Improvement of Insulin Resistance in Obese Polycystic Ovarian Syndrome Patients on Low Carbohydrate Diet

Kim, Sang Man; Lee, Ki Ho; Lee, Duck Joo; Yoo, Keun Jai; Choi, Kyu Hong; Han, In Kwon

Abstract

BACKGROUND: Insulin resistance has been reported to act as an important cause in the etiology of obesity and polycystic ovarian syndrome is associated with insulin resistance. Previous studies have shown that weight loss may decrease the serum insulin level and improve the symptoms related to polycystic ovarian syndrome. However, there has been controversial debate on whether weight loss is an independent effect. The objective of this study is to determine the effect of low carbohydrate diet on insulin resistance in obese patients with polycystic ovarian syndrome.
MATERIALS AND METHODS
Thirty-nine obese patients (BMI >25kg/m2) with polycystic ovarian syndrome visited our Center for Bariatric and Infertility at Samsung Cheil Hospital were selected for this study. All patients underwent tests for fasting blood sugar and serum insulin level. The subjects were recommended to restrict carbohydrate and total caloric for six months. We evaluated diet practice performance and graded as no change, slightly reduced, moderately reduced, markedly reduced. The efficacy of low carbohydrate diet or weight loss was independently assessed in accordance with the changes of fasting blood sugar, serum insulin and HOMA index.
RESULTS
A slight decrease in body weight(from 75.4+/-16.4kg to 70.9+/-14.3kg) and body fat(from 37.6+/-5.5% to 36.2+/-6.4%) were found in 39 patients with low carbohydrate diet compared with the initial to that of 6-month follow-up(paired t-test, p<0.01). A significant overall reduction in HOMA index(5.6+/-3.0 to 4.1+/-2.7, paired t-test, p<0.01) was observed. However, HOMAIR was significantly associated with low carbohydrate diet(correlation coefficient; 0.742, p<0.01) whereas weight reduction nor body fat did not. (correlation coefficient 0.275 and 0.022)
CONCLUSIONS
These results suggest that diet in low carbohydrate is effective in improving insulin resistance of obese patients with polycystic ovarian syndrome. Our findings do not support the previous belief that weight or body fat reduction may prevent insulin resistance in these patients. However, detailed studies must be designed with more strict restriction of carbohydrate in a large number of patients.