Background
Methods
Search strategy
Eligibility criteria
Outcome measure
Study selection
Data extraction
Quality assessment
Risk of bias assessment
Statistical analysis
Results
Search results, study selection, study characteristics, and quality assessment
Author (year) setting | Study design | Sample size | Groups (mean age and bmi) | PCOS diagnosis criteria | Life style modification | Follow up duration | outcome | Main result |
---|---|---|---|---|---|---|---|---|
Wong et al., 2016 USA | RCT | 19 | Group 1: patient with diet intervention and Weight loss n = 9 Mean age:16.3 ± 2.2 Mean BMI baseline: 32.80 ± 3.20 Mean BMI after:30.9 ± 3.70 Group 2: patient with diet intervention and non-Weight loss n = 10 Mean age:15.4 ± 1.3 Mean BMI baseline:36.50 ± 4.30 Mean BMI after:36.10 ± 4.70 | Androgen Excess Society | Diet LGL (45% carbohydrate, 35% fat, 20% protein) or LF (55% carbohydrate, 25% fat, 20% protein) diet | 6 months | BMI, BP,FBS FBI,SHBG,TG HDL, LDL,TT FT, BT | ↓BMI |
Lass et al., 2011 German | NRS | 59 | Group 1: patient with lifestyle intervention and Weight loss n = 26 Mean age:14.9 ± 0.8 Mean BMI baseline:32.20 ± 3.70 Mean BMI after:28.30 ± 3.40 Group 2: patient with lifestyle intervention and non-Weight loss n = 33 Mean age:15.1 ± 0.7 Mean BMI baseline:33.90 ± 6.8 Mean BMI after:34.60 ± 6.90 | National Institutes of Health | Diet 30% fat, 15% proteins, and 55% carbohydrates including 5% sugar Exercise dancing, ball games, jogging, trampoline jumping Behavior | 12 months | BMI, BP,FBS FBI, SHBG HOMA, TG HDL, LDL, FSH LH, FT, AFI | ↓BMI, ↓TG, ↓HOMA, ↓testosterone, ↓FAI, ↓LH, ↓systole and ↓diastole blood pressure |
Reinehr et al., 2017 German | NRS | 20 | Group 1: patient with lifestyle intervention and Weight loss n = 10 Mean age:: 14.9 ± 1.4 Mean BMI baseline:32.20 ± 4.10 Mean BMI after: 27.40 ± 2.5 Group 2: patient with lifestyle intervention and non-Weight loss n = 10 Mean age:15 ± 1.2 Mean BMI baseline:31.40 ± 4.90 Mean BMI after:33.30 ± 6.6 | Endocrine Society proposed | Diet 30% fat, 15% proteins, and 55% carbohydrates including 5% sugar Exercise dancing, ball games, jogging, trampoline jumping Behavior | 12 months | BMI, SHBG HOMA, FSH LH, FT, AFI AMH | ↓BMI, ↓LH, ↑SHBG, ↓FAI, ↓HOMA, ↓AMH |
Hoeger et al., 2008 USA | RCT | 18 | Group 1: patient with lifestyle intervention n = 8 Mean age: 15.4 ± 1.2 Mean BMI baseline:36 ± 6.20 Mean BMI after: 34.90 ± 7 Group 2: patient with no intervention (control) n = 10 Mean age: 15.4 ± 1.7 Mean BMI baseline:34.90 ± 6.7 Mean BMI after: 34.90 ± 6.70 | Rotterdam criterion | Diet Hypo caroric diet with 500 kcal/d deficit Exercise:30 min/d of moderate to intense activity | 6 months | BMI, BP,FBS FBI, TG, SHBG HDL, LDL, TT AFI, FG | ↓FAI, ↑SHBG, ↓Diastolic blood pressure |
Ornestein et al., 2011 Chicago | RCT | 16 | Group 1: patient with diet intervention n = 16 Mean age: 15.8 ± 2.2 Mean BMI baseline: 35.70 ± 6 Mean BMI after: 32.90 ± 5.80 | Rotterdam criterion | Diet:Low fat less than 40 g per day of fat, with five servings of starch per day and an ad libitum intake of fat-free dairy foods, fruits, vegetables low carbohydrate: 40 g carbohydrate daily by adding low glycemic index foods, such as nuts, fruits, And whole grains. | 3 months | BMI | ↓BMI |
