http://informahealthcare.com/gye ISSN: 0951-3590 (print), 1473-0766 (electronic) Gynecol Endocrinol, Early Online: 1–3 ! 2014 Informa UK Ltd. DOI: 10.3109/09513590.2014.984677
ORIGINAL ARTICLE
Dietary habits in adolescent girls with polycystic ovarian syndrome Maria Eleftheriadou1, Konstantinos Stefanidis1, Katerina Lykeridou2, Iakovos Iliadis3, and Lina Michala1 1st Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece, 2Technical Institute of Athens, School of Midwifery, Athens, Greece, and 3Music Secondary School of Ilion, Athens, Greece
Gynecol Endocrinol Downloaded from informahealthcare.com by Nyu Medical Center on 02/19/15 For personal use only.
1
Abstract
Keywords
The phenotype of polycystic ovarian syndrome (PCOS) is known to worsen with weight gain, increased ingestion of carbohydrates and a sedentary lifestyle. The purpose of this study was to assess the dietary habits in a group of adolescent girls with PCOS. Adolescents with PCOS were recruited and asked to complete a questionnaire on their eating habits and a recall dietary diary, from which their caloric and macronutrient intake was calculated. Results were compared with those from a group of normal controls. Thirty-five women with PCOS and 46 controls were included. Girls with PCOS were less likely to have cereals for breakfast (20.7 versus 66.7%) and as a result consumed less fibre than controls. They were more likely to eat an evening meal (97.1 versus 78.3%) and eat this over an hour later when compared to controls. Despite having comparable body mass indexes, girls with PCOS ate a daily surplus calorie average of 3% versus controls that had a negative calorie intake of 0.72% (p ¼ 0.047). Ameliorating eating habits early in adolescence in girls with PCOS may improve future metabolic concerns related to a genetic predisposition and worsened by an unhealthy lifestyle.
Adolescent health, diet, lifestyle, metabolic syndrome, PCOS
Introduction Polycystic ovarian syndrome (PCOS) is characterized by chronic oligo- or anovulation, biochemical or clinical hyperandrogenism and the presence of sonographic evidence of polycystic ovarian morphology, while excluding other disorders known to cause hyperandrogenism and anovulation [1]. Although obesity is not part of the diagnostic criteria of PCOS, approximately 50% of women with the condition are overweight or obese [2], and weight gain frequently precedes the onset of oligomenorrhea and hyperandrogenism, suggesting a pathogenetic role of obesity in the subsequent development of the syndrome’s symptomatology. In the early 1980s, interest in PCOS mainly focused on menstrual dysfunction [3] and gradually extended to endocrine and metabolic issues, including insulin resistance [4], hyperandrogenism [5] and obesity. Although data on PCOS in adolescence are scanty, there is a general agreement that the clinical, metabolic and endocrine features of adolescents with PCOS are similar to those of adult women. Nevertheless, as adolescents tend to have anovulatory cycles, due to an immature hypothalamic– pituitary–ovarian axis, it has been suggested that the diagnosis of PCOS should be deferred at least until two years after menarche, and it has also been suggested that to decrease false-positive diagnoses, insulin resistance should be included in the diagnosis [6,7]. Environmental factors appear to play an important role in the development of the condition [8]. Physical activity [9] in particular plays an important role and may affect the phenotype of PCOS patients, including adolescents. In a study published by our group, we demonstrated that adolescent girls with PCOS are prone to a more sedentary way of life, when compared to their
Address for correspondence: Lina Michala, 1st Department of Obstetrics and Gynaecology, University of Athens, Vas Sofias 80, Athens, Greece. Tel: +30 2107770461. E-mail: [email protected]
History Received 11 March 2014 Revised 28 October 2014 Accepted 3 November 2014 Published online 27 November 2014
peers [10] and this, as years progress, may predispose them to obesity, impacting on deterioration of their symptoms [11]. The purpose of this study was to record dietary habits in adolescent girls suffering with PCOS and compare them with a group of healthy controls.
