A Comparison of a Pulse-Based Diet and the Therapeutic Lifestyle Changes Diet in Combination with Exercise and Health Counselling on the Cardio-Metabolic Risk Profile in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

Kazemi, Maryam; McBreairty, Laura E.; Chizen, Donna R.; Pierson, Roger A.; Chilibeck, Philip D.; Zello, Gordon A.

doi:10.3390/nu10101387

Cited by 118Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsDiet, Metabolism, and Disease

A Comparison of a Pulse-Based Diet and the Therapeutic Lifestyle Changes Diet in Combination with Exercise and Health Counselling on the Cardio-Metabolic Risk Profile in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

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Kazemi, Maryam, McBreairty, Laura E., Chizen, Donna R., Pierson, Roger A., Chilibeck, Philip D., Zello, Gordon A.·2018·Nutrients

DOI 10.3390/nu10101387PMC PMC6212867

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Abstract

We compared the effects of a low-glycemic index pulse-based diet, containing lentils, beans, split peas, and chickpeas, to the Therapeutic Lifestyle Changes (TLC) diet on cardio-metabolic measures in women with polycystic ovary syndrome (PCOS). Ninety-five women (18–35 years) enrolled in a 16-week intervention; 30 women in the pulse-based and 31 in the TLC groups completed the study. Women participated in aerobic exercise training (minimum 5 days/week for 45 min/day) and were counselled (monthly) about PCOS and lifestyle modification. Women underwent longitudinal follow-up post-intervention. The pulse-based group had a greater reduction in total area under the curve for insulin response to a 75-g oral glucose tolerance test (mean change ± SD: −121.0 ± 229.9 vs. −27.4 ± 110.2 µIU/mL × min; p = 0.05); diastolic blood pressure (−3.6 ± 6.7 vs. −0.2 ± 6.7 mmHg, p = 0.05); triglyceride (−0.2 ± 0.6 vs. 0.0 ± 0.5 mmol/L, p = 0.04); low-density lipoprotein cholesterol (−0.2 ± 0.4 vs. −0.1 ± 0.4 mmol/L, p = 0.05); total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C; −0.4 ± 0.4 vs. 0.1 ± 0.4, p < 0.001); and a greater increase in HDL-C (0.1 ± 0.2 vs. −0.1 ± 0.2 mmol/L, p < 0.01) than the TLC group. Decreased TC/HDL-C (p = 0.02) at six-month and increased HDL-C and decreased TC/HDL-C (p ≤ 0.02) at 12-month post-intervention were maintained in the pulse-based group. A pulse-based diet may be more effective than the TLC diet at improving cardio-metabolic disease risk factors in women with PCOS. Trial registration: CinicalTrials.gov identifier, NCT01288638.

