Optimizing carbohydrate quality: a path to better health for women with PCOS

Introduction The rising global prevalence of polycystic ovary syndrome (PCOS) poses a significant threat to women’s metabolic and reproductive health. The carbohydrate quality—particularly dietary fiber, glycemic index (GI), and glycemic load (GL)—in addressing metabolic and reproductive abnormalities remains debated due to the condition’s heterogeneity. “The ongoing debate regarding PCOS arises from its complexity and heterogeneity, including variations in clinical symptoms, underlying causes, and treatment responses.” This study aimed to perform a meta-analysis of randomized clinical trials to examine the effects of high fiber and low glycemic index (LGI)/low glycemic load (LGL) dietary interventions on metabolic parameters in women with PCOS. Methods A systematic literature search was conducted using PubMed, EMBASE, the Cochrane Library, Web of Science, Ovid MEDLINE, and Scopus to identify eligible studies. The outcomes were reported as standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity among studies was evaluated using the chi-square test and the I 2 statistic. Results The study showed high dietary fiber and LGI significantly reduced fasting glucose and insulin resistance. Both high fiber and the LGI diet significantly reduced triglycerides and Low-density lipoprotein cholesterol (LDL-C), with fiber also increasing High-density lipoprotein cholesterol (HDL-C). High-fiber and LGI diets increased Sex Hormone-Binding Globulin (SHBG) and reduced Free androgen index (FAI). Discussion This meta-analysis highlights the significant benefits of optimizing dietary carbohydrate quality on glycolipid metabolism, sex hormone levels, and weight in women with PCOS. While further high-quality studies are needed, the findings suggest that dietary fiber and LGI/LGL consumption have distinct effects on metabolic parameters. Therefore, treatment strategies should incorporate personalized dietary interventions tailored to the specific needs of women with PCOS within a shared decision-making framework. Systematic review registration www.crd.york.ac.uk , identifier PROSPERO CRD42024579681.