Ladson et al., 2011 USA | RCT | 11 | Group 1: patient with lifestyle intervention n = 11 Mean age: 15.4 ± 1.2 Mean BMI baseline: no reported Mean BMI after: no reporte | National Institutes of Health | Diet: 55% carbohydrate, 30% fat, and 15% protein. Exercise: 35–45 stair stepper, stationary bike, elliptical machine, treadmill, or dancing to music | 6 months | BP, FBS, FBI HOMA, TG SHBG, HDL LDL, FSH LH, BT,AFI | No significant difference in all of measurement outcome |
Nidhi et al., India 2012 | RCT | 71 | Group 1: patient with yoga intervention n = 42 Mean age:16.22 ± 1.13 Mean BMI baseline:20.22 ± 1.65 Mean BMI after:20.11 ± 1.70 Group 2: patient with exercise intervention n = 43 Mean age:16.22 ± 0.93 Mean BMI baseline:21.28 ± 3.05 Mean BMI after: 21.59 ± 2.78 | Rotterdam criterion | Exercise: A yoga suryanamaskara, asanas, pranayama, and meditation | 3 months | BMI, FBS,FBI HOMA, TG HDL, LDL | ↓FBS, ↓HOMA, ↓TG, ↓LDL |
Nidhi et al., India 2013 | RCT | 72 | Group 1: patient with lifestyle intervention n = 45 Mean age: 16.22 ± 1.13 Mean BMI baseline:20.39 ± 2.60 Mean BMI after:20.41 ± 2 Group 2: patient with no intervention (control) n = 45 Mean age:16.22 ± 0.93 Mean BMI baseline:21.39 ± 3.20 Mean BMI after:21.70 ± 2.88 | Rotterdam criterion | Exercise: A yoga suryanamaskara, asanas, pranayama, and meditation | 3 months | BMI, FSH, LH TT, AMH, FG menstrual period | ↓TT, ↓LH, ↓AMH, ↓FG, menstural period improve |
Carolo et al., 2017 Brazil | NRS | 18 | Group 1: patient with lifestyle intervention and Weight loss n = 9 Mean age:16.56 ± 1.33 Mean BMI baseline:88.10 ± 13.3 Mean BMI after:81.40 ± 11.20 Group 2: patient with diet intervention and non-Weight loss n = 9 Mean age:16 ± 1.66 Mean BMI baseline:78.70 ± 17.30 Mean BMI after:84.8 ± 20.7 | Endocrine Society | Diet 55–75% of carbohydrate, 10–15% of Protein and 15–30% of total fat. | 6 months | BMI | Dietary interventions were not beneficial for BMI improve. |
Rofey et al., 2009 USA | NRS | 12 | Group 1: patient with lifestyle intervention n = 12 Mean age: 15.8 Mean BMI baseline:39 ± 9 Mean BMI after:35 ± 6 | National Institutes of Health | Behavior: cognitive–behavioral therapy (CBT) Exercise: (yoga instructor, local swim coach, climbing wall supervisor) | 3 months | BMI | ↓ BMI. |
Marzouk et al., 2015 Egypt | RCT | 60 | Group 1: patient with diet intervention n = 30 Mean age:19.3 ± 1.3 Mean BMI baseline:36.4 ± 4.7 Mean BMI after:33.20 ± 3.8 Group 2: patient with no intervention (control) n = 30 Mean age:20.1 ± 1.8 Mean BMI baseline:35.8 ± 4.8 Mean BMI after:35.7 ± 4.67 | Rotterdam criterion | Diet 15–20% of protein, 30% of fat, 50–55% of carbohydrates | 6 months | BMI, FG menstrual period | ↓ BMI, ↓FG, menstrual period improve. |
Meta-analysis of outcomes
Outcomes | N | aI2% | cPublication bias | Pooled SMD (95%CI) | bMeta-regression coefficient (P-Value) | ||
---|---|---|---|---|---|---|---|
SMD | LCI | UCI | |||||
BMI | |||||||