Materials and methods We included adolescent girls with PCOS attending a tertiary referral clinic for adolescent gynaecology, between August 2009 and March 2010. PCOS was diagnosed when girls fulfilled all three of the ESHRE criteria and were at least two years post menarche, in an attempt to minimise false-positive diagnoses. Normal controls were recruited from a local secondary school. Exclusion criteria were as follows: (a) chronic disease, (b) being on a weight-loss diet, (c) food allergies, (d) receiving medication and (e) pregnancy. A parent or guardian signed a consent form prior to participation in this study. We developed a questionnaire to identify dietary habits based on those by Rocket et al. [12,13], La Moreno et al. [14] and NHANES III [15], which all subjects completed based on recollection of what they had done over the precious two weeks. In summary, the questionnaire assessed the number of meals eaten by adolescents in a day, the time they were eaten, whether they ate between meals, whether food was cooked at home, whether they ate out or had ‘‘take away’’, whether they consumed soft drinks and sugar-based snacks and whether they ate out of pleasure or necessity. Patients and controls were weighted and measured and were asked to detail their dietary intake of the previous day. Calorie, nutrient and water intake information was extracted from their dietary calendar using the programme Diet Analysis Plus (version: 6,1, 2,0 ESHA Research for Thompson Learning), which also allowed the calculation of the ideal calorie and
2
M. Eleftheriadou et al.
Gynecol Endocrinol, Early Online: 1–3
Table 1. Anthropometric data for girls with PCOS and controls. PCOS BMI Waist circumference (cm) Hip circumference (cm) WHR
23.8 78 96.3 0.81
(4.2) (10.3) (16) (0.17)
Non PCOS 22.6 75.4 95.4 0.77
(4.5) (9.9) (11.8) (0.05)
p 0.240 0.245 0.785 0.285
Mean value (SD). p Value was calculated using t-test.
nutrient consumption for each adolescent, taking into consideration her age, height, weight and level of activity.
Gynecol Endocrinol Downloaded from informahealthcare.com by Nyu Medical Center on 02/19/15 For personal use only.
Results We identified 35 girls with PCOS and 46 controls. Mean age was 15.1 and 14.6 years, respectively. Their anthropometric data are listed in Table 1. The largest percentage of both groups generally consumed breakfast (82.9% of PCOS girls and 78.3% of controls). Milk was commonly included in their breakfast at a rate of 86.2% for PCOS girls and 88.9% for healthy controls. Breakfast cereals was consumed at a statistically significant higher rate (p50.001) by healthy controls (66.7%) as opposed to PCOS girls (20.7%), leading to a higher level of fibre intake; 51.7% of adolescents with PCOS ate high sugar content items for breakfast, such as cakes, croissants, toast with honey or jam), whereas the percentage of similar food items in the control group was 33.2%. An evening meal was consumed by 97.1% of PCOS girls and 78.3% of controls, the difference being statistically different (p ¼ 0.014). Mean time of evening meal consumption was also significantly later among PCOS girls when compared to controls (10.47 pm versus 9.05 pm, p50.020). Eating between meals was more common in girls with PCOS (85.7 versus 73.9%); however, the difference did not reach statistical significance. All adolescents reported ingesting at least one soft drink per day and a high proportion (58.7% of PCOS girls and 45.7% of controls) reported having their meals while watching TV. Girls with PCOS were more likely to state that they ate out of pleasure (73% versus 41%) rather than because this was a biological necessity, which was the case in the majority of the non PCOS girls. However, this difference did not reach statistical significance (p ¼ 0.06). Girls with PCOS had a higher average daily intake of calories (2324.8 kcal/d) than the non-PCOS group (2217 kcal/d). The excess daily caloric intake by PCOS girls was +3%, whereas controls had a negative intake of 0.72% (p ¼ 0.047). As far as macronutrients were concerned, there were no significant statistical differences between the two groups, although PCOS girls had a higher total fat, monounsaturated fats and polyunsaturated fats consumption when compared with controls (156.2% versus 142.8%, 167.9% versus 144.2% and 41% versus 36.9%, respectively). Daily cholesterol intake was also higher in the PCOS group (283.4 g versus 217 g). All girls had a much lower daily consumption of dietary fibre than the recommended value of 25 g, with those suffering with PCOS eating almost one gram less a day than controls (17.7 versus 18.9 g/d).
