Role of Dietary Fiber in PCOS Anovulation

多囊卵巢综合征(PCOS)是女性因无排卵而导致不孕的最常见原因。 胰岛素抵抗伴代偿性高胰岛素血症在其 病理生理学。生活方式措施，包括节食和减肥，通常被认为是第一线 改善多囊卵巢综合征患者生殖结局的管理。尽管减肥已被证明有益于 恢复排卵功能，改善多囊卵巢综合征患者排卵的最佳饮食结构 不清楚。了解改善多囊卵巢综合征妇女生殖功能的最佳饮食 极大地加强了多囊卵巢综合征的不孕不育管理，但到目前为止，很少有研究检查饮食的作用 关于多囊卵巢综合征生殖异常的成分。强有力的证据表明，高膳食纤维 摄食可以改善胰岛素敏感性，尽管还没有发表的研究探讨高血糖对胰岛素的影响 纤维摄入对多囊卵巢综合征患者排卵率的影响。美国人平均每日总膳食纤维摄入量 低于14克，远低于建议的每天20至35克。研究表明，摄入量为28- 每天36克纤维，包括可溶性和不溶性纤维，改善胰岛素敏感性，减少血液循环 成人中的胰岛素。我们假设6个月的纤维补充剂将改善 绝经前患有多囊卵巢综合征的女性，体重减轻不受影响。在这项试点研究中，我们将确定 在患有多囊卵巢综合征的妇女中进行一项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岁到45岁之间的多囊卵巢综合征患者(体重指数为45 Kg/m2)，以确定在日常体重维持的基础上每天添加多达22克的纤维补充剂的效果 饮食对排卵的影响。补充纤维，而不是改变膳食纤维的摄入量，可能 可行地转化为临床实践。具体地说，我们将：1)生成以下范围的初步数据 在基线和补充纤维6个月后的结果测量：测量的排卵率 通过尿孕二醇-3-葡萄糖醛酸苷测定；胰岛素敏感性，由经常采样的 静脉葡萄糖耐量试验.循环雄激素、雌二醇、性激素浓度 结合球蛋白和黄体生成素；以及通过视觉模拟标尺测量的饱足感；2)量化 注册策略、留存、合规性、参与者特征和数据收集挑战；3) 确定22克液体纤维补充剂的剂量是否可耐受且足够 以影响多囊卵巢综合征妇女的排卵率和胰岛素敏感性；以及4)确定6个月是否 补充纤维的时间足以影响排卵率和胰岛素敏感性 多囊卵巢综合征。

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.