disease by sex and race. Journal of the American College of Cardiology 2017 69 1204– 1205. (10.1016/j.jacc.2016.10.088) 28254184 PMC5481721
Not checked in the free run.
- cites [27] Gurka MJ Golden SH Musani SK Sims M Vishnu A Guo Y Cardel M Pearson TA DeBoer MD. Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk in Communities Study and Jackson Heart Study. Diabetologia 2017 60 1261– 1270. (10.1007/s00125-017-4267-6) 28378033 PMC5481783
Not checked in the free run.
Classified as probably not a substantial claim.
Interpretationown dataThe study provides robust evidence supporting the recommendation for achieving a minimum of 5-10% sustainable weight loss in future lifestyle interventions.
“we do provide robust evidence that supports the recommendation for achieving a minimum of 5–10% sustainable weight loss in future LSIs, as described in the current PCOS guideline (1).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Teede HJ Misso ML Costello MF Dokras A Laven J Moran L Piltonen T Norman RJ & International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility 2018 110 364– 379. (10.1016/j.fertnstert.2018.05.004) 30033227 PMC6939856
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationExercise has an important positive effect on insulin resistance.
“These studies also demonstrated the important positive effect of exercise on insulin resistance (33).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Palomba S Giallauria F Falbo A Russo T Oppedisano R Tolino A Colao A Vigorito C Zullo F Orio F. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Human Reproduction 2008 23 642– 650. (10.1093/humrep/dem391) 18158291
Not checked in the free run.
May combine two claims.
PremisecitationWomen with PCOS exhibit metabolic derangements at a young age, which is believed to worsen with ageing and excess weight.
“women with PCOS exhibit metabolic derangements at a young age, which is believed to worsen with ageing (35) and excess weight (9)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [35] Pinola P Puukka K Piltonen TT Puurunen J Vanky E Sundstrom-Poromaa I Stener-Victorin E Linden Hirschberg A Ravn P Skovsager Andersen M Normo- and hyperandrogenic women with polycystic ovary syndrome exhibit an adverse metabolic profile through life. Fertility and Sterility 2017 107 788.e2– 795.e2. (10.1016/j.fertnstert.2016.12.017) 28089571
Not checked in the free run.
- cites [9] Lim SS Kakoly NS Tan JWJ Fitzgerald G Bahri Khomami M Joham AE Cooray SD Misso ML Norman RJ Harrison CL Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obesity Reviews 2019 20 339– 352. (10.1111/obr.12762) 30339316
Not checked in the free run.
May combine two claims.
Interpretationown dataThe cMetS z-score makes it possible to follow changes over time and to assess the effects of certain lifestyle interventions, as demonstrated by the current RCT.
“Moreover, this individual severity score makes it possible to follow changes over time and to assess the effects of certain LSIs, as demonstrated by the current RCT.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningThe authors expected high discontinuation rates and anticipated this with the sample size calculation.
“we expected to have high discontinuation rates and anticipated this with the sample size calculation (22).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] Jiskoot G Benneheij SH Beerthuizen A de Niet JE de Klerk C Timman R Busschbach JJ Laven JS. A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial. Reproductive Health 2017 14 34. (10.1186/s12978-017-0295-4) PMC5339998 28264692
Not checked in the free run.
May combine two claims.
Interpretationown dataThe changes in metabolic health were very much determined by the extent of advice and guidance provided in the lifestyle programme as well as by the amount of weight loss achieved in that programme.
“These changes were very much determined by the extent of advice and guidance provided in the lifestyle programme as well as by the amount of weight loss achieved in that programme.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenThe impact of metabolic derangement on cardiovascular health in reproductive-aged women with PCOS is likely similar to its impact on women without PCOS.
“its impact on their cardiovascular health is likely similar to its impact on women without PCOS.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Evidence is lacking on changes in the prevalence and severity of MetS in overweight and obese women with PCOS as a result of long-term three-component LSIs.
“However, evidence is still lacking on changes in the prevalence and severity of MetS in overweight and obese women with PCOS as a result of long-term three-component LSIs.”