Discussion Our study suggests that PCOS girls consume more daily calories and in general have worse dietary habits than controls, as demonstrated by the percentage having high sugar content food for breakfast and also as shown by their tendency to eat an evening meal more often and later in the day. It is therefore likely that, although their current body mass index was comparable to
those of controls, their body weight and body fat percentage will gradually increase and reach overweight levels. Similar results have been shown by Barr et al. [16] in adult women, although caloric intake reported in that study was slightly lower than in our study. Others have shown that lean adult women with PCOS have a slightly lower calorie intake than controls, suggesting that they have to restrict their diet more to maintain their body weight within normal limits [17]. Although no statistically significant differences were found with regards to macronutrient consumption, there was a tendency towards higher total fat, mono- and poly-unsaturated fats and cholesterol in the PCOS group. Similar conclusions were drawn by Jeanes et al. [18] and Wild et al. [19]. This is an important finding because increased consumption of lipids leads by definition to a higher calorie intake and the development of obesity in the long run [20]. Fibre intake was lower in the PCOS group, and the difference was primarily attributable to the ingestion of less cereals for breakfast. Both groups, however, consumed much less than the recommended daily fibre amount and this, along with the daily consumption of soft drinks by all adolescents, suggests that dietary habits in general were far from ideal. Furthermore, worryingly, non healthy snacks were commonly consumed [21]. Although our study did not demonstrate a statistically significant difference in the level of snacking, other researchers have shown that adult women with PCOS are more prone to eating between meals when compared to controls [22]. Non healthy snacks, likely to contain advanced glycation end-products were also commonly consumed among adolescents, and this may further intensify the phenotype of PCOS as recently shown [23]. PCOS adolescents in our study were more likely to eat out of pleasure rather than out of necessity, and this may again lead to a progressively increasing caloric intake. This may represent a tendency to bulimic eating pattern, a behaviour that has been shown to be common among women with PCOS [24,25]. The deleterious effects of poor lifestyle habits on general health are well known, leading to heart disease, diabetes and other metabolic disorders. In patients with diagnosed PCOS, this may be more detrimental, given their genetic tendency to metabolic syndrome. It may be that, adolescent girls with PCOS are an ideal target group to implement changes.
Conclusion Poor eating habits were demonstrated in this group of adolescent PCOS patients and this may contribute to the development of obesity in later life. Increased body weight increases long-term health risks and should be tackled with lifestyle interventions early in life.
Declaration of interest The authors have no conflicts of interest to declare.
References 1. Ehrmann DA. Polycystic ovary syndrome. N. England J Med 2005; 352:1223–36. 2. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745–9. 3. Siegberg R, Nilsson CG, Stenman UH, Widholm O. Endocnnologic features of oligomenoirhoeic adolescent girls. Fertil Stent 1986;46: 852–7. 4. Arslanian SA, Lewy VD, Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab 2001;86:66–71.
Gynecol Endocrinol Downloaded from informahealthcare.com by Nyu Medical Center on 02/19/15 For personal use only.
DOI: 10.3109/09513590.2014.984677
5. Ibanez L, Potau N, Virdis R, et al. Postpubertal outcome in girls diagnosed of premature pubarche during childhood: increased frequency of functional ovarian hyperandrogenism. J Clin Endocrinol Metab 1993;76:1599–603. 6. Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol 2010;203: 201.e1–5. 7. Sultan C, Pariss F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril 2006;86:S6. 8. Azziz R. Polycystic ovary syndrome is a family affair. J Clin Endocrinol Metab 2008;93:1579–81. 9. Julie JD, Johnstone EB, Rousseau JA, et al. Physical activity in women with polycystic ovary syndrome: prevalence, predictors, and positive health associations. Am J Obstet Gynecol 2011;204: 352.e1–6. 10. Eleftheriadou M, Michala L, Lykeridou A, et al. Dietary and exercise habits among adolescents girls with PCOS. J Pediatr Adolesc Gynecol.2012;25(3):172–4. 11. The Amsterdam ESHRE/ASRM 3rd PCOS Consensus Workshop Group. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS). Hum Reprod 2012;27:14–24. 12. Rockett HR, Wolf AM, Colditz GA. Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. J Am Diet Assoc 1995;95:336–40. 13. Rockett HR, Colditz GA. Assessing diets of children and adolescents. Am J Clin Nutr 1997;65:1116S–22S. 14. La Moreno M, Kersting S, de Henauw, M, et al. How to measure dietary intake and food habits in adolescence: the European perspective. Int J Obes 2005;29:S66–77. 15. Cho S, Dietrich M, Brown CJP, et al. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr 2003;22:296–302.
