Dietary pattern in women with polycystic ovary syndrome with and without associated non-alcoholic fatty liver disease: A cross-sectional study

Guimarães, Thais Cristine Moura; Taranto, Daniela Oliveira de Lima; Couto, Claudia Alves; Nardelli, Mateus Jorge; Cândido, Ana Lucia; Hott, Cristina de Almeida; Anastácio, Lucilene Rezende; Reis, Fernando M.; Rocha, Ana Luiza Lunardi; Faria, Luciana Costa

doi:10.1016/j.clinsp.2023.100288

Brasil

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100288 linkcopy

Dietary pattern in women with polycystic ovary syndrome with and without associated non-alcoholic fatty liver disease: A cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

The role of diet in NAFLD development is still uncertain in PCOS women.
Anthropometry and sedentarism were different between PCOS women with and without NAFLD.
Food intake and dietary patterns were similar between PCOS women with and without NAFLD.

Abstract

Introduction Women with Polycystic Ovary Syndrome (PCOS) have a higher prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) than the general population. PCOS and NAFLD have common metabolic risk factors, however, the role of diet in NAFLD development is still uncertain in PCOS women.

Objective To evaluate and compare the dietary patterns and nutritional intake in patients with PCOS with and without NAFLD.

Method Cross-sectional study that included patients with PCOS diagnosed according to Rotterdam criteria. All participants were submitted to abdominal ultrasound to investigate liver steatosis. Dietary profile was assessed by 24-hour food recall (24hR), and Food Frequency Questionnaire (FFQ). Diet quality was assessed by the Healthy Eating Index (HEI) adapted for the Brazilian population. Physical activity practice was also assessed.

Results 87 participants were included (average age 35.2 ± 5.7 years), among whom, 67 (77%) had NAFLD. The group with PCOS and NAFLD presented higher body mass index (BMI) (34.9 ± 4.5 vs. 30.4 ± 4.9 kg/m2; p = 0.001), Waist Circumference (WC) (103 [97‒113] vs. 95 [87.5‒100] cm; p < 0.001) and were considered physically active less frequently than those without NAFLD (34.3% vs. 60%; p = 0.04). Food intake and dietary patterns assessed by 24hR, FFQ and HEI presented no difference between the groups.

Conclusions PCOS women with coexistent NAFLD had higher BMI, WC and were less physically active than those without NAFLD. Dietary evaluation showed that PCOS women with NAFLD had no significant difference in macro and micronutrients or food group intake and diet quality in comparison to those without NAFLD.

Keywords Polycystic ovary syndrome; Nonalcoholic fatty liver disease; Diet

	All participants with PCOS (n= 87)	PCOS and NAFLD (n= 67)	PCOS without NAFLD (n= 20)	p-value
Age (years)	35.2 ± 5.7	35.8 ± 5.5	33.3 ± 6.3	0.084^a a Student t-test.
BMI (kg/m²)	33.8 ± 4.9	34.9 ± 4.5	30.4 ± 4.9	< 0.001 ^a a Student t-test.
Eutrophic	3 (3.4)	0 (0.0)	3 (15.0)	0.003 ^d d Fisher's exact test.
Overweight	14 (16.1)	11 (16.4)	3 (15.0)
Obesity grade 1	33 (37.9)	22 (32.8)	11 (55.0)
Obesity grade 2	28 (32.2)	25 (37.3)	3 (15.0)
Obesity grade 3	9 (10.3)	9 (13.4)	0 (0.0)
Waist circumference (cm)	102.0 (95.0‒112.0)	103.0 (97.0‒113.0)	95.0 (87.5‒100.0)	< 0.001 ^b b Mann-Whitney test.
Central obesity	79 (90.8)	64 (95.5)	15 (75.0)	0.014 ^d d Fisher's exact test.
Physically active	35 (40.2)	23 (34.3)	12 (60.0)	0.040 ^c c Chi-Square test.
Hyperandrogenism	67 (77.0)	53 (79.1)	14 (70.0)	0.383^d d Fisher's exact test.
Metabolic syndrome	43 (50.6)	39 (59.1)	4 (21.1)	0.003 ^c c Chi-Square test.
Insulin resistance	72/83 (86.7)	61/65 (93.8)	11/18 (61.1)	0.001 ^d d Fisher's exact test.
Diabetes mellitus	11 (12.6)	10 (14.9)	1 (5.0)	0.241^d d Fisher's exact test.
Arterial hypertension	22 (25.3)	18 (26.9)	4 (20.0)	0.535^c c Chi-Square test.
Dyslipidemia	14 (16.1)	12 (17.9)	2 (10.0)	0.507^d d Fisher's exact test.
Triglycerides (mg/dL)	133 (101‒180)	140 (113‒193)	92 (64‒151)	0.003 ^b b Mann-Whitney test.
Total cholesterol (mg/dL)	191 ± 33	196 ± 34	176 ± 27	0.021 ^a a Student t-test.
LDL-cholesterol (mg/dL)	116 ± 29	118 ± 29	108 ± 29	0.177^a a Student t-test.
HDL-cholesterol (mg/dL)	45 ± 9	45 ± 9	47 ± 7	0.506^a a Student t-test.
Fasting glycemia (mg/dL)	89 (83‒95)	89 (84‒98)	85 (82‒93)	0.060^b b Mann-Whitney test.
Glycohemoglobin (%)	5.5 ± 0.4	5.6 ± 0.4	5.4 ± 0.3	0.096^a a Student t-test.