The paper relies on this without support.
The cMetS z-score is a valid measure of metabolic syndrome severity in reproductive-aged women with PCOS.
“we used the cMetS z-score for the first time in a cohort of reproductive-aged women with PCOS.”
The paper relies on this without support.
The predictive ability of the cMetS severity score for future coronary heart disease and type 2 diabetes in the general population extends to women with PCOS.
“We believe that it could be very helpful in predicting similar risks in women with PCOS as well.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In five of the phone-based publications, either text messages providing feedback to patients or both text messages and phone calls with patients are mentioned.
“In five of them, either text messages providing feedback to the patients [48,49,50,51], or both text messages and phone calls with the patients are mentioned [96].”
From Polycystic Ovary Syndrome and the Internet of Things: A Scoping Review (2024) · cites this paper as [48]
The Subjects and methods section describes patient-tailored SMS feedback, supporting the text-message part of the description. It describes group meetings but does not mention phone calls with patients, which is the part specifically attached to this citation. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe other four phone-based publications refer to a study conducted in the Netherlands, including a 2022 report, two 2020 papers, and a 2017 protocol.
“The other four publications refer to a study conducted in the Netherlands, including the 2022 report on the trial [48], two 2020 papers focusing on the primary outcome [50], and secondary analysis [49], as well as the protocol published in 2017 [51].”
From Polycystic Ovary Syndrome and the Internet of Things: A Scoping Review (2024) · cites this paper as [48]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
HDL did not increase in every group
MinorThe discussion says HDL increased within all groups, but Table 3 shows it fell from 0.94 to 0.90 mmol/L in SMS+.
“BP, WC, cholesterol, and LDL decreased, and HDL increased within all groups.”
“| SMS+ | 0.94 | 0.92 | 0.91 | 0.90 | 0.90 | −0.04 | 0.200 |”
Blood pressure did not decrease in every group
MinorThe discussion says BP decreased within all groups, whereas the results explicitly say systolic BP increased in CAU.
“BP, WC, cholesterol, and LDL decreased, and HDL increased within all groups.”
“and increased from 119 to 121 mmHg in the CAU group.”
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Clinical utility of metabolic syndrome severity scores: considerations for practitioners
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Flagged first, then by citations
Research works printed but not linked: 1
- [30]Global Recommendations on Physical Activity for Health. Geneva: World Health Organization, 2010. 26180873
Cited by
Sorted by citations
Armanini, D., Boscaro, M., Bordin, L., & Sabbadin, C. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23084110 · Cited by 324 · see citing works
The Role of Lifestyle Interventions in PCOS Management: A Systematic Review
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Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies
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Polycystic Ovary Syndrome and the Internet of Things: A Scoping Review
Graca, S., Alloh, F., Lagojda, L., Dallaway, A., Kyrou, I., Randeva, H. S., & Kite, C. (2024) · Healthcare · doi:10.3390/healthcare12161671 · Cited by 14 · see citing works
- Authors
- Dietz de Loos, A., Jiskoot, G., Beerthuizen, A., Busschbach, J., & Laven, J.
- Affiliations
- 1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands
- Erasmus MC (NL)
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-01-01
- Volume
- 186
- Issue
- 1
- Pages
- 53-64
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- PMC
- PMC8679850
- OpenAlex
- W3210453214
- Semantic Scholar
- a50368a9c85efe41cbbb7498527fc57208f002a2
- Cited by
- 33
- References
- 37
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 6 · 2023: 6 · 2022: 3
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- polycystic ovary syndrome, metabolic syndrome, lifestyle intervention, short message service, cognitive behavioral therapy, diet, physical activity, weight loss, obesity, metabolic health
- MeSH terms
- Smartphone, Adult, Behavior Therapy, Combined Modality Therapy, Diet Therapy, Exercise Therapy, Female, Humans, Life Style, Monitoring, Physiologic, Netherlands, Obesity, Patient Education as Topic, Polycystic Ovary Syndrome, Prevalence, Treatment Outcome, Metabolic Syndrome, Overweight
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
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