Intervention: lifestyle | 4 | 69.9 | 0.088 | −0.442 | − 0.986 | 0.102 | − 0.47 (0.119) |
Intervention: Exercise | 2 | 0.0 | 0.125 | 0.017 | −0.226 | 0.260 | −0.038 (0.896) |
Intervention: Diet | 4 | 0.0 | 0.147 | −0.450 | −0.760 | − 0.139 | − 0.47 (0.128) |
Control | 3 | 0.0 | 0.568 | 0.057 | −0.242 | 0.356 | Reference |
FG score | 1 | ||||||
Intervention: lifestyle | – | – | −0.509 | −1.360 | 0.341 | −0.57 (0.344) | |
Intervention: Exercise | 1 | – | – | −0.575 | − 0.996 | −0.153 | − 0.63 (0.139) |
Intervention: Diet | 1 | – | – | − 0.807 | − 1.334 | −0.280 | − 0.86 (0.108) |
Control | 3 | – | – | 0.056 | − 0.243 | 0.355 | Reference |
SBP | |||||||
Intervention: lifestyle | 2 | 72.2 | 0.602 | − 0.070 | −0.743 | 0.602 | − 0.335 (0.651) |
Intervention: Exercise | 0 | – | – | – | – | – | – |
Intervention: Diet | 1 | 0 | – | 0.267 | − 0.372 | 0.907 | 0 .014 (0.986) |
Control | 1 | – | – | 0.252 | − 0.588 | 1.091 | Reference |
DBP | |||||||
Intervention: lifestyle | 2 | 68.8 | 0.117 | −0.216 | − 0.855 | 0.422 | 0.135 (0.861) |
Intervention: Exercise | 0 | – | – | – | – | – | – |
Intervention: Diet | 1 | 0 | 0.317 | −0.451 | − 1.093 | 0.191 | −0.081 (0.905) |
Control | 1 | – | – | − 0.349 | − 1.192 | 0.494 | Reference |
Menstrual cycle | |||||||
Intervention: lifestyle | 0 | – | – | – | – | – | NA |
Intervention: Exercise | 1 | – | – | 1.165 | 0.718 | 1.613 | NA |
Intervention: Diet | 1 | – | – | 0.467 | − 0.046 | 0.980 | NA |
Control | 2 | 53 | 0.317 | 0.344 | − 0.138 | 0.826 | NA |
FBS | |||||||
Intervention: lifestyle | 2 | 0 | – | 0.113 | −0.219 | 0.445 | 0.246 (0.746) |
Intervention: Exercise | 1 | 94 | 0.317 | −0.530 | − 1.808 | 0.748 | − 0.374 (0.636) |
Intervention: Diet | 1 | – | – | − 0.092 | − 0.729 | 0.545 | 0.052 (0.950) |
Control | 1 | – | – | − 0.148 | − 0.985 | 0.689 | Reference |
FBI | |||||||
Intervention: lifestyle | 2 | 78.3 | 0.117 | −0.066 | −0.824 | 0.693 | −0.192 (0.814) |
Intervention: Exercise | 1 | 85.1 | 0.317 | −0.126 | −0.914 | 0.661 | − 0.444 (0.779) |
Intervention: Diet | 1 | 0 | – | − 0.108 | −0.749 | 0.533 | −0.234 (0.758) |
Control | 1 | – | – | 0.126 | − 0.711 | 0.962 | Reference |
HOMA-IR | |||||||
Intervention: lifestyle | 2 | 0 | 0.254 | 0.000 | − 0.312 | 0.312 | – |
Intervention: Exercise | 1 | 0 | 0.317 | 0.000 | −0.301 | 0.301 | – |
Intervention: Diet | 0 | – | – | – | – | – | – |
Control | 0 | – | – | – | – | – | – |
TG | |||||||
Intervention: lifestyle | 2 | 64.1 | 0.317 | −0.097 | − 0.705 | 0.511 | − 0.095 (0.235) |
Intervention: Exercise | 1 | 0 | 0.317 | −0.321 | − 0.624 | −0.018 | − 0.180 (0.584) |
Intervention: Diet | 1 | 0 | 0.117 | −0.097 | −0.705 | 0.511 | −0.041 (0.784) |
Control | 1 | – | – | −0.236 | −1.075 | 0.603 | Reference |
SHBG | |||||||
Intervention: lifestyle | 3 | 70.1 | 0.421 | 0.593 | −0.004 | 1.191 | 0.341 (0.623) |
Intervention: Exercise | 0 | – | – | – | – | – | – |
Intervention: Diet | 1 | 0 | 0.117 | 0.007 | − 0.630 | 0.644 | − 0.224 (0.784) |
Control | 1 | – | – | 0.235 | − 0.604 | 1.074 | Reference |
HDL | |||||||
Intervention: lifestyle | 2 | 35.5 | 0.217 | 0.317 | − 0.115 | 0.749 | −0.075 (0.879) |
