Reduced Carbohydrate Diet Intervention for PCOS

多囊卵巢综合征（PCOS）是一种异质性综合征，影响5-10%的女性， 生育年龄其特征是循环胰岛素升高，胰岛素敏感性降低，不育， 雄激素过多症和导致生活质量下降的多种症状。胰岛素升高 PCOS的特征可能通过降低胰岛素敏感性在其发病机制中起主要作用， 刺激睾酮（T）产生并增加其游离部分。虽然许多患有PCOS的女性 超重/肥胖（10-50%），那些谁是非肥胖患有相同的症状，他们的肥胖 同行因此，与PCOS相关的代谢紊乱可能使体重增加 增加，这反过来又通过恶化胰岛素抵抗而加剧PCOS。膳食血糖负荷的调控 (GL)可能降低胰岛素水平，改善生殖和代谢结果。没有研究测试过 在非肥胖PCOS女性中，低GL饮食对维持体重的有效性 本建议的具体目的是确定是否有足够的热量，较低的GL饮食比 正常热量标准（STD）饮食改善非肥胖妇女的生殖和代谢结果 PCOS。我们假设，在没有体重变化的情况下，较低的GL饮食在以下方面更有效： 减少胰岛素分泌，增加胰岛素敏感性，减少异位脂肪组织， 炎症和改善生殖健康。此外，较低的GL饮食会增加饱腹感， 饥饿，通过肠道激素介导的影响。该项目已缩小范围，以适应2年 与ARRA相关的资金周期。它将侧重于非肥胖人群的具体目标1（2个原始目标） 妇女，并将为具体目标2奠定基础工作，这将在更新阶段进行。 开发一种优化PCOS妇女生殖和代谢健康的饮食， 减少对药物治疗的依赖，改善生活质量，即使没有减肥。 该项目是第一个在非肥胖妇女中进行高度控制的营养干预的新项目 在体重稳定的条件下，使用胰岛素敏感性和β细胞功能的稳健措施， （数学建模）;脂肪分布（内脏脂肪CT扫描，肌细胞内脂质MRS）;炎症; 饱腹感和肠道激素谱（生长激素释放肽，GLP-1）;以及生殖内分泌轴。结果是 这项研究可以作为一个起点，从中探索超重PCOS妇女的最佳饮食。 首席研究员/项目总监（最后，第一，中间）：Gower，Barbara Ann PHS 398/2590（Rev.09/04） 饮食干预（8周，交叉设计） 降低-GL标准 碳水化合物：40% 55% 低GL菜单项中/高GL菜单项 Glycoprotein负载差异：31%（菜单周期平均值） 蛋白质：30% 15% 脂肪：30%（<10%）30%（<10%饱和脂肪） 饱和脂肪）

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome affecting 5-10% of women of reproductive age. It is characterized by elevated circulating insulin, reduced insulin sensitivity, infertility, hyperandrogenism, and a multitude of symptoms that result in a decreased quality of life. The elevated insulin characteristic of PCOS is likely to play a major role in its pathogenesis by reducing insulin sensitivity and stimulating testosterone (T) production and increasing its free fraction. Although many women with PCOS are overweight/obese (10-50%), those who are non-obese suffer from the same symptoms as their obese counterparts. Thus, it is likely that the metabolic disturbances associated with PCOS predispose to weight gain, which in turn exacerbates PCOS by worsening insulin resistance. Manipulation of dietary glycemic load (GL) may lower insulin and improve both reproductive and metabolic outcomes. No study has tested the efficacy of a eucaloric (weight-maintenance) lower GL diet among non-obese women with PCOS. The Specific Aim of this proposal is to determine if a eucaloric, lower GL diet is more effective than a eucaloric, standard (STD) diet in improving reproductive and metabolic outcomes of non-obese women with PCOS. We hypothesize that, in the absence of weight change, the lower GL diet will be more effective in decreasing insulin secretion, increasing insulin sensitivity, decreasing ectopic adipose tissue, decreasing inflammation, and improving reproductive health. Further, the lower GL diet will increase satiety and decrease hunger, effects mediated via gut hormones. This project has been reduced in scope to accommodate the 2-yr funding period associated with the ARRA. It will focus on Specific Aim 1 (of 2 original aims) in non-obese women, and will lay the ground work for Specific Aim 2, which will be conducted in the renewal phase. Development of a diet that optimizes reproductive and metabolic health among women with PCOS will reduce reliance on pharmacologic treatments and improve quality of life, even in the absence of weight loss. This project is novel in being the first to conduct a highly controlled nutrition intervention in non-obese women with PCOS under weight stable conditions, utilizing robust measures of insulin sensitivity and β-cell function (mathematical modeling); fat distribution (CT scan for visceral fat, MRS for intramyocellular lipid); inflammation; satiety and the gut hormone profile (ghrelin, GLP-1); and the reproductive-endocrine axis. The results from this study can be used as a starting point from which to explore optimal diets for overweight women with PCOS. Principal Investigator/Program Director (Last, First, Middle): Gower, Barbara Ann PHS 398/2590 (Rev. 09/04) Page Continuation Format Page Diet intervention (8-week, cross-over design) Reduced-GL STD Carbohydrate:40% 55% Low GL menu items Moderate/high GL menu items Glycemic load differential: 31% (average over menu cycle) Protein: 30% 15% Fat: 30% (<10% 30% (<10% saturated fat) saturated fat)