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Relation of nutrients and hormones in polycystic ovary syndrome^1,2,3

¹ From the Department of Internal Medicine, Division of Endocrinology, Clinical Nutrition and Vascular Medicine, University of California, Davis, Davis, CA (SEK-K); the Department of Biostatistics, School of Public Health, University of Michigan at Ann Arbor, Ann Arbor, MI (AT); and the Department of Nutrition, Family and Consumer Sciences, California State University, Sacramento, CA (WMC)

Background: Insulin resistance, infertility, and hirsutism, common characteristics of polycystic ovary syndrome (PCOS), improve with even modest weight loss. Optimal dietary treatment for PCOS is not known.

Objective: We compared the effects of acute protein administration with those of glucose challenges on hormones related to obesity and insulin resistance (ie, cortisol and insulin), hirsutism [ie, dehydroepiandosterone (DHEA) and androstenedione], and hunger (ie, ghrelin).

Design: Patients with PCOS (n = 28; aged 26 ± 2 y) were tested with a 5-h oral-glucose-tolerance test (OGTT) and a euvolemic, euenergetic protein challenge.

Results: Glucose ingestion caused larger fluctuations in blood glucose and more hyperinsulinemia than did protein (P < 0.01, overall treatment-by-time interaction). During the protein challenge, cortisol and DHEA declined over 5 h. During OGTT, cortisol and DHEA increased after the third hour and began to show significant divergence from protein from the fourth hour (P 0.01). During OGTT, 18 patients who had a blood glucose nadir of <69 mg/dL had elevated cortisol (baseline: 10.4 ± 0.4; nadir: 5.9 ± 0.1; peak: 12.7 ± 0.9 µg/dL) and DHEA (baseline: 15.6 ± 1.3; nadir: 11.2 ± 1.0; peak: 24.6 ± 1.6 ng/mL) (P < 0.01), whereas the remaining 10 patients with a glucose nadir of 76 ± 2 mg/dL had no increase in adrenal steroids. Both glucose and protein suppressed ghrelin (from 935 ± 57 to 777 ± 51 pg/mL and from 948 ± 60 to 816 ± 61 pg/mL, respectively). After glucose ingestion, ghrelin returned to baseline by 4 h and increased to 1094 ± 135 pg/mL at 5 h. After the protein challenge, ghrelin remained below the baseline (872 ± 60 pg/mL) even at 5 h. The overall treatment effect was highly significant (P < 0.0001).

Conclusions: Glucose ingestion caused significantly more hyperinsulinemia than did protein, and it stimulated cortisol and DHEA. Protein intake suppressed ghrelin significantly longer than did glucose, which suggested a prolonged satietogenic effect. These findings provide mechanistic support for increasing protein intake and restricting the simple sugar intake in a PCOS diet.

Key Words: Polycystic ovary syndrome • PCOS • whey protein • adrenal steroids • ghrelin

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				L. Shi, S. A Wudy, A. E Buyken, M. F Hartmann, and T. Remer Body fat and animal protein intakes are associated with adrenal androgen secretion in children Am. J. Clinical Nutrition, November 1, 2009; 90(5): 1321 - 1328. [Abstract] [Full Text] [PDF]

				G. U. Liepa, A. Sengupta, and D. Karsies Polycystic Ovary Syndrome (PCOS) and Other Androgen Excess-Related Conditions: Can Changes in Dietary Intake Make a Difference? Nutr Clin Pract, February 1, 2008; 23(1): 63 - 71. [Abstract] [Full Text] [PDF]