Dietary habits in adolescents with PCOS
3
16. Barr S., Hart K., Reeves S, Jeanes Y. Dietary intake, body composition and physical activity levels in women with polycystic ovary syndrome compared with healthy controls. J Hum Nutr Diet 2008;21:377–82. 17. Wright CE, Zborowski JV, Talbott1 EO, et al. Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. Int J Obesity 2004;28:1026–32. 18. Jeanes Y, Barr S, Reeves S, et al. Dietary intake, body composition and energy expenditure in women withpolycystic ovary syndrome (PCOS) compared with healthy controls: an observational study. Proc Nutr Soc 2008;67:E423. 19. Wild RA, Painter PC, Coulson PB, et al. Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1985;61: 946–51. 20. Bray GA, Popkin BM. Dietary fat intake does affect obesity! Am J Clin Nutr 1998;68:1157–73. 21. Ellenbogen SJ, Ludwig DS, Ebbeling CB, et al. Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 2006; 117:673–80. 22. Wylie J, Barr S, Jeanes Y. Eating frequency and snacking habits in women with polycystic ovary syndrome. J Hum Nutr Diet 2009;22: 274–5. 23. Tantalaki E, Piperi C, Livadas S, et al. Impact of dietary modification of advanced glycation end products (AGEs) on the hormonal and metabolic profile of women with polycystic ovary syndrome (PCOS). Hormones (Athens) 2014;13:65–73. 24. Michelmore KF, Balen AH, Dunger DB. Polycystic ovaries and eating disorders: are they related? Hum Reprod 2001; 16:765–9. 25. McCluskey S, Lacey JH, Pearce JM. Binge-eating and polycystic ovaries. Lancet 1992;340:723.
ORIGINAL ARTICLE
Dietary habits in adolescent girls with polycystic ovarian syndrome Maria Eleftheriadou1, Konstantinos Stefanidis1, Katerina Lykeridou2, Iakovos Iliadis3, and Lina Michala1 1st Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece, 2Technical Institute of Athens, School of Midwifery, Athens, Greece, and 3Music Secondary School of Ilion, Athens, Greece
Gynecol Endocrinol Downloaded from informahealthcare.com by Nyu Medical Center on 02/19/15 For personal use only.
1
Abstract
Keywords
The phenotype of polycystic ovarian syndrome (PCOS) is known to worsen with weight gain, increased ingestion of carbohydrates and a sedentary lifestyle. The purpose of this study was to assess the dietary habits in a group of adolescent girls with PCOS. Adolescents with PCOS were recruited and asked to complete a questionnaire on their eating habits and a recall dietary diary, from which their caloric and macronutrient intake was calculated. Results were compared with those from a group of normal controls. Thirty-five women with PCOS and 46 controls were included. Girls with PCOS were less likely to have cereals for breakfast (20.7 versus 66.7%) and as a result consumed less fibre than controls. They were more likely to eat an evening meal (97.1 versus 78.3%) and eat this over an hour later when compared to controls. Despite having comparable body mass indexes, girls with PCOS ate a daily surplus calorie average of 3% versus controls that had a negative calorie intake of 0.72% (p ¼ 0.047). Ameliorating eating habits early in adolescence in girls with PCOS may improve future metabolic concerns related to a genetic predisposition and worsened by an unhealthy lifestyle.