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A low glycemic index diet based on pulses can lead to improvement of fasting insulin and decrease of inflammatory markers in women with PCOS.
“The study by Kazemi et al. (2018) then provided some substantiation of the fact that the low glycemic index diet, based on pulses, can lead to the improvement of fasting insulin and the decrease of inflammatory markers in case women who have PCOS take it [130].”
From Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management (2025) · cites this paper as [130]
Results §3.4 (page unavailable) reports that fasting insulin decreased during the intervention, but the decrease did not differ between the pulse-based and TLC diet groups. Methods §§2.4–2.5 (pages unavailable) says the study measured hsCRP, an inflammatory marker; the passages reviewed do not report a decrease in it or other inflammatory markers. The claim therefore supports the fasting-insulin outcome, but not the attributed decrease in inflammatory markers. (LLM, conf=0.87)
Experimental — accuracy not yet measured
A low glycemic index diet based on pulses can lead to improvement of fasting insulin and decrease of inflammatory markers in women with PCOS.
“The study by Kazemi et al. (2018) then provided some substantiation of the fact that the low glycemic index diet, based on pulses, can lead to the improvement of fasting insulin and the decrease of inflammatory markers in case women who have PCOS take it [130].”
From Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management (2025) · cites this paper as Kazemi et al. (2018)
Results §3.4 reports that fasting insulin decreased during the 16-week intervention in women with PCOS, but the decrease did not differ between the pulse-based and TLC diet groups. Methods §2.4 lists hsCRP as a measured inflammatory marker, but the passages from our copy do not report a decrease in inflammatory markers. The study also combined diet with exercise and counselling, so it does not isolate the diet’s effect. (LLM, conf=0.86)
Experimental — accuracy not yet measured
At 12 months, only the increased HDL-C concentrations and lower total cholesterol/HDL-C ratio stayed improved in the pulse-based group, while other improvements returned to pre-intervention levels.
“At 12 months, only the increased HDL-C concentrations and lower total cholesterol/HDL-C ratio stayed improved in the pulse-based group. Other improvements in cardiometabolic risk returned to pre-intervention levels [108].”
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 [108]
Results §3.8 reports that, in the pulse-based group, HDL-C remained higher and the total cholesterol/HDL-C ratio remained lower than baseline at 12 months. The Discussion says other cardiometabolic measures tended to revert toward pre-intervention levels, but Results §3.8 also reports no significant change from 16 weeks to 12 months in several measures. Thus, saying all other improvements returned to pre-intervention levels overstates the findings. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Initial changes to cardiometabolic risk in both the pulse-based and therapeutic lifestyle changes groups included a decrease in BMI, WC, systolic blood pressure, glucose, insulin, and total cholesterol concentrations.
“Initial changes to cardiometabolic risk included a decrease in BMI, WC, systolic blood pressure (SBP), glucose, insulin, and total cholesterol concentrations in both the pulse-based and therapeutic lifestyle changes groups”
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 [108]
Many lifestyle intervention studies lacked a comparison group, had a small sample size, suffered from high attrition rates, and did not report on the length of duration.
“Many studies lacked a comparison group [100,105,110,111,112], had a small sample size [105,109,110,112,113], suffered from high attrition rates [100,108,113], and did not report on the length of duration [105]”
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 [108]

The study had a high attrition rate and poor response rate to dietary recalls.
“this study had a high attrition rate and poor response rate to dietary recalls [108]”
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 [108]
The pulse-based group initially had a significantly larger decrease in DBP, insulin area under the curve, triglyceride, LDL-C, and total cholesterol/HDL-C ratio concentrations compared to the therapeutic lifestyle changes diet.
“The pulse-based group initially had a significantly larger decrease in DBP, insulin area under the curve, triglyceride, LDL-C, and total cholesterol/HDL-C ratio concentrations compared to the therapeutic lifestyle changes diet”
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 [108]
The baseline mean BMI was 32.5 ± 8.4 kg/m2 for the pulse-based group and 33.3 ± 9.0 kg/m2 for the therapeutic lifestyle changes group.
“the baseline mean BMI was 32.5 ± 8.4 kg/m2 and 33.3 ± 9.0 kg/m2 for the pulse-based and therapeutic lifestyle changes groups, respectively [108]”
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 [108]
The Results section says baseline characteristics are presented in Table 1, but the passages available from our copy do not include the table’s BMI values. Searches for the stated numbers and for baseline BMI found no passage that verifies either group’s mean or standard deviation. (LLM, conf=0.70)
Experimental — accuracy not yet measured
In women with PCOS, a low GI pulse-based diet produced a greater decrease in the total area under the curve for insulin response to a 75-g oral glucose tolerance test than the Therapeutic Lifestyle Changes diet and improved lipid profile.
“The group of women on the pulse-based diet had a greater decrease in the total area under the curve (AUC) for insulin response to a 75-g oral glucose tolerance test than the TLC group and improved lipid profile, indicating that a legume-based diet may be more effective in improving cardiometabolic risk factors in women with PCOS [30].”
From Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [30]