	PCOS (n= 87)	PCOS and NAFLD (n= 67)	PCOS without NAFLD (n= 20)	p-value
Energy (kcal)	1445 (1082‒1817)	1415 (1013‒1821)	1494 (1259‒1815)	0.432^c c Mann-Whitney test.
Energy (kcal/kg)	21.4 ± 9.3	21.1 ± 9.4	22.6 ± 9.0	0.543^b b Student t-test.
Protein (g)	62 (47‒83)	59 (44‒83)	76 (57‒93)	0.067^c c Mann-Whitney test.
Protein (g/kg) ^a a Per quilogram of adjusted body weight.	0.96 ± 0.46	0.9 ± 0.4	1.1 ± 0.5	0.122^b b Student t-test.
Carbohydrates (g)	193 ± 83	189 ± 86	207 ± 70	0.402^b b Student t-test.
Lipids (g)	45 (34‒64)	46 (34‒65)	45 (34‒64)	0.780^c c Mann-Whitney test.
Cholesterol (g)	136 (97‒247)	128 (95‒293)	147 (102‒196)	0.905^c c Mann-Whitney test.
Monounsaturated fat	13 (10‒21)	14 (10‒21)	13 (6‒15)	0.126^c c Mann-Whitney test.
Saturated fat (g)	15 (10‒21)	15 (10‒21)	14 (10‒23)	0.495^c c Mann-Whitney test.
Polyunsaturated fatty acid (g)	8 (5‒14)	8 (5‒14)	7 (6‒11)	0.704^c c Mann-Whitney test.
Sugar (g)	29 (15‒54)	30 (13‒59)	28 (18‒40)	0.996^c c Mann-Whitney test.
Fiber (g)	14 (10‒19)	13 (9‒19)	15 (12‒21)	0.252^c c Mann-Whitney test.
Calcium (mg)	401 (241‒631)	404 (269‒624)	401 (176‒835)	0.862^c c Mann-Whitney test.
Magnesium (mg)	189 ± 85	181 ± 86	218 ± 76	0.091^b b Student t-test.
Manganese (mg)	1.4 (1.1‒2.4)	1.6 (1.1‒2.5)	1.3 (0.9‒1.9)	0.386^c c Mann-Whitney test.
Phosphorus (mg)	708 (488‒1001)	697 (490‒996)	746 (484‒1235)	0.558^c c Mann-Whitney test.
Potassium (mg)	1805 (1256‒2390)	1776 (1233‒2387)	1938 (1482‒2520)	0.509^c c Mann-Whitney test.
Selenium (µg)	66 (48‒106)	64 (48‒99)	74 (42‒116)	0.468^c c Mann-Whitney test.
Sodium (mg)	1456 (1052‒2157)	1338 (1066‒1883)	2022 (919‒2776)	0.201^c c Mann-Whitney test.
Zinc (mg)	7 (5‒11)	7 (5‒11)	7 (3‒10)	0.515^c c Mann-Whitney test.
Vitamin A (µg)	253 (142‒538)	243 (148‒533)	302 (123‒580)	0.895^c c Mann-Whitney test.
Vitamin B1 (mg)	1.0 (0.7‒1.4)	1.0 (0.7‒1.4)	1.0 (0.7‒1.4)	0.841^c c Mann-Whitney test.
Vitamin B2 (mg)	1.0 (0.7‒1.4)	1.0 (0.7‒1.5)	1.0 (0.7‒1.4)	0.704^c c Mann-Whitney test.
Vitamin B3 (mg)	14.4 (8.8‒18.8)	14 (8‒20)	14 (9‒16)	0.481^c c Mann-Whitney test.
Vitamin B6 (mg)	1.1 (0.8‒1.5)	1.1 (0.8‒1.5)	1.1 (0.7‒1.8)	0.508^c c Mann-Whitney test.
Vitamin B9 (mg)	180 (112‒255)	188 (108‒258)	160 (115‒217)	0.588^c c Mann-Whitney test.
Vitamin B12 (µg)	2.0 (1.1‒4.0)	2.0 (1.0‒3.9)	2.1 (1.6‒4.1)	0.438^c c Mann-Whitney test.
Vitamin C (µg)	42 (22‒100)	49 (19‒105)	37 (23‒86)	0.920^c c Mann-Whitney test.
Vitamin D (µg)	1.3 (0.6‒2.3)	1.3 (0.6‒2.4)	1.2 (0.5‒2.2)	0.602^c c Mann-Whitney test.
Vitamin E (µg)	6 (4‒10)	6 (3‒11)	6 (5‒8)	0.920^c c Mann-Whitney test.