Adolescent health, diet, lifestyle, metabolic syndrome, PCOS
Introduction Polycystic ovarian syndrome (PCOS) is characterized by chronic oligo- or anovulation, biochemical or clinical hyperandrogenism and the presence of sonographic evidence of polycystic ovarian morphology, while excluding other disorders known to cause hyperandrogenism and anovulation [1]. Although obesity is not part of the diagnostic criteria of PCOS, approximately 50% of women with the condition are overweight or obese [2], and weight gain frequently precedes the onset of oligomenorrhea and hyperandrogenism, suggesting a pathogenetic role of obesity in the subsequent development of the syndrome’s symptomatology. In the early 1980s, interest in PCOS mainly focused on menstrual dysfunction [3] and gradually extended to endocrine and metabolic issues, including insulin resistance [4], hyperandrogenism [5] and obesity. Although data on PCOS in adolescence are scanty, there is a general agreement that the clinical, metabolic and endocrine features of adolescents with PCOS are similar to those of adult women. Nevertheless, as adolescents tend to have anovulatory cycles, due to an immature hypothalamic– pituitary–ovarian axis, it has been suggested that the diagnosis of PCOS should be deferred at least until two years after menarche, and it has also been suggested that to decrease false-positive diagnoses, insulin resistance should be included in the diagnosis [6,7]. Environmental factors appear to play an important role in the development of the condition [8]. Physical activity [9] in particular plays an important role and may affect the phenotype of PCOS patients, including adolescents. In a study published by our group, we demonstrated that adolescent girls with PCOS are prone to a more sedentary way of life, when compared to their
Address for correspondence: Lina Michala, 1st Department of Obstetrics and Gynaecology, University of Athens, Vas Sofias 80, Athens, Greece. Tel: +30 2107770461. E-mail: [email protected]
History Received 11 March 2014 Revised 28 October 2014 Accepted 3 November 2014 Published online 27 November 2014
peers [10] and this, as years progress, may predispose them to obesity, impacting on deterioration of their symptoms [11]. The purpose of this study was to record dietary habits in adolescent girls suffering with PCOS and compare them with a group of healthy controls.
Materials and methods We included adolescent girls with PCOS attending a tertiary referral clinic for adolescent gynaecology, between August 2009 and March 2010. PCOS was diagnosed when girls fulfilled all three of the ESHRE criteria and were at least two years post menarche, in an attempt to minimise false-positive diagnoses. Normal controls were recruited from a local secondary school. Exclusion criteria were as follows: (a) chronic disease, (b) being on a weight-loss diet, (c) food allergies, (d) receiving medication and (e) pregnancy. A parent or guardian signed a consent form prior to participation in this study. We developed a questionnaire to identify dietary habits based on those by Rocket et al. [12,13], La Moreno et al. [14] and NHANES III [15], which all subjects completed based on recollection of what they had done over the precious two weeks. In summary, the questionnaire assessed the number of meals eaten by adolescents in a day, the time they were eaten, whether they ate between meals, whether food was cooked at home, whether they ate out or had ‘‘take away’’, whether they consumed soft drinks and sugar-based snacks and whether they ate out of pleasure or necessity. Patients and controls were weighted and measured and were asked to detail their dietary intake of the previous day. Calorie, nutrient and water intake information was extracted from their dietary calendar using the programme Diet Analysis Plus (version: 6,1, 2,0 ESHA Research for Thompson Learning), which also allowed the calculation of the ideal calorie and
2
M. Eleftheriadou et al.
Gynecol Endocrinol, Early Online: 1–3
Table 1. Anthropometric data for girls with PCOS and controls. PCOS BMI Waist circumference (cm) Hip circumference (cm) WHR
23.8 78 96.3 0.81
(4.2) (10.3) (16) (0.17)
Non PCOS 22.6 75.4 95.4 0.77
(4.5) (9.9) (11.8) (0.05)
p 0.240 0.245 0.785 0.285
Mean value (SD). p Value was calculated using t-test.
nutrient consumption for each adolescent, taking into consideration her age, height, weight and level of activity.
Gynecol Endocrinol Downloaded from informahealthcare.com by Nyu Medical Center on 02/19/15 For personal use only.