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Do Common Beans (Phaseolus vulgaris L.) Promote Good Health in Humans? A Systematic Review and Meta-Analysis of Clinical and Randomized Controlled Trials
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Neck circumference is a good predictor for insulin resistance in women with polycystic ovary syndrome
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A randomized controlled trial of a lifestyle intervention with longitudinal follow‐up on ovarian dysmorphology in women with polycystic ovary syndrome
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The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis
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Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management
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Osteosarcopenia in Reproductive-Aged Women with Polycystic Ovary Syndrome: A Multicenter Case-Control Study
Kazemi, M., Jarrett, B. Y., Parry, S. A., Thalacker‐Mercer, A. E., Hoeger, K. M., Spandorfer, S. D., & Lujan, M. E. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa426 · Cited by 29 · see citing works
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Polycystic ovary syndrome is a risk factor for sarcopenic obesity: a case control study
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Self-management in patients with coronary heart disease after stent implantation at the long-term stage: a cross-sectional study
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Comprehensive evaluation of disparities in cardiometabolic and reproductive risk between Hispanic and White women with polycystic ovary syndrome in the United States: a systematic review and meta-analysis
Kazemi, M., Kim, J. Y., Wan, C., Xiong, J. D., Parry, S. A., Azziz, R., & Lujan, M. E. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.07.032 · Cited by 27 · see citing works
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Are Dietary Indices Associated with Polycystic Ovary Syndrome and Its Phenotypes? A Preliminary Study
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The Effect of a Low Glycemic Index Pulse-Based Diet on Insulin Sensitivity, Insulin Resistance, Bone Resorption and Cardiovascular Risk Factors during Bed Rest
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Altered Molecular Pathways and Biomarkers of Endometrial Receptivity in Infertile Women with Polycystic Ovary Syndrome
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AMH Is a Good Predictor of Metabolic Risk in Women with PCOS: A Cross-Sectional Study
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Performance Analysis of a Novel Hybrid Segmentation Method for Polycystic Ovarian Syndrome Monitoring
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Trends and Patterns of Chickpea Consumption among United States Adults: Analyses of National Health and Nutrition Examination Survey Data
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Disparities in cardio metabolic risk between Black and White women with polycystic ovary syndrome: a systematic review and meta-analysis
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Consumption of pistachio nuts positively affects lipid profiles: A systematic review and meta-analysis of randomized controlled trials
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Effects of high-protein diets on the cardiometabolic factors and reproductive hormones of women with polycystic ovary syndrome: a systematic review and meta-analysis
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A Low-Glycemic Index, High-Fiber, Pulse-Based Diet Improves Lipid Profile, but Does Not Affect Performance in Soccer Players
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Effect of a pulse-based diet and aerobic exercise on bone measures and body composition in women with polycystic ovary syndrome: A randomized controlled trial
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Oral Administration of Fermented Milk from Co-Starter Containing Lactobacillus plantarum Y44 Shows an Ameliorating Effect on Hypertension in Spontaneously Hypertensive Rats
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Effectiveness of Chickpeas on Blood Sugar: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Weight Management in Adolescents with Polycystic Ovary Syndrome
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Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS)
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The Effect of Time-Restricted Eating on Insulin Levels and Insulin Sensitivity in Patients with Polycystic Ovarian Syndrome: A Systematic Review
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A Systematic Review of the Twelve Most Popular Bean Varieties, Highlighting Their Potential as Functional Foods Based on the Health Benefits Derived from Their Nutritional Profiles, Focused on Non-Communicable Diseases
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Eight weeks of lentil consumption attenuates insulin resistance progression without increased gastrointestinal symptom severity: A randomized clinical trial
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The Effect of Non-Oil Seed Legume Intake on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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The Influence of Dietary Patterns on Polycystic Ovary Syndrome Management in Women: A Review of Randomized Controlled Trials with and Without an Isocaloric Dietary Design
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Legume intakes on cardiometabolic profile and gut microbiome function: systematic review and meta-analyses of randomised controlled trials
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Impact of an online multicomponent very-low-carbohydrate program in women with polycystic ovary syndrome: a pilot study
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Pulses and Prevention and Management of Chronic Disease
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Time-restricted eating for body weight management in women with polycystic ovary syndrome: a randomized controlled trial
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Lifestyle interventions in women with polycystic ovary syndrome: A scoping systematic review of randomised evidence
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Knowledge, Attitudes, and Barriers towards Dietary Pulse Consumption in Women with Polycystic Ovary Syndrome Participating in a Multi-Disciplinary Lifestyle Intervention to Improve Women’s Health
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Glycemic Index of lentil- and cherry-based sport nutrition products for endurance athletes
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The effects of nonsoy legumes consumption on serum levels of inflammatory biomarkers and Adiponectin in overweight/obese adults: A systematic review and meta-analysis of randomized controlled trials
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Time-restricted eating plus calorie-restricted diet versus calorie-restricted diet in women with polycystic ovary syndrome
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Compositional profiling and bioefficacy studies of pulses-supplemented isocaloric designer biscuits for recently diagnosed diabetic individuals
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Staying up late increases cardiovascular disease risk in women with polycystic ovary syndrome
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Serum adiponectin level is negatively related to insulin resistance in women with polycystic ovary syndrome
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Bean Spread Enriched with Spelt as a Novel Source of Bioactive Peptides with Potential Anti-Metabolic Syndrome Properties
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Time‐Restricted Eating to Improve Metabolic Abnormalities in Polycystic Ovarian Syndrome (TimeMAP)
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Association of Quantitative Characteristics with Growth Hormone Gene (GH Gene) in Kerinci Duck Using PCR-RFLP Method
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Effect of Health Education in Improving Knowledge, Attitudes and Practices of Preventable Cancers amongst Reproductive Age Women A Randomized Field Trial
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Examining the Role of Nutrition in Cancer Survivorship and Female Fertility: A Narrative Review
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Medical Research Council Hot Topic workshop report: Planning a UK Nutrition and Healthy Life Expectancy Trial
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Effect of two types of time-restricted eating on glycemic, lipid indices, and weight in women with polycystic ovary syndrome: a randomized controlled trial
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Nutrition interventions in women with polycystic ovary syndrome: a systematic review
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Association of Glycemic Index, Glycemic Load, and Carbohydrate Intake with Antral Follicle Counts Among Subfertile Females
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Carbohydrate Quantity vs. Quality in Polycystic Ovary Syndrome: Population-Based Meta-Analysis Combined with GBD Data-Driven Assessment
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A Machine Learning based Improvised Follicle Polycystic Ovarian Detection Through Ultrasound Images Through IOT
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Weight loss effects of non-pharmacological interventions in women with polycystic ovary syndrome: a systematic review and network meta-analysis
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A Review of Dietary Interventions for Polycystic Ovary Syndrome: Identifying the Optimal Approach
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Impact of dietary fiber on PCOS: a systematic review
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Effect of Non-Soy Legumes on Lipid Profile: A Systematic Review and Meta-analysis of Randomized Controlled Trials
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THE ROLE OF SOY AND OTHER SOURCES OF EXOGENOUS ESTROGENS IN MODIFICATION OF PCOS SYMPTOMS AND OTHER HORMONAL DISORDERS IN WOMEN
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Greater Intake of Pulses Is Associated with Lower Prevalence of Cardiometabolic Diseases among Adults in the United States: NHANES, 1999 to 2018
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Polycystic Ovary Syndrome: Pathophysiology, Presentation and Treatment a Mini-Review Article
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Implications of Plant Foods in Weight Management: Focus on Metabolic Health
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Legume - an inconspicuous fighter against the metabolic syndrome
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Nutritional and clinical profile of women with polycystic ovary syndrome
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Nutritional Management of Polycystic Ovary Syndrome: Insights into Diet and Nutrition Strategies
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The effect of Bushenhuoxue nutritional decoction in the treatment of overweight patients with polycystic ovarian syndrome
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Condutas nutricionais no cuidado das manifestações da Síndrome dos Ovários Policísticos
Assunção, C. M. V., & de Carvalho, L. M. F. (2021) · Research Society and Development · doi:10.33448/rsd-v10i17.24260 · Cited by 1 · see citing works