	PCOS (n= 87)	PCOS and NAFLD (n= 67)	PCOS without NAFLD (n= 20)	p-value
Cereals	4 (0‒15)	4 (0‒8)	4 (1‒15)	0.975^a a Mann-Whitney test.
Vegetable oils	22 (0‒90)	30 (1‒90)	15 (0‒30)	0.405^a a Mann-Whitney test.
Fruit	2.1 ± 1.4	2.1 ± 1.4	2,0 ± 1.6	0.823^b b Student t-test.
Vegetables greens	4 (0‒13)	4 (0‒13)	4 (0‒13)	0.388^a a Mann-Whitney test.
Poultry, fish, meats	1 (0‒15)	1 (0‒15)	1 (1‒3)	0.704^a a Mann-Whitney test.
Oil seeds	1 (0‒7)	1 (0‒7)	1 (0‒2)	0.293^a a Mann-Whitney test.
Meat fats	1 (0‒3)	0.7 (0‒2)	1 (0‒3)	0.129^a a Mann-Whitney test.
Refined sugar and salt	1 (0‒3)	1 (0‒3)	1 (0‒2)	0.113^a a Mann-Whitney test.

	PCOS with NAFLD (n= 67)	PCOS without NAFLD (n= 20)	p-value
Cereal, bread, tubercules, and roots (points)	1.90 (1.43‒10.0)	1.89 (1.50‒2.27)	0.700
Vegetables (points)	9.51 (5.36‒10.0)	10.0 (5.84‒10.0)	0.416
Fruits (points)	6.67 (3.33‒10.0)	6.54 (3.39‒10.0)	0.958
Meat (points)	10.0 (10.0‒10.0)	10.0 (10.0‒10.0)	0.464
Dairy and derivates (points)	3.3 (0.0‒6.7)	3.3 (0.0‒6.7)	0.445
Sugar and sweets (points)	10.0 (10.0‒10.0)	10.0 (5.7‒10.0)	0.341
Oil and fat (points)	0.0 (0.0‒10.0)	10.0 (0.0‒10.0)	0.231
Total fat (points)	5.0 (5.0‒10.0)	10.0 (5.0‒10.0)	0.066
Saturated fat (points)	10.0 (5.0‒10.0)	10.0 (5.0‒10.0)	0.300
Cholesterol (points)	10.0 (5.0‒10.0)	10.0 (10.0‒10.0)	0.060
Diet variety (points)	11.0 (9.0‒14.0)	12.5 (9.7‒15.2)	0.277

Classification of diet quality	PCOS (n= 87)	PCOS with NAFLD (n= 67)	PCOS without NAFLD (n= 19)	p-value
Bad quality, n (%)	14 (16.0)	13 (19.4)	1 (5.2)	0.158
Needs improvement, n (%)	62 (71.2)	45 (67.2)	17 (89.5)
Good quality, n (%)	10 (11.5)	9 (13.4)	1 (5.2)

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[TFN1] ^a
Student t-test.

[TFN2] ^b
Mann-Whitney test.

[TFN3] ^c
Chi-Square test.

[TFN4] ^d
Fisher's exact test.