Results We identified 35 girls with PCOS and 46 controls. Mean age was 15.1 and 14.6 years, respectively. Their anthropometric data are listed in Table 1. The largest percentage of both groups generally consumed breakfast (82.9% of PCOS girls and 78.3% of controls). Milk was commonly included in their breakfast at a rate of 86.2% for PCOS girls and 88.9% for healthy controls. Breakfast cereals was consumed at a statistically significant higher rate (p50.001) by healthy controls (66.7%) as opposed to PCOS girls (20.7%), leading to a higher level of fibre intake; 51.7% of adolescents with PCOS ate high sugar content items for breakfast, such as cakes, croissants, toast with honey or jam), whereas the percentage of similar food items in the control group was 33.2%. An evening meal was consumed by 97.1% of PCOS girls and 78.3% of controls, the difference being statistically different (p ¼ 0.014). Mean time of evening meal consumption was also significantly later among PCOS girls when compared to controls (10.47 pm versus 9.05 pm, p50.020). Eating between meals was more common in girls with PCOS (85.7 versus 73.9%); however, the difference did not reach statistical significance. All adolescents reported ingesting at least one soft drink per day and a high proportion (58.7% of PCOS girls and 45.7% of controls) reported having their meals while watching TV. Girls with PCOS were more likely to state that they ate out of pleasure (73% versus 41%) rather than because this was a biological necessity, which was the case in the majority of the non PCOS girls. However, this difference did not reach statistical significance (p ¼ 0.06). Girls with PCOS had a higher average daily intake of calories (2324.8 kcal/d) than the non-PCOS group (2217 kcal/d). The excess daily caloric intake by PCOS girls was +3%, whereas controls had a negative intake of 0.72% (p ¼ 0.047). As far as macronutrients were concerned, there were no significant statistical differences between the two groups, although PCOS girls had a higher total fat, monounsaturated fats and polyunsaturated fats consumption when compared with controls (156.2% versus 142.8%, 167.9% versus 144.2% and 41% versus 36.9%, respectively). Daily cholesterol intake was also higher in the PCOS group (283.4 g versus 217 g). All girls had a much lower daily consumption of dietary fibre than the recommended value of 25 g, with those suffering with PCOS eating almost one gram less a day than controls (17.7 versus 18.9 g/d).
Discussion Our study suggests that PCOS girls consume more daily calories and in general have worse dietary habits than controls, as demonstrated by the percentage having high sugar content food for breakfast and also as shown by their tendency to eat an evening meal more often and later in the day. It is therefore likely that, although their current body mass index was comparable to
those of controls, their body weight and body fat percentage will gradually increase and reach overweight levels. Similar results have been shown by Barr et al. [16] in adult women, although caloric intake reported in that study was slightly lower than in our study. Others have shown that lean adult women with PCOS have a slightly lower calorie intake than controls, suggesting that they have to restrict their diet more to maintain their body weight within normal limits [17]. Although no statistically significant differences were found with regards to macronutrient consumption, there was a tendency towards higher total fat, mono- and poly-unsaturated fats and cholesterol in the PCOS group. Similar conclusions were drawn by Jeanes et al. [18] and Wild et al. [19]. This is an important finding because increased consumption of lipids leads by definition to a higher calorie intake and the development of obesity in the long run [20]. Fibre intake was lower in the PCOS group, and the difference was primarily attributable to the ingestion of less cereals for breakfast. Both groups, however, consumed much less than the recommended daily fibre amount and this, along with the daily consumption of soft drinks by all adolescents, suggests that dietary habits in general were far from ideal. Furthermore, worryingly, non healthy snacks were commonly consumed [21]. Although our study did not demonstrate a statistically significant difference in the level of snacking, other researchers have shown that adult women with PCOS are more prone to eating between meals when compared to controls [22]. Non healthy snacks, likely to contain advanced glycation end-products were also commonly consumed among adolescents, and this may further intensify the phenotype of PCOS as recently shown [23]. PCOS adolescents in our study were more likely to eat out of pleasure rather than out of necessity, and this may again lead to a progressively increasing caloric intake. This may represent a tendency to bulimic eating pattern, a behaviour that has been shown to be common among women with PCOS [24,25]. The deleterious effects of poor lifestyle habits on general health are well known, leading to heart disease, diabetes and other metabolic disorders. In patients with diagnosed PCOS, this may be more detrimental, given their genetic tendency to metabolic syndrome. It may be that, adolescent girls with PCOS are an ideal target group to implement changes.