A Multidisciplinary Lifestyle Intervention for Women with Polycystic Ovary Syndrome: The Role of a Pulse-Based Diet and Aerobic Exercise on Reproductive, Cardio-Metabolic, and Quality of Life Outcomes
Kazemi, M. (2018)
Self-citation
A Randomized Clinical Trial in Women with Polycystic Ovary Syndrome: Effects of a Pulse‐Based Diet and Exercise Intervention on Blood Lipids, Body Composition and Reproductive Measures
McBreairty, L. E., Kazemi, M., Gordon, J. J., Pierson, R. A., Chizen, D. R., Chilibeck, P. D., & Zello, G. A. (2017) · The FASEB Journal · doi:10.1096/fasebj.31.1_supplement.31.6
Self-citation
The “pulse” diet & PCOS
Chizen, D. R., Serrao, S. B., Rooke, J. J., McBreairty, L. E., Pierson, R. A., Chilibeck, P. D., & Zello, G. A. (2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.07.908 · Cited by 6 · see citing works
Self-citation
A pulse‐based diet and exercise training in women with polycystic ovarian syndrome: effects on body composition, blood lipids and reproductive measures (117.5)
McBreairty, L. E., Zello, G. A., Rooke, J. J., Serrao, S. B., Pierson, R. A., Chizen, D. R., & Chilibeck, P. D. (2014) · The FASEB Journal · doi:10.1096/fasebj.28.1_supplement.117.5
Self-citation
A pulse‐based diet intervention in women with polycystic ovarian syndrome (PCOS): Compliance, and effects on body composition, fertility and metabolic measures
Zello, G. A., Ramachandran, K., Rooke, J. J., Serrao, S. B., Chizen, D. R., & Chilibeck, P. D. (2013) · The FASEB Journal · doi:10.1096/fasebj.27.1_supplement.630.5 · Cited by 2 · see citing works
Self-citation

