Role of Dietary Fiber in PCOS Anovulation

多囊卵巢综合征（PCOS）是女性无排卵不孕症的最常见原因 胰岛素抵抗伴代偿性高胰岛素血症在其发病机制中起着核心作用。 病理生理学生活方式的措施，包括饮食和减肥，往往被视为第一线 管理，以改善PCOS的生殖结果。虽然减肥已被证明有益于 恢复排卵功能，改善PCOS排卵的最佳饮食组成仍然是 不清楚了解改善多囊卵巢综合症女性生殖功能的最佳饮食将 大大提高不孕症的管理PCOS，但到目前为止，很少有研究已经审查了饮食的作用， PCOS的生殖异常。强有力的证据表明，高膳食纤维 营养可以改善胰岛素敏感性，尽管没有发表的研究调查了高胰岛素的作用。 纤维摄入量对PCOS妇女排卵率的影响。美国人平均每日膳食纤维摄入量 低于14克，远远低于推荐的20至35克/天。研究表明，28- 36克纤维/天，由可溶性和不溶性纤维组成，改善胰岛素敏感性，减少循环 成人的胰岛素我们假设，6个月的纤维补充将改善排卵， 绝经前PCOS女性，与体重减轻无关。在这项试点研究中，我们将确定 在PCOS患者中进行更大规模的双盲随机试验来验证这一假设的可行性。 因此，我们将评估15名年龄在18至45岁之间（体重指数< 45 kg/m2），以确定添加高达22 g/天的纤维补充剂对其通常体重维持的影响 排卵期的饮食补充纤维，而不是改变膳食纤维的摄入量， 将其转化为临床实践。具体而言，我们将：1）生成关于 在基线和补充纤维6个月后的结果测量：排卵率，如测量的 通过尿孕激素-3-葡萄糖醛酸苷测量;胰岛素敏感性，通过频繁采样 静脉葡萄糖耐量试验;循环雄激素、雌二醇、性激素浓度 结合球蛋白和促黄体生成素;和饱腹感，如通过视觉模拟量表测量的; 2）量化 招募策略、保留、合规性、参与者特征和数据收集挑战; 3） 确定高达22克的液体纤维补充剂的剂量是否是可耐受的和足够的 影响多囊卵巢综合征妇女的排卵率和胰岛素敏感性。（4）确定6个月 补充纤维的持续时间足以影响排卵率和胰岛素敏感性， PCOS。

Polycystic ovary syndrome (PCOS) is the most common cause of female infertility due to anovulation in the United States, and insulin resistance with compensatory hyperinsulinemia plays a central role in its pathophysiology. Lifestyle measures, including diet and weight loss, are frequently considered as first-line management for improving reproductive outcomes in PCOS. Although weight loss has proven beneficial in restoring ovulatory function, the optimal dietary composition for improving ovulation in PCOS remains unclear. Understanding the optimal diet for improving reproductive function in women with PCOS would greatly enhance infertility management for PCOS, but to date few studies have examined the role of dietary composition on reproductive abnormalities in PCOS. Strong evidence suggests that high dietary fiber ngestion can improve insulin sensitivity although no published studies have investigated the effect of high fiber intake on ovulation rates in women with PCOS. The average total daily dietary fiber intake in Americans is less than 14 g, much less than the recommended 20 to 35 g/day. Studies have shown that intakes of 28- 36 g fiber/day, consisting of both soluble and insoluble fiber, improve insulin sensitivity and reduce circulating insulin in adults. We hypothesize that 6 months of fiber supplementation will improve ovulation in premenopausal women with PCOS, independent of weight loss. In this pilot study, we will determine the feasibility of conducting a larger double-blind, randomized trial in women with PCOS to test this hypothesis. Therefore, we will evaluate 15 women with PCOS between ages 18 to 45 years (body mass index < 45 kg/m2)to identify the effect of adding up to 22 g/day of fiber supplementation to their usual weightmaintenance diets on ovulation. Fiber supplementation, as opposed to change in dietary fiber intake, could feasibly be translated into clinical practice. Specifically, we will: 1) Generate preliminary data on the range of outcome measures at baseline and after 6 months of fiber supplementation on: ovulation rates, as measured by urinary pregnanediol-3-glucuronide measurements; insulin sensitivity, as measured by frequently sampled intravenous glucose tolerance testing; concentrations of circulating androgens, estradiol, sex-hormone binding globulin, and luteinizing hormone; and satiety, as measured by a visual analog scale; 2) Quantify enrollment strategies, retention, compliance, participant characteristics, and data collection challenges; 3) Determine whether a dose of up to 22 grams of liquid fiber supplementation would be tolerable and sufficient to affect ovulation rates and insulin sensitivity in women with PCOS.; and 4) Determine whether 6-month duration of fiber supplementation is sufficient to affect ovulation rates and insulin sensitivity in women with PCOS.