Intervention: Exercise | 1 | 0 | 0.117 | 0.089 | −0.212 | 0.389 | −0.311 (0.532) |
Intervention: Diet | 1 | 0 | 0.117 | 0.056 | −0.582 | 0.694 | −0.343 (0.560) |
Control | 1 | – | – | 0.400 | − 0.445 | 1.245 | Reference |
LDL | |||||||
Intervention: lifestyle | 2 | 0 | 0.317 | −0.059 | − 0.390 | 0.273 | 0.063 (0.898) |
Intervention: Exercise | 1 | 54.1% | 0.117 | −0.431 | − 0.882 | 0.021 | −0.301 (0.542) |
Intervention: Diet | 1 | 0 | 0.117 | −0.455 | − 1.100 | 0.190 | −0.333 (0.571) |
Control | 1 | – | – | −0.122 | − 0.958 | 0.715 | Reference |
FSH | |||||||
Intervention: lifestyle | 2 | 28.2 | 0.254 | 0.049 | −0.337 | 0.435 | 0.202 (0.635) |
Intervention: Exercise | 0 | 0 | – | − 0.207 | −0.621 | 0.207 | −0.063 (0.900) |
Intervention: Diet | 0 | – | – | – | – | – | – |
Control | 1 | – | – | − 0.144 | −0.558 | 0.270 | Reference |
LH | |||||||
Intervention: lifestyle | 2 | 28.2 | 0.254 | −1.235 | −2.440 | − 0.030 | −2.115 (0.564) |
Intervention: Exercise | 0 | 0 | – | − 0.561 | −0.982 | − 0.140 | −0.982 (0.894) |
Intervention: Diet | 0 | – | – | – | – | – | – |
Control | 1 | – | – | 0.420 | 0.003 | 0.838 | Reference |
TT | |||||||
Intervention: lifestyle | 1 | – | – | 0.140 | −0.697 | 0.977 | −0.0476 (0.952) |
Intervention: Exercise | 1 | – | – | −0.288 | − 0.703 | 0.128 | − 0.476 (0.236) |
Intervention: Diet | 1 | 0 | 0.117 | −0.050 | − 0.686 | 0.586 | −0.238 (0.592) |
Control | 1 | 0 | 0.117 | 0.188 | −0.183 | 0.559 | Reference |
FT | 2 | 80.2 | |||||
Intervention: lifestyle | 0.542 | −0.486 | − 1.277 | 0.306 | – | ||
Intervention: Exercise | 0 | – | – | – | – | – | – |
Intervention: Diet | 1 | 81 | 0.117 | −1.042 | − 2.737 | 0.653 | – |
Control | 0 | – | – | – | – | – | Reference |
BT Intervention: lifestyle | 0 | – | – | – | – | – | – |
Intervention: Exercise | 0 | – | – | – | – | – | – |
Intervention: Diet | 1 | 0 | – | −0.073 | −0.710 | 0.564 | – |
Control | 0 | – | – | – | – | – | Reference |
AFI | |||||||
Intervention: lifestyle | 3 | 73.8 | 0.452 | −0.778 | − 1.425 | −0.131 | − 0.918 (0.400) |
Intervention: Exercise | 0 | – | – | – | – | – | – |
Intervention: Diet | 0 | – | – | – | – | – | – |
Control | 1 | 0 | – | 0.119 | −0.718 | 0.955 | Reference |
AMH | |||||||
Intervention: lifestyle | 1 | 87.2 | 0.117 | −1.230 | −3.259 | 0.798 | −1.084 (0.654) |
Intervention: Exercise | 1 | – | – | −0.809 | − 1.239 | −0.378 | −0.622 (0.541) |
Intervention: Diet | 0 | – | – | – | – | – | – |
Control | 1 | – | – | − 0.187 | −0.601 | 0.227 | Reference |
Body mass index
Clinical parameters
Metabolic parameters
Hormonal parameters
Meta-regression analysis
Outcomes | aMeta-regression coefficient |
---|---|
(P-Value) | |
BMI | −.005669 (0.911) |
FG score | .0198017 (0.878) |
SBP | −.1612566 (0.245) |
DBP | .1273615 (0.353) |
Menstrual cycle | @ |
FBS | .010024 (0.945) |
fasting blood insulin | .0809897 (0.596) |
HOMA-IR | @ |
TG | −.0863414 (0.439) |
SHBG | .0365641 (0.785) |
HDL | .0754495 (0.403) |
LDL | .0311606 (0.720) |
FSH | .0223895 (0.639) |
LH | −.2349961 (0.564) |
TT | .0136399 (0.944) |
FT | @ |
BT | @ |
AFI | .0597252 (0.778) |
AMHr | @ |