Authors: Kazemi, M., McBreairty, L. E., Chizen, D. R., Pierson, R. A., Chilibeck, P. D., & Zello, G. A.
Affiliations: University of Saskatchewan (CA)
Corresponding author: Zello, Gordon A.
ORCID: Kazemi, Maryam
McBreairty, Laura E.
Chizen, Donna R.
Pierson, Roger A.
Chilibeck, Philip D.
Zello, Gordon A.
Venue: Nutrients
Publisher: MDPI AG
Published: 2018-09-30
Volume: 10
Issue: 10
Pages: 1387
ISSN: 2072-6643 (ISSN-L)
DOI: 10.3390/nu10101387
PMC: PMC6212867
OpenAlex: W2893962441
Cited by: 118
References: 115
Citations by year: 2026: 14 · 2025: 15 · 2024: 15 · 2023: 19 · 2022: 11 · 2021: 21 · 2020: 17 · 2019: 6
FWCI: 11.80
Type: journal article
Language: en
Open access: gold
dx.doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Nutrients (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Funders: Agriculture and Agri-Food Canada (G00011676)
Saskatchewan Pulse Growers (G00014962 - SPCD - Effect of a Pulse-Based Diet)
Canada Foundation for Innovation (29638)
Colleges of Graduate and Postdoctoral Studies and Pharmacy and Nutrition Scholarships and Awards (University of Saskatchewan, Canada)
Saskatchewan Health Research Foundation (Saskatchewan, Canada)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords: polycystic ovary syndrome, low glycemic index diet, aerobic exercise training, health counseling, lifestyle modification, cardiometabolic risk, insulin resistance, HDL cholesterol, TC/HDL-C ratio, triglycerides, blood pressure, LDL cholesterol, women's health, dietary intervention, lifestyle intervention
MeSH terms: Adolescent, Adult, Blood Glucose, Cardiovascular Diseases, Counseling, Diet, Female, Humans, Insulin, Insulin Resistance, Fabaceae, Life Style, Lipids, Metabolic Diseases, Polycystic Ovary Syndrome, Risk Factors, Exercise, Single-Blind Method, Lens Plant, Glycemic Index

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A Comparison of a Pulse-Based Diet and the Therapeutic Lifestyle Changes Diet in Combination with Exercise and Health Counselling on the Cardio-Metabolic Risk Profile in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

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