Conclusion Poor eating habits were demonstrated in this group of adolescent PCOS patients and this may contribute to the development of obesity in later life. Increased body weight increases long-term health risks and should be tackled with lifestyle interventions early in life.
Declaration of interest The authors have no conflicts of interest to declare.
References 1. Ehrmann DA. Polycystic ovary syndrome. N. England J Med 2005; 352:1223–36. 2. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745–9. 3. Siegberg R, Nilsson CG, Stenman UH, Widholm O. Endocnnologic features of oligomenoirhoeic adolescent girls. Fertil Stent 1986;46: 852–7. 4. Arslanian SA, Lewy VD, Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab 2001;86:66–71.
Gynecol Endocrinol Downloaded from informahealthcare.com by Nyu Medical Center on 02/19/15 For personal use only.
DOI: 10.3109/09513590.2014.984677
5. Ibanez L, Potau N, Virdis R, et al. Postpubertal outcome in girls diagnosed of premature pubarche during childhood: increased frequency of functional ovarian hyperandrogenism. J Clin Endocrinol Metab 1993;76:1599–603. 6. Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol 2010;203: 201.e1–5. 7. Sultan C, Pariss F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril 2006;86:S6. 8. Azziz R. Polycystic ovary syndrome is a family affair. J Clin Endocrinol Metab 2008;93:1579–81. 9. Julie JD, Johnstone EB, Rousseau JA, et al. Physical activity in women with polycystic ovary syndrome: prevalence, predictors, and positive health associations. Am J Obstet Gynecol 2011;204: 352.e1–6. 10. Eleftheriadou M, Michala L, Lykeridou A, et al. Dietary and exercise habits among adolescents girls with PCOS. J Pediatr Adolesc Gynecol.2012;25(3):172–4. 11. The Amsterdam ESHRE/ASRM 3rd PCOS Consensus Workshop Group. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS). Hum Reprod 2012;27:14–24. 12. Rockett HR, Wolf AM, Colditz GA. Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. J Am Diet Assoc 1995;95:336–40. 13. Rockett HR, Colditz GA. Assessing diets of children and adolescents. Am J Clin Nutr 1997;65:1116S–22S. 14. La Moreno M, Kersting S, de Henauw, M, et al. How to measure dietary intake and food habits in adolescence: the European perspective. Int J Obes 2005;29:S66–77. 15. Cho S, Dietrich M, Brown CJP, et al. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr 2003;22:296–302.
Dietary habits in adolescents with PCOS
3
16. Barr S., Hart K., Reeves S, Jeanes Y. Dietary intake, body composition and physical activity levels in women with polycystic ovary syndrome compared with healthy controls. J Hum Nutr Diet 2008;21:377–82. 17. Wright CE, Zborowski JV, Talbott1 EO, et al. Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. Int J Obesity 2004;28:1026–32. 18. Jeanes Y, Barr S, Reeves S, et al. Dietary intake, body composition and energy expenditure in women withpolycystic ovary syndrome (PCOS) compared with healthy controls: an observational study. Proc Nutr Soc 2008;67:E423. 19. Wild RA, Painter PC, Coulson PB, et al. Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1985;61: 946–51. 20. Bray GA, Popkin BM. Dietary fat intake does affect obesity! Am J Clin Nutr 1998;68:1157–73. 21. Ellenbogen SJ, Ludwig DS, Ebbeling CB, et al. Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 2006; 117:673–80. 22. Wylie J, Barr S, Jeanes Y. Eating frequency and snacking habits in women with polycystic ovary syndrome. J Hum Nutr Diet 2009;22: 274–5. 23. Tantalaki E, Piperi C, Livadas S, et al. Impact of dietary modification of advanced glycation end products (AGEs) on the hormonal and metabolic profile of women with polycystic ovary syndrome (PCOS). Hormones (Athens) 2014;13:65–73. 24. Michelmore KF, Balen AH, Dunger DB. Polycystic ovaries and eating disorders: are they related? Hum Reprod 2001; 16:765–9. 25. McCluskey S, Lacey JH, Pearce JM. Binge-eating and polycystic ovaries. Lancet 1